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TEST 3 - Advanced Pathophysiology Summer 2024 UTA 5315 Mitral Valve Stenosis Answer - - 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
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Mitral Valve Stenosis Answer - - Characterized by NARROWING of mitral valve
left ventricle
Hyperlipidemia Answer - Leading cause of coronary artery disease
Most commonly affects promximal portions of coronary arteries, larger branches of carotid arteries, circle of Willis (base of brain), large vessels of lower extremities, renal arteries, mesenteric (intestinal) arteries Consequences of Atherosclerosis Answer - Reduced blood flow Coronary artery disease, myocardial infarction, carotid artery disease, cerebral vascular disease, stroke, mesenteric ischemia, peripheral vascular disease, renal artery stenosis Congenital Heart Disease Answer - -Most common heart disease affecting children -Etiology is unknown in 90% of cases Causes: Genetic/environmental factors (multifactorial factors) Primary genetic factors (single gene disorders, chromosome disorders) Sole environmental factors (Accutane/isotretinoin for acne, alcohol, maternal rubella infection) Maternal Risk Factors: Age over 45, prior child with heart defect, poorly controlled diabetes during pregnancy, alcohol, congenital infection during pregnancy (rubella), aspirin, lupus, Dilantin/phenytoin/diphenylhydantoin for seizures LEFT to RIGHT shunt (Congenital heart defect) Answer - -Oxygenated blood from the left side of the heart mixes with unoxygenated blood in the right side of the heart. -Oxygen saturation on left side is usually 95%, whereas right side is 75%
-Multiple VSDs are associated with Tetralogy of Fallot, Cri du Chat Syndrome, and Fetal Alcohol Syndrome. -Associated with development of atrial septal defects, patent ductus arteriosus, coarction (congenital narrowing) of aorta, aortic valve stenosis, INCREASED RISK FOR DEVELOPING ENDOCARDITIS at some point in life ( infection of the heart's inner lining, usually involving the heart valves) Atrial Septal Defect (most common congenital heart defect in adults) Answer - -Most common cause is a patent foramen ovale (hole) that does not close -Associated with FETAL ALCOHOL SYNDROME and DOWN SYNDROME -Sign: Midsystolic murmur at upper sternal border -Increases risk for EMBOLUS Patent Ductus Arteriosus Answer - Patent ductus arteriosus (PDA) is a persistent opening between the two major blood vessels leading from the heart. The opening, called the ductus arteriosus, is a normal part of a baby's circulatory system before birth that usually closes shortly after birth. If it remains open, however, it's called a patent ductus arteriosus. Sign: Machine-like murmur heard continuously throughout systole and diastole Reversal may occur if pulmonary hptn occurs from increased blood flow through the pulmonary artery. If this happens, unoxygenated blood will enter the aorta below the level of the subclavian artery and the child will be cyanotic in the lower body, but not in the upper body. Associated with congenital rubella, Tetralogy of Fallot, respiratory distress syndrome, and transposition of great vessels (unoxygenated blood does not pick up oxygen in lungs and is pumped back to body) Right to left shunt Answer - Tetralogy of Fallot is most common cyanotic congenital heart defect. Impaired gas exchanged r/t decreased pulmonary blood flow Right side of heart = Deoxygenated Left side = Oxygenated
contracting!*
-Catecholamines - epinephrine & norepinephrine make heart pump harder -Increases in intracellular calcium -Decreased sodium in blood (decreases activity of the sodium/calcium exchanger) -DIGITALIS: increases intracellular calcium What decreases contraction and promotes r? (improves diastolic heart failure) Answer - Diastolic heart failure needs help relaxing! -Beta Blockers: Block effects of catecholamines. Metoprolol, Bystolic -Acidosis -Hypoxia/hypercapnia -Calcium channel blockers Systole Answer - Contraction of heart as it shoots blood Diastole Answer - Relaxing of heart so it can fill with blood Systolic heart failure Answer - Heart can't contract Diastolic heart failure Answer - Heart can't relax Coronary artery dominance Answer - 85% of people are right dominant Right dominant - posterior descending artery arises from right coronary artery Left dominant - posterior descending artery arises from left circumflex artery (about 8% of population) Codominant - posterior descending artery arises from both the left & right coronary arteries Most common site of coronary artery occlusion Answer - Left circumflex artery So if a left dominant person has an occlusion in the left circumflex artery, they have a higher chance for poor outcomes. Dysphagia in coronary artery disease Answer - When left atria enlarges (as in from occlusion r/t coronary artery disease), it enlarges and compresses the esophagus. It can also compress the left recurrent laryngeal nerve and cause hoarseness. Coronary Artery Disease: Risk Factors Answer - Advanced age, male, post- menopausal, family history, dyslipidemia, hypertension, smoking, diabetes, obesity, sedentary lifestyle, diet high in fat. Why does hypertension put a person at increased risk for developing coronary artery disease? Answer - Causes endothelial damage, making it easier for cholesterol to accumulate in damaged area, also triggers inflammatory response and allows buildup of more cholesterol, macrophages, foam cells, platelets
-Ventricular septum rupture: Produces a left to right shunt (ventricular septal defect), causing right heart failure. Associated with thrombosis in the LEFT ANTERIOR DESCENDING ARTERY - WIDOW MAKER!
Secondary Pneumothorax Answer - -Caused by injury -Tension pneumothorax occurs when air is trapped in the thoracic cavity and cannot escape. Site of the injury on the pleural membrane acts as a one-way valve and only allows air into the thoracic cavity. -Person may experience complete lung collapse. Sings: Deviated trachea, shortness of breath, hypotension. Pulmonary Edema Answer - Accumulation of water in alveolar sacs. Prevents proper exchange of gases. Symptoms: Dyspnea, chest pain, hypoxia, ORTHOPNEA, PAROXYSMAL NOCTURNAL DYSPNEA *Most common CAUSE is LEFT-SIDE HEART FAILURE. Backup up blood increases capillary hydrostatic pressure which pushes fluid into the alveolar sac. Acute Respiratory Distress Syndrome Answer - Type of respiratory failure which results from massive lung inflammation and widespread alveolar capillary damage Damage significantly impairs gas exchange and the patient will have significant issues with oxygenation Causes: Pneumonia, sepsis, massive trauma, burns, aspiration, DIC, pancreatitis Three Phases of ARDS Answer - 1. inflammatory Phase. Occurs in first 72 hours following initial insult or injury. Inflammatory cascade increases capillary permeability, allowing fluid, proteins, blood cells to leak out of circulation into pulmonary interstitium (extracellular area). Gas exchange is impaired.
and mediates t-cell immune responses
-Klebsiella Pneumoniae: Common in hospitalized, debilitated patients, diabetics, and alcoholics. Elderly infected with this bacteria have a high mortality! -Haemophilus Influenza: Commonly seen in infants and children. Occurs in adults with COPD. Healthcare-Associated Pneumonia Answer - -Occurs in any individual who has had contact with healthcare system -Patients who have received infusion therapy or dialysis or have resided in a nursing home within 90 days of the diagnosis are said to have a healthcare-associated pneumonia -Common causes: Gram-negative (harder to treat) Klebsiella, Pseudomonas aeruginosa, E-Coli Hospital-Acquired Pneumonia Answer - -Diagnosed 48 hours after admission to hospital -Common causes: Gram-negative (harder to treat) Klebsiella, Pseudomonas aeruginosa, E-Coli Tuberculosis Answer - -Most commonly occurs in disadvantaged populations -Caused by mycobacterium tuberculosis -Spread via droplets containing the organism Tuberculosis Stages Answer - 1. Primary infection: Macrophages engulf the mycobacterium and form a granuloma (mass) called a Ghon. Inflammatory cascade is triggered. Center of lesion necroses and eventually calcifies. This infection is usually asymptomatic and does not cause active disease.
-Mean pulmonary arterial pressure greater than 25 at rest (normal is 15-18)