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Definition and Epidemiology

MS is almost always caused by rheumatic heart disease. Thus, with the marked reduction of rheumatic carditis during the past four decades, the occurrence of MS has lessened. Less-common causes of obstruction across the mitral valve that prevents normal emptying of the left atrium into the left ventricle during diastole include congenital stenoses, masses such as vegetation and clots or benign tumors (atrial myxomas), and profound calcification of the mitral anulus. Damage to the mitral valve from rheumatic fever will cause the commissures of the leaflets themselves to fuse, the leaflets to thicken and fibrose, and the chordae to thicken and shorten, resulting in a thickened, scarred valve that is funnel shaped with a “fish mouth” appearance.

Pathophysiology

The central pathophysiologic feature of MS is obstruction across the mitral valve during diastole. This results in a pressure gradient between the left atrium and the left ventricle. The increased left atrial pressure is transmitted to the pulmonary veins and capillaries and eventually to the pulmonary arteries and right side of the heart. The normal mitral valve area (MVA) is 4 to 5 cm2. 11 There is usually no detectable pressure gradient across the normal mitral valve, even when flow is increased with exercise. As the valve area is reduced, the gradient across the valve increases. When the valve area is reduced to 2.5 cm2, hemodynamically significant stenosis is present. 11 MS usually becomes symptomatic when the mitral valve opening is reduced to 1.5 cm2 or less. 11 With this degree of obstruction, the mean gradient, even at rest, is likely to be more than 20 mm Hg throughout diastole. With a further rise to 25 to 30 mm Hg, the left atrial pressure will exceed plasma oncotic pressure, and episodes of orthopnea or paroxysmal nocturnal dyspnea will develop. Chronic elevation of left atrial pressure produces a passive pressure load on the pulmonary vessel and causes hypertrophy and hyperplasia. In addition, there is a reactive vasoconstrictive aspect. Pulmonary hypertension may develop, which over time may produce right ventricular hypertrophy.

4. In evaluating mitral valve incompetency, you expect to find the following murmur:
A. systolic with radiation to axilla
B. diastolic with little radiation
C. diastolic with radiation to axilla
D. localized systolic

5. Signs and symptoms consistent with endocarditis include all of the following except:
A. bradycardia
B. Osler nodes
C. hematuria
D. petechiae

6. The most helpful test in suspected bacterial endocarditis includes:
A. urine culture
B. blood culture
C. CXR
D. myocardial biopsy

B. 54 yo with prosthetic aortic valve

7. Of the following patients, who is in greatest need of endocarditis prophylaxis when planning dental work?
A. 22 yo with MVP and trace regurgitation on echo
B. 54 yo with prosthetic aortic valve
C. 66 yo with cardiomyopathy
D. 58 yo with history of 3 vessel coronary bypass graft with drug eluting stents 1 year ago

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2 Thoughts to “South University NURSING NSG 6005 Mid Term Final Questions Answer”

  1. Jessica Bowden

    How legit is thid

    1. edusolutionguide

      This is as per what has been published on the site.

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