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Mitral Valve Regurgitation

Share this: Facebook Twitter Reddit LinkedIn WhatsApp Mitral Valve Regurgitation This patient is a forty-eight-year-old plumber. His general practitioner referred him following an insurance medical exam during which a systolic murmur was identified. He was noticed to have a heart murmur when examined for an inguinal hernia repair ten years previously but has not had any recent follow-up. He is a non- smoker that only drinks socially. During the physical exam, the patient does not report any symptoms, and he is fit and well. Cardiovascular examination reveals: pulse sixty beats per minute, regular, with a normal character; blood pressure 160/70 mmHg. Jugular venous pressure was not elevated. His heart sounds are normal. There is a pansystolic murmur heard in all areas and radiating to the axilla. The apex beat is displaced two centimeters laterally. There are no other abnormal findings. The electrocardiogram results came back normal, and the echocardiogram shows a mildly dilated left ventricle with normal function and normal left atrial dimensions. This patient is experiencing chronic mitral regurgitation (Lilly, 2015). This paper will discuss clinical manifestations, normal physiology, pathophysiology, medical management, and current research regarding mitral regurgitation. Clinical Manifestations The patient presented with a systolic murmur heard in all areas and radiating to the axilla and elevated blood pressure. The result of the echocardiogram is that there is a mildly dilated left ventricle and the electrocardiogram is normal. The clinical manifestations of mitral regurgitation differ depending on if the problem is acute or chronic (Lilly, 2016). As the degree of the regurgitation increases the severity of the symptoms that the patient experiences also increase. The symptoms often experienced with mitral regurgitation are dyspnea, especially when laying down, increased fatigue, heart palpitations, and edema in the lower extremities. Mitral regurgitation is often mild and progresses slowly; therefore, it is possible to have it for years and never experience any symptoms (Mayoclinic, 2019). When the disease has progressed, it is common to hear a murmur when auscultating over the heart that radiates to the axilla. This murmur reflects the continues pressure gradient between the left ventricle and the left atria (Lilly, 2016). This sound can be increased, thereby supporting the cause of the murmur, by having the patient clench their fist and forearm. Chronic mitral regurgitation may be caused by degeneration of the valve, rheumatic deformity, congenital valve defects, or extensive calcification of the mitral valve (Lilly, 2016). There are a few different tests that may be performed to diagnose mitral regurgitation. Echocardiogram results that would indicate mitral regurgitation are systolic flow from the left ventricle into the left atrium, and in cases of a chronic issue it would show enlarged left atrial and ventricle (Lily, 2016). In the case study presented, the patient’s echocardiogram demonstrated a mildly enlarged left ventricle. Chest radiographs in a patient with mitral regurgitation would also show dilation of the left atrial and ventricle as well as signs of pulmonary venous congestion. In a cardiac catheterization, mitral regurgitation will cause an increase in the pulmonary artery wedge pressure (Lilly, 2016). Normal Physiology Mitral regurgitation is the backflow of blood in the heart from the left ventricle to the left atrium. This process affects the body by causing increased pressure in the heart and decreasing the blood flow to the body. The result of increased pressure in the heart chronically is that the left atrial and ventricle become enlarged and the increased pressure can start building and affect the pulmonary system (Lee, et al., 2015). Having a decreased blood flow in the systemic system increases fatigue and dyspnea in the patient when it is a chronic issue. The cause of mitral regurgitation is that the mitral valve is experiencing degeneration of the collagen fiber network and myxomatous degeneration (Deborde, et al., 2016). The collagen fiber network that makes up the mitral valve is composed of molecules consisting of triple helix amino acid chains stabilized by hydrogen bonds. The structural characteristic of the collagen structure and the mechanical properties of the collagen at the molecular level are the base of the kinetics of the biaxial stretch of the mitral valve (Lee, et al., 2015) On a cellular level, there are three structural layers that make up the leaflets of the mitral valve. The fibrosa is the stiff layer on the ventricular surface that is made up of collagen fiber; the atrials are a thin layer on the atrial surface that is more compliant and is composed of elastic fibers and the spongiosa, which is composed of glycosaminoglycans and proteoglycans. Mitral valve regurgitation is often caused by mitral valve prolapse, which is characterized by thickened leaflets (Deborde, et al., 2016). Homeostasis of the valve itself is maintained by valvular interstitial cells that can sense pressure and respond to environmental changes, remodeling, and are able to maintain the strength and durability of the valve. The mechanical stress of the valve is transmitted to the cells through their interactions with the extracellular matrix. The surface of the mitral valve is covered with endothelial cells that maintain the integrity of the valves and also regulates the leaflets’ mechanical properties (Deborde et all, 2016). In mild and acute mitral regurgitation, there is usually not much or any effect on the heart. Problems arise when mitral regurgitation is a chronic problem that is left untreated. The heart itself is affected by mitral regurgitation by experiencing increased pressure from the backflow of the blood that leads to