Mitral Stenosis Usually due to rheumatic carditis causing valve thickening by fibrosis and calcification Rheumatic fever most

ost common cause of mitral stenosis Nonrheumatic causes: - calcium accumulation - thrombus formation Usually asymptomatic Pathophysiology | Signs and Symptoms The valve leaflets fuse and become stiff Chordae tendinae contract and shorten Valve opening narrows preventing normal blood flow from the left atrium to the left ventricle Left atrial pressure rises and dilatesPulmonary artery pressure increasesRight ventricular hypertrophies As valvular orifice narrows and lung pressure increases, client experiences dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and dry cough Hemoptysis and pulmonary edema appear as pulmonary hypertension & congestion progress Right-sided heart failure may occur late Mitral Regurgitation Major cause is RHD Other causes - papillary muscle dysfunction or rupture - infected endocarditis - congenital anomaly Usually progresses slowly Asymptomatic Pathophysiology | Signs and Symptoms During diastole, regurgitant output flows from the LA to the LV along with normal blood flow The increased volume must be ejected during the next systoleTo compensate for the increased volume & pressure, LA & LV dilate & hypertrophy When LV fails, fatigue & chronic weakness beginDyspnea on exertion develop late Anxiety, atypical chest pains, palpitation Aortic stenosis Congenital valvular disease or malformation is the predominant cause Rheumatic aortic stenosis is always concomitant w/ rheumatic disease of the MV (30-70 y/o) Atherosclerosis & degenerative calcification of AV in >70 y/o

Pathophysiology | Signs and Symptoms Aortic valve narrows & obstructs LV outflow during systoleIncreased resistance to ejection or afterload results in ventricular hypertrophyCardiac output becomes fixed and unable to increase to meet the demands of the body during exertion Eventually, LV fails, volume backs up in the LA & pulmonary system becomes congested Dyspnea, angina, syncope on exertion Marked fatigue, debilitation & peripheral cyanosis Narrow pulse pressure Aortic Regurgitation Causes - infective endocarditis - congenital anatomic aortic valve abnormalities - hypertension Asymptomatic for many years because of LV compensation Pathophysiology | Signs and Symptoms Aortic valve leaflets do not close properly during diastoleAnnulus (valve ring that attaches to the leaflets) may be dilated, loose, or deformedRegurgitation of blood from the aorta back into the LV during diastoleTo compensate, LV dilates & hypertrophies to accommodate the greater blood volume As disease progresses & LV fails, exertional dyspnea, orthopnea, palpitations & paroxysmal nocturnal dyspnea occurs Bounding arterial pulse, widened pulse pressure w/ an elevated systolic but decreased diastolic pressure High-pitched, blowing, diastolic murmur