Valvular Disease, Inflammatory Disease, Shock

ConditionEtiologyPathogenesisManifestationsCompensations

Aortic Stenosis

Aortic valve not opening fully, aging (calcification)

Narrowing of aortic valve due to calcification

- Early: asymptomatic
- Late: angina, dyspnea, fatigue, exercise intolerance, arrhythmias, clots
- End-stage: pulmonary congestion, cardiogenic shock

- Increase in LV pressure to force blood through valve

Mitral Stenosis

Rheumatic fever, aging, endocarditis

Calcification of mitral valve leaflets and chordae tendineae

- Early: asymptomatic
- Late: dyspnea, pulmonary congestion, atrial fibrillation, clots
- End-stage: right-sided HF, cardiogenic shock

- Left atrial hypertrophy to compensate for impaired emptying

Infective Endocarditis

Subacute: defective valves by Strep
Acute: normal valves by Staph bacteria

Systemic inflammation, masses (vegetations) on valves

- Subacute: fatigue, anorexia, cough, dyspnea
- Acute: fever, chills, drowsiness

- Embolization of vegetations obstructs arteries

Pericarditis

Secondary to surgery, MI, viral infection

Inflammation of pericardium, friction causing discomfort

- Chest pain
- Dyspnea
- Tachycardia (maintains CO)

- Tachycardia to maintain CO

Hypovolemic Shock

Significant loss of blood/plasma (e.g., dehydration)

Decreased cardiac output due to reduced blood volume

- Early: anxiety, thirst, tachycardia, cool skin
- Late: lethargy, acidosis, decreased kidney function, organ failure

- Persistent vasoconstriction

Vasogenic Shock

Vasodilation from loss of sympathetic tone (e.g., injury)

Blood relocates due to vasodilation

- Early: anxiety, thirst, tachycardia, cool skin
- Late: lethargy, acidosis, decreased kidney function

- Depression of cardiac function due to decreased blood flow

Cardiogenic Shock

MI, arrhythmia, valve disease, cardiomyopathy

Inability for heart to pump effectively

- Early: anxiety, thirst, tachycardia, cool skin
- Late: lethargy, acidosis, decreased kidney function

- Increase HR to attempt to maintain CO