cardiac and pulmonary congestion. Both the left atrial and ventricles become dilated when this pressure is increased in a chronic manner (Lee, et al., 2015). Pathophysiology Molecularly, when there is a disruption of the collagen bonds of the mitral valve, it affects the mitral valve’s ability to stretch and keep a proper seal, preventing backflow of blood into the left atrium. When the kinetics of the collagen bonds are disrupted, it has a negative effect on the valve and therefore, the heart (Deborde, et al., 2016). Mitral valve regurgitation is mainly due to myxomatous degeneration, leading to altered mechanical stress and turbulent flow near the mitral valve leaflets. The mitral valve is a structure in the heart that opens, allowing blood flow to the left ventricle, during diastole and closes, preventing blood flow to the left ventricle, during systole. The valve prevents the backflow of blood into the left ventricle. Cellular changes are mainly in the spongiosa and then extend to the other layers resulting in disruption of the collagen organization in the fibrosa (Deborde, et al., 2016). When there is mitral valve regurgitation, the entire heart is affected. In chronic mitral valve regurgitation, there is dilation of both the left atrium and ventricle as a result of the increased blood pressure in the heart. This increased pressure can build and subsequently affects the pulmonary and systemic system if left untreated (Lilly, 2016). Medical Management The management of mitral regurgitation depends on the cause but most commonly requires surgical intervention. While there are medications that may be prescribed to decreases blood pressure as well as vasodilators that would potentially decrease arterial resistance thereby decreases pressure in the heart and decrease the amount of regurgitation, these are only used to stabilize a patient until surgery can take place (Lilly, 2016). Surgical intervention is necessary when the patient’s ejection fraction is less than sixty percent or as soon as a patient begins to have symptoms of mitral regurgitation. The surgical options are to either repair or replace the mitral valve. Repairing the valve is the optimum choice when possible. Repair is an option when the leaflet becomes perforated, and it can be patched or when it is possible to reattach ruptured chordae (Lilli, 2016). When repair is possible, it eliminates later issues that can arise later on when artificial vales are used because the native valve tissue can be preserved (Mayoclinic, 2019). A newer option for repairing mitral valves in patients who are at high surgical risk is to repair the mitral valve with the use of a catheter through the femoral vein as opposed to percutaneously repairing the valve (Muller, et al., 2017). Although, in cases of severe mitral regurgitation, percutaneous repair is the most effective method of repair. (Lilly, 2016) When replacement of the mitral valve is necessary, there are options in both the type of surgery and the type of replacement valve. While many mitral valve replacement surgeries require a sternotomy, there are some cases where the repair can be made through a few incisions in the sternum. Mechanical valves are the most common and will last a lifetime, although they require the patient to take anticoagulants. Tissue valves are made of bovine or porcine tissue and often last for ten to twenty years. Biological tissue valves are the least common type of valve used in replacements and also last for only ten to twenty years (Muller, et al., 2017). Repairing or replacing the valve is the only way to treat the disease long term. Mitral regurgitation is classified as primary if the regurgitation is due to a structural defect or secondary if it results from left ventricular enlargement (Lilly, 2016). The mortality rate after mitral valve repair is only two percent compared to a five to seven percent mortality rate when the valve is replaced. Some degree of prevention of mitral regurgitation can be made with a healthy lifestyle, but no guarantee having a healthy diet and exercising will prevent mitral regurgitation. The prognosis of mitral valve regurgitation is dependent on the degree of regurgitation and if the patient seeks treatment. In an acute and severe situation, even when surgery is performed, there is a thirty-day mortality rate of twenty to twenty-five percent (Lilly, 2016). Current Research There is research being conducted currently comparing the long-term results of mitral valve repair to replacement. In a randomized trial comparing the left ventricular end-diastolic index, there was no significant difference seen when comparing mitral valve repair and replacement during the first two years. This was also the case for survival rates and left ventricular remodeling. However, mitral regurgitation did reoccur more often in the patients that had their mitral valves repaired. The reoccurrence mitral regurgitation led to more cardiovascular hospital admissions as well as more heart-failure related adverse events (Goldstein, et al., 2016). Further research is being conducted to determine if transcatheter mitral valve repair may improve the clinical outcome in patients with heart failure in conjunction with mitral regurgitation. Six-hundred and fourteen patients were enrolled in the study with three hundred of them being in the device group who underwent transcatheter mitral valve repair. In the patients in the device group, there was a lower mortality rate within two years as well as a lower rate of hospitalization for heart failure (Stone, et al., 2018). References Deborde, C., Simionescu, D. T., Wright, C., Liao, J., Sierad, L. N.,
After reading Empty Hallways: The Hidden Shortage of Healthcare Workers, identify the two powerful factors that work together to create the staffing crisis. Briefly explain these two factors.. I don’t know how to handle this Health & Medical question and need guidance.

