TEST 3 - Advanced Pathophysiology Summer 2023 UTA 5315
1. 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
2. Mitral Valve Regurgitation: -Characterized by INCOMPLETE CLOSURE of
mi- tral 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/vol- ume, PULMONARY EDEMA
-S/sx: Dyspnea, rales, pansystolic murmur, S3 & S4 heart sounds
3. 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
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.
4. 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, coarcta- tion (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 over- whelming left ventricle),
normal or decreased pulse 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
