MSN 377 ACTUAL 2026 STUDY GUIDE EXAM
QUESTIONS AND SOLUTIONS RATED A+
✔✔Mitral Valve Stenosis: Ethology and Pathophysiology - ✔✔Most result from
rheumatic heart disease because of the scarring
Scarring the valve leaflets and the chordae tendineae
Block blood flow and create a pressure difference between LA and LV during diastolic
(LA isn't able to empty into the LV as easily as it should which results in enlargement of
the LA which causes increased stretch and release of ANP - LA an become dilated
because of increased pressure)
At risk for atrial fibrillation and increased pulmonary and right heart pressures
Decreased cardiac output
Blood flow backs up from LA to pulmonary system which can lead to RV working harder
and eventually causes RV failure
✔✔Mitral Valve Stenosis: Clinical Manifestations - ✔✔DOE caused by reduced lung
compliance
Diastolic murmur - best heard at the apex
Hoarseness
Hemoptysis
Chest pain
Stroke - may not be adequately perfusing brain
✔✔Mitral Valve Regurgitation: Etiology and Pathophysiology - ✔✔Most common causes
are MI, RHD, mitral valve prolapse ,and IE
Blood flow back flows from the LV to the LA during systole
Acute MR: pulmonary edema and cardiogenic shock
Chronic MR: LA and LV enlargement
Decreased CO
(Valve should be closed but now it's open because. it can't close)
✔✔Mitral Valve Regurgitation: Clinical Manifestations - ✔✔Asymptomatic for many
years
,Holosystolic murmur best heard at the apex (throughout the whole duration of systole;
valve isn't closing at all during systole)
S3 (hear sloshing)
Weakness, fatigue (lack of adequate CO)
Palpitations (heart trying to beat faster to make up for low CO)
Dyspnea, orthopnea, PND
Peripheral edema (eventually R sided heart effects)
Acute Mitral Regurgitation: EMERGENCY, thready peripheral pulses and cool, clammy
skin, extremely low CO
Rapid intervention (MV repair or replacement if critical)
Severity of symptoms base don severity of condition
Hear murmur if valve is open
✔✔Mitral Valve Prolapse: Etiology and Pathophysiology - ✔✔Most common form of
valvular disease in the US - occurs most commonly in young adults
Usually has a genetic cause/predisposition
Valve leaflets prolapse or buckle back into the LA during systole
Usually benign but can cause MR, IE, SCD, HF, and cerebral ischemia
Can cause regurgitant valves
Increase risk for developing infective endocarditis
✔✔Mitral Valve Prolapse: Clinical Manifestations - ✔✔Covers a broad range of severity
Most are asymptomatic; 10% become symptomatic
Systolic murmur can occur
Dysrhythmias can also occur (PVCs, PSVT, VT)
Palpitations, lightheadedness, syncope
Chest pain
, Early symptoms: weakness, fatigue
Decreased perfusion -> heart beats faster -> palpitations, syncope
✔✔Aortic Valve Stenosis: Etiology and Pathophysiology - ✔✔Congenital, RF, or
atherosclerotic
Can be life threatening if valve is severely stenotic -> severely decreased CO
Obstruction of blood for from LV into aorta during systole
LV hypertrophy and increased myocardial O2 consumption
Decreased CO, pulmonary HTN, HF
If untreated, 50% mortality in 1yr
Increase in fluid volume in pulmonary vasculature
Increased pulmonary vascular resistance which leads to pulmonary hypertension which
leads to R sided HF
Increases in myocardial oxygen demand
✔✔Aortic Valve Stenosis: Clinical Manifestations - ✔✔Develops when valve orifice is
about 1/3 of its normal size
Angina/chest pain from lack of perfusion - caution with nitro (can dilate coronary arteries
but also decrease pressure and you may not be able to get enough blood circulating)
Syncope (decrease perfusion to brain)
DOE
Systolic murmur - valve should be open during systole but it isn't because it's stenotic
✔✔Aortic Valve Regurgitation: Etiology and Pathophysiology - ✔✔Primary disease of
the aortic vale leaflets and/or aortic root
Acute: trauma, IE, aortic dissection
Chronic: is a symptom of RHD
Causes backward flow of blood from the ascending aorta into the LV during diastole
