The most commonly affected heart valve in RHD is?

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2016

Child Health Nursing (Pediatrics)

Easy

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2016

Explanation

The mitral valve is the most common site of involvement in Rheumatic Heart Disease (RHD).
This is primarily due to the high mechanical stress and pressure exerted on the left side of the heart, where the mitral valve is located.
In the acute phase, this often manifests as mitral regurgitation, which can progress to mitral stenosis in the chronic phase.
Pathology texts indicate that the mitral valve is affected alone in about 37% of chronic RHD cases.

Option A: The aortic valve is the second most commonly affected valve, not the most common. Its involvement usually occurs in conjunction with the mitral valve rather than in isolation.
Option C: The pulmonary valve is the least commonly affected valve in RHD. Its involvement is considered rare.
Option D: The tricuspid valve is the third most commonly affected valve. Significant tricuspid involvement is uncommon and usually only seen when the mitral and aortic valves are also diseased.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Valve involvement in Rheumatic Heart Disease (RHD) as background academic context rather than a clinical decision trigger.
Nurses must be vigilant in assessing heart sounds in patients with a history of rheumatic fever, listening for murmurs that could indicate developing valvular disease like mitral regurgitation or stenosis.
Patient education is a key nursing role, emphasizing the critical importance of adhering to the long-term penicillin prophylaxis schedule to prevent RHD progression and recurrence.
What if? If a patient with known RHD presents with new-onset atrial fibrillation, the nurse should suspect worsening mitral stenosis. This is because the stenotic valve causes the left atrium to enlarge, which predisposes the patient to this arrhythmia. This would require immediate physician notification and potential anticoagulation therapy.

How to Approach the Question

First, identify the key terms in the question: 'Rheumatic Heart Disease (RHD)' and 'most commonly affected heart valve'.
This is a factual recall question based on the known pathophysiology of RHD.
Recall that RHD is an inflammatory condition that disproportionately affects the left side of the heart due to higher pressures.
Mentally list the heart valves and their locations. The mitral and aortic valves are on the left; the tricuspid and pulmonary are on the right.
Remember the order of frequency of involvement: Mitral is first, followed by Aortic, then Tricuspid, and finally Pulmonary.
Select the 'Mitral' valve as the correct answer based on this established pattern.

Concept Tested & Keywords

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