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TEST 3 - Advanced Pathophysiology
Summer 2018 UTA 5315 Questions
and Answers (100% Pass)
Mitral Valve Stenosis
✓ - Characterized by NARROWING of mitral valve
- Normal is 4-6 cm
-Narrowed is less than 2.5 cm
- Caused by RHEUMATIC FEVER
-More common in WOMEN
-Oxygenated blood comes back into heart into the left atrium and down
through the mitral valve to the left ventricle
- Complex: Stenosis leads to volume/pressure in left atrium, which results in
atrial hypertrophy/dilation, which increases pressure/volume in the
pulmonary circulation & causes PULMONARY EDEMA
- Simplified: Skinny mitral valve doesn't let blood pass through easily, so
blood backs up into the left atrium and causes it to swell, then backs up into
the lung and causes resp. symptoms
-S/sx: dyspnea, hemoptysis, a-fib, dysphagia, pulmonary hypertension
Mitral Valve Regurgitation
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✓ -Characterized by INCOMPLETE CLOSURE of mitral valve
-Caused by MITRAL VALVE PROLAPSE (flaps don't close together properly,
leaving valve ajar); more common in WOMEN; STICKING CHEST PAIN
-Blood in left ventricle backs up to left ventricle during systole (mitral valve
should be closed during systole/contraction of heart)
-Leads to atrial dilation/hypertrophy, increased pulmonary vascular
pressure/volume, PULMONARY EDEMA
-S/sx: Dyspnea, rales, pansystolic murmur, S3 & S4 heart sounds
Aortic Valve Stenosis
✓ -Most common valvular disease
-Most common causes are aortic valve CALCIFICATION (stiffening) in people
over 60; congenital aortic valve stenosis in people less than 30
-Normal valve 3 cm; symptoms seen when valve less than 1 cm; severe when
valve is less than 0.5 cm
-Narrowed valve prevents outflow from left ventricle to aorta. This backs up
blood to the left atrium and ultimately floods the lung causing PULMONARY
EDEMA
S/Sx: Pulmonary hypertension/edema, poor outflow of aorta to body (aorta
sends out oxygenated blood to body), causing fainting or chest pain
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Simplified: Aorta is stiff and can't send out oxygenated blood properly to the
body, depriving tissues of oxygen. Blood gets backed up into lungs, causing
pulmonary edema.
Aortic Valve Regurgitation
✓ -Valve is TOO WIDE or TOO NARROW, blood doesn't pass through
effectively, causing back flow of blood into the left ventricle
-Marked by EARLY DIASTOLIC MURMUR (on systole, heart contracts and
pushes blood up the aorta, but on diastole, heart relaxes and ineffective
aortic valve is not able to hold blood up in aorta, so blood falls and makes a
swish sound, which is the murmur)
-Most commonly caused by AORTIC ROOT DILATION(starting point of aorta is
too wide)
-Other causes: infective endocarditis, rheumatic fever, aortitis from syphilis,
coarctation (congenital narrowing of aorta), aortic dissection (tear),
ankylosing spondylitis (inflammatory arthritis)
-Acute: increases left ventricular end-diastolic pressure (LVEDP) (increased
blood back down in the left ventricle increases pressure), decreased stroke
volume (not much blood is being pushed from left ventricle because blood's
backed up and overwhelming left ventricle), normal or decreased pulse
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pressure, decreased cardiac output (aorta is not effectively pumping blood
from heart)
Chronic: Body adjusts; LVEDP normalizes, systolic bp increases
(compensation: harder contraction to push blood out of aorta before it falls
back down to left ventricle), diastolic bp decreases (compensation:
decreased relaxation of heart to stop blood from seeping back out of aorta),
cardiac output is normal, pulse pressure is increase. Blood ultimately is
backed up into the left atrium and pulmonary circulation.
Atherosclerosis Causes
✓ -Begins with tissue injury
Sources of injury:
CIGARETTES (toxins)
Hypertension (increased force of the blood hitting the blood vessel can
weaken it)
Diabetes
Hyperlipidemia (lipids take place of endothelial cells lining the blood vessel,
initiating an inflammatory response)
Patho of Atherosclerosis r/t Hyperlipidemia - Inflammatory Response
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