Critical Elements Exemplary (100%) Proficient (90%) Needs Improvement (70%) Not Evident (0%) Value Critical Thinking and Reflection Journal supports claims with particularly relevant examples of personal experience, previous learning, or logical thought process Journal supports claims with a relevant examples of personal experience, previous learning, or logical thought process Journal supports claims with a relevant personal experience, previous learning, or logical thought process Journal does not support claims with reflection on relevant personal examples 25 Integration and Application Journal shows excellent depth of knowledge of the module content and exhibits careful consideration of the topic Journal shows good depth of knowledge of the module content and demonstrates that the student has read the module content Journal shows limited depth of knowledge, indicating the student may have reviewed the module content but needs to explore further Journal does not address the prompt and reflects that the student has not read the module content 25 Voice Journals is written in a style that is appealing and appropriate for the intended audience and a consistent voice is evident throughout Journal is written in a style that is generally appropriate for the intended audience and an attempt is made to use a consistent voice Journal is written in a style that considers the audience, but the author’s voice is not consistent and difficult to identify Journal does not attempt to use a style that considers audience and there is no evidence of author voice 25 Writing Journal is free of errors in organization and grammar Journal contains limited errors of organization and grammar which rarely interrupt the flow Journal contains errors of organization and grammar but are limited enough so that journal can be understood Journal contains major errors of organization and grammar making the blog difficult to understand 25 Earned Total 100%
After reading Empty Hallways: The Hidden Shortage of Healthcare Workers, identify the two powerful factors that work together to create the staffing crisis. Briefly explain these two factors.

Inherit Gender Inequality in Capitalist System. Paper details The paper should focus on the concept of ecological feminism or “ecofeminism”. The main argument should revolve around the idea that as long as the capitalist system continues, the gender inequality will continue its existence. It should be argued that the capitalist system is focused on the appropriation of the unpaid work of the women and the nature by cheapening it. Thus, as capitalism with the Civilizing Project continues to rule the abstractions of Society and Nature, the rift between capitalists and nature and women would broaden, the nature and women would cheapen. How does the big ‘E’ Environmentalism, relates to questions of work and class, broadly conceived?How do arguments about Cheap Nature as strategy help us to see the relation between capital accumulation and modern forms of geocultural domination like sexism)? The paper should include a historical path of how gender was defined within the history and how did the exploitation of women continue throughout the history. It should include at least 15 historical facts about the topic. The references within the text should be done from the documents I will be attaching, and the citations should include the authors surname, year of the source and the page number.Inherit Gender Inequality in Capitalist System
Written analysis of Self-Reflection.

Assignment Details: Review all the critical thinking assignments you have completed in this course. Prepare a critical review of what you have learned about cyber security management in organizations. The Five (5) critical assignments titles are as below:- Systems and Controls Assessment- Malware, Malware analysis, detection, prevention and the recommended practices- System security, system security goals (CIA), security controls, security assessments and Auditing Best Practices- Network Security, Windows network security, techniques to secure networks, CIA Triad to Secure the Organization Network and No risk network.- Software Security, Microsoft Applications Security, Techniques to Secure Applications and Best Practices for Securing Applications Deliverables: Present your well-written self-reflection in Four to five pages not including the title and reference pages, and should cite at least four scholarly resources other than the course materials. Be sure to reference readings from the course. Cite all sources using the academic writing standards and APA style guidelines. There should be an introduction and conclusion It is strongly encouraged that you submit all assignments to the TurnItIn Originality Check prior to submitting it to your instructor for grading. The similarity should be less than 20%
Written analysis of Self-Reflection

CAHS English Silent Spring environment Attention Discussion

CAHS English Silent Spring environment Attention Discussion.

I’m working on a english writing question and need a sample draft to help me learn.

. Before you set Silent Spring and its warnings aside, take some time to compose your own thoughts about its impact. Did the book have the effect that its author seemed to desire? Is the environment cleaner, safer, and less “silent” than in 1963?Draft two short speeches explaining your position on the state of the environment and society’s attention to Rachel Carson’s recommendations. Write one of the speeches for a more formal context, such as addressing your local city council or participating in a formal debate. Write the other speech for a context in which you might try to persuade other young people to see your point of view or inspire them to act.
CAHS English Silent Spring environment Attention Discussion

University of New Haven Planned Duration for The Testing Project Worksheet

online homework help University of New Haven Planned Duration for The Testing Project Worksheet.