QUESTIONS AND SOLUTIONS RATED A+
✔✔Mitral Valve Stenosis: Ethology and Pathophysiology - ✔✔Most result from
rheumatic heart disease because of the scarring
Scarring the valve leaflets and the chordae tendineae
Block blood flow and create a pressure difference between LA and LV during diastolic
(LA isn't able to empty into the LV as easily as it should which results in enlargement of
the LA which causes increased stretch and release of ANP - LA an become dilated
because of increased pressure)
At risk for atrial fibrillation and increased pulmonary and right heart pressures
Decreased cardiac output
Blood flow backs up from LA to pulmonary system which can lead to RV working harder
and eventually causes RV failure
✔✔Mitral Valve Stenosis: Clinical Manifestations - ✔✔DOE caused by reduced lung
compliance
Diastolic murmur - best heard at the apex
Hoarseness
Hemoptysis
Chest pain
Stroke - may not be adequately perfusing brain
✔✔Mitral Valve Regurgitation: Etiology and Pathophysiology - ✔✔Most common causes
are MI, RHD, mitral valve prolapse ,and IE
Blood flow back flows from the LV to the LA during systole
Acute MR: pulmonary edema and cardiogenic shock
Chronic MR: LA and LV enlargement
Decreased CO
(Valve should be closed but now it's open because. it can't close)
✔✔Mitral Valve Regurgitation: Clinical Manifestations - ✔✔Asymptomatic for many
years
,Holosystolic murmur best heard at the apex (throughout the whole duration of systole;
valve isn't closing at all during systole)
S3 (hear sloshing)
Weakness, fatigue (lack of adequate CO)
Palpitations (heart trying to beat faster to make up for low CO)
Dyspnea, orthopnea, PND
Peripheral edema (eventually R sided heart effects)
Acute Mitral Regurgitation: EMERGENCY, thready peripheral pulses and cool, clammy
skin, extremely low CO
Rapid intervention (MV repair or replacement if critical)
Severity of symptoms base don severity of condition
Hear murmur if valve is open
✔✔Mitral Valve Prolapse: Etiology and Pathophysiology - ✔✔Most common form of
valvular disease in the US - occurs most commonly in young adults
Usually has a genetic cause/predisposition
Valve leaflets prolapse or buckle back into the LA during systole
Usually benign but can cause MR, IE, SCD, HF, and cerebral ischemia
Can cause regurgitant valves
Increase risk for developing infective endocarditis
✔✔Mitral Valve Prolapse: Clinical Manifestations - ✔✔Covers a broad range of severity
Most are asymptomatic; 10% become symptomatic
Systolic murmur can occur
Dysrhythmias can also occur (PVCs, PSVT, VT)
Palpitations, lightheadedness, syncope
Chest pain
, Early symptoms: weakness, fatigue
Decreased perfusion -> heart beats faster -> palpitations, syncope
✔✔Aortic Valve Stenosis: Etiology and Pathophysiology - ✔✔Congenital, RF, or
atherosclerotic
Can be life threatening if valve is severely stenotic -> severely decreased CO
Obstruction of blood for from LV into aorta during systole
LV hypertrophy and increased myocardial O2 consumption
Decreased CO, pulmonary HTN, HF
If untreated, 50% mortality in 1yr
Increase in fluid volume in pulmonary vasculature
Increased pulmonary vascular resistance which leads to pulmonary hypertension which
leads to R sided HF
Increases in myocardial oxygen demand
✔✔Aortic Valve Stenosis: Clinical Manifestations - ✔✔Develops when valve orifice is
about 1/3 of its normal size
Angina/chest pain from lack of perfusion - caution with nitro (can dilate coronary arteries
but also decrease pressure and you may not be able to get enough blood circulating)
Syncope (decrease perfusion to brain)
DOE
Systolic murmur - valve should be open during systole but it isn't because it's stenotic
✔✔Aortic Valve Regurgitation: Etiology and Pathophysiology - ✔✔Primary disease of
the aortic vale leaflets and/or aortic root
Acute: trauma, IE, aortic dissection
Chronic: is a symptom of RHD
Causes backward flow of blood from the ascending aorta into the LV during diastole
