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A 60 year old woman with a history of obesity and DM II experienced a…
A 60 year old woman with a history of obesity and DM II experienced a myocardial infarction that caused permanent damage to the papillary muscle of the left ventricle, resulting in a failure of the mitral valve to close. BP is 95/55, BR is 30 breaths per min, HR is 125 per minute. Breathing is labored and heart is gurgling.
Upstream causes
Indirect
Indirect factors could possibly be lack of exercise, genetics, physchological factors, over eating, possible medication side effects and smoking.
Direct
Direct cause of a myocardial infarction is due to the coronary arteries becoming blocked by substances such as cholesterol which causes a buildup and plaque along the walls of the artery
Downstream Effects
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due to insufficient blood flow can have effect all body parts that require oxygen for proper function
patient will experience fatigue and will require surgery. Shortness of breath will also occur. Pressure in the lungs can also occur and lead to fluid accumulation
The direct effect of the mitral valve failure includes back flow to the heart causing regurgitation which can lead to heart failure
This may produce symptoms ranging from shortness of breath during exertion, coughing, congestion around the heart and lungs, swelling of the legs and feet.
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Background
Heart Anatomy
Left Side of heart
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Mitral valve - lies between the Left atrium and left ventricle , consist of two tapered cusps.
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aorta - largest blood vessel, transport oxygen rich blood
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Right Side of Heart
Right atrium -The right atrium receives deoxygenated blood from the body through the vena cava and pumps it into the right ventricle
Right ventricle -receives deoxygenated blood from the right atrium and pumps it under low pressure into the lungs via the pulmonary artery.
Tricuspid valve -allowing blood to flow from the right atrium to the right ventricle in your heart and preventing blood from flowing backward.
superior vena cava - return deoxygenated blood from the systemic circulation to the right atrium of the heart.
inferior vena cava -It carries deoxygenated blood from the lower half of the body to the right atrium of the heart.
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Papillary muscles
The papillary muscles pull on the chordae tendineae and help open the cusps when ventricles are relaxing and filling with blood
The chord tendineae play a vital role in holding the atrioventricular valves in place while the heart is pumping blood.
Normal Heart Sound
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These heart sounds, often described as Lub-dup, are associated with the heart valves closing.
The basic rhythm of the heart sounds is lub-dup, pause, lub dub , pause, and so on.
The first sound occurs as the AV valves close. it signifies the point when ventricular pressure rises above atria pressure. The first sound tends to be louder, longer, and more resonant than the second one.
The second sound occurs as the SL valves snap shut at the beginning of ventricular relaxation, resulting in a short, sharp sound.
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Mean arterial pressure, preload, after load, and peripheral pressure.
Mean arterial pressure -MAP, or mean arterial pressure, is defined as the average pressure in a patient's arteries during one cardiac cycle. It is considered a better indicator of perfusion to vital organs than systolic blood pressure
Preload -Preload, also known as the left ventricular end-diastolic pressure (LVEDP), is the amount of ventricular stretch at the end of diastole.
After load - also known as the systemic vascular resistance (SVR), is the amount of resistance the heart must overcome to open the aortic valve and push the blood volume out into the systemic circulation
Peripheral pressure -Peripheral resistance is the resistance of the arteries to blood flow. As the arteries constrict, the resistance increases and as they dilate, resistance decreases. Peripheral resistance is determined by three factors: Autonomic activity: sympathetic activity constricts peripheral arteries
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