Question 1Your team has been asked to test and document enhancements to a web application that allows buyers to purchase custom-printed canvas shoes. The tasks and dependencies are as follows:Create a testing planOnce the testing plan is ready, your team can:Test the user interfacesTest the databaseTest the networkWrite the documentation first draftWhen the user interface tests are complete, you can:Perform user testing—enlist some users to test the user interfaceWhen the database and network testing are complete, you can:Perform integration testing—network with the databaseWhen the user testing of the user interface and the database testing are complete, you can:Perform integration testing—database, network, and user interfaceWhen all integration testing and user testing are complete, you can:Perform system testingThen you can:Review and revise documentationAfter all other tasks are complete, you can:Obtain management approvalDuration estimates for the tasks: a. 3 days b. 10 days c. 6 days d. 7 days e. 20 days f. 5 days g. 3 days h. 2 days i. 8 days j. 4 daysk. 5 daysCreate a network diagram and a Gantt chart for the project tasks. Ask your instructor if you are permitted to use software such as Microsoft Project to help you prepare your diagrams.What is the planned duration for the testing project?What is the critical path for the testing project?For each task NOT on the critical path, calculate the amount of slack available.If the user testing of the user interface takes 15 days, what will the impact be on the project duration?Question 2Wedding cost estimation: Given the following information, calculate the estimated costs for a wedding with 250 guests and a bridal party of six, using the methods indicated. Show your work.Note that members of the bridal party are already counted as guests, you don’t need to add them twice.Parametric estimateBottom-up estimateAnalogous cost estimateYou will probably notice some differences in the estimated values. Are these differences significant? What might cause the differences? If you were estimating a significant project in the future, which method(s) would you use and why?Wedding Cost EstimatesItemDollarsGroom’s brother’s wedding, last year, 175 guests, similar venue and style$20,300Catering$65 per personPhotographer$1,500Rental of hall$500Clothing, bride$2,000Clothing, groom$750Flowers$800Other décor items$500Cake$500Gifts for bridal party$80 eachWedding planner$2,000Wedding planner’s estimate of typical cost for this kind of wedding$10,000 plus $75 per guestQuestion 3Cost reimbursable contract calculation.A contract calls for a total payment of $800,000 with a guarantee. Essentially the contractor is guaranteed to make at least $200,000 above his costs. If the contractor can demonstrate his costs exceed $600,000, the project will pay the difference, with a $50,000 ceiling on the overage. The contractor demonstrates he spent $623,000. How much (gross) must the project remit to the contractor?Another option for the same contract has the contractor guaranteed to be paid his costs plus 20%, for costs that exceed $600,000. With the same initial assumption—guarantee of $800,000 gross payment (no requirement to itemize costs), but if the contractor can show that costs exceed $600,000, the project will pay $800,000 plus the costs that exceed $600,000, plus 20% of those excess costs, with a ceiling of $900,000 gross. The contractor demonstrates he spent $623,000. How much (gross) must the project remit to the contractor?Under option 3.2, at what dollar amount of total costs would the contractor be assuming all of the excess costs beyond that point?In which option did the project assume more of the risk of a cost overrun? Explain.
University of New Haven Planned Duration for The Testing Project Worksheet

Columbia Southern University Personal Financial Management Questions

Columbia Southern University Personal Financial Management Questions.

1.How would you describe your own personal learning style, and how does it affect your ability to communicate and remain professional in the workplace?2.Explain personal financial management and why it is important to your professional success. What tips could you give to a colleague who may be struggling with personal financial management3.Explain one of your goals using the specific, measurable, attainable, relevant, and time-bound (SMART) method. What is one area of strength and one area of weakness of your goal? What can you do to improve the weakness you identified?200 words a piece in your own words no plagrisim
Columbia Southern University Personal Financial Management Questions

Northwestern College COSO Framework of Internal Controls Research Paper

Northwestern College COSO Framework of Internal Controls Research Paper.

The COSO framework of internal controls is practiced within companies around the world. The objectives of the COSO framework are closely related to its five components. For this week’s activity, please discuss these five components of the COSO framework. Be sure to include each components’ impact on each of the COSO framework objectives. What do you feel an auditor would most be concerned with during an IT audit? Lastly, discuss suggestions for integrating COSO framework compliance into a company in which you are familiar. Your paper should meet the following requirements: Be approximately 3-4 pages in length, Follow APA6 guidelines. Your paper should include an introduction, a body with fully developed content, and a conclusion. At least two scholarly journal articles.
Northwestern College COSO Framework of Internal Controls Research Paper