Crimes of the Heart: A Case Study on Cardiac Anatomy (12 points)

Crimes of the Heart: A Case Study on Cardiac Anatomy (12 points) Tiffaney is worried about her newborn son. Ever since she brought Caleb home from the hospital it has been so hard to get him to eat and he seems to be breathing too hard all the time. She stopped breast-feeding and tried every bottle and formula on the market, but nothing has worked. So, at his one month check-up, her stomach is in knots as they place Caleb on the scale. The nurse says, “9 pounds, 7 ounces.” Tiffaney realizes Caleb has only gained one pound since he was born and she breaks into tears. Dr. Baker checks over Caleb in the exam room, taking extra time feeling and listening to his chest. During the exam, Tiffaney explains her struggle with trying to get her son to eat and how he cries almost the entire day. After the exam Dr. Baker says, “When I listen to Caleb’s heart I hear an extra sound called a murmur. I want to use a chest radiographs, echocardiogram and an electrocardiogram (ECG) to get a good picture of all the parts of his heart.” Dr. Baker heard a Grade II/VI holosystolic murmur at the mid lower sternal border. After a full day of tests, Tiffaney meets with Dr. Baker in his office. He explains, “The chest radiographs show cardiomegaly. The ECG shows normal PR interval and a left axis deviation. The echocardiogram reveals blood shunting from left to right with all four chambers of the heart dilated. Short Answer Questions: 1. Dr. Baker spends a long time listening to (auscultating) Caleb’s heart. Where on the thoracic surface do you auscultate to the tricuspid, mitral (bicuspid), pulmonary, and aortic valves? (2 points) 2. Caleb has abnormal heart sounds that tipped the doctor off to a problem. a. Name the normal sounds of the heart and indicate what causes these sounds. (1 point) b. Based on the location of Caleb’s abnormal heart sound, what anatomical structure is abnormal? Explain your answer based on the clinical findings of Caleb. (2 points) 3. The defect in Caleb’s heart allows blood to mix between the two ventricular chambers. c. Based on your understanding of blood pressure and resistance in the heart and great vessels, why is Caleb’s blood moving from left-to-right during systole? (1 point) 4. When an echocardiogram is performed, the technician color-codes oxygenated blood (red) and deoxygenated blood (blue). d. In a healthy baby, what color would the blood be within the right and left ventricles, respectively? (1 point) e. Based on Caleb’s echocardiogram findings, what color would the blood be within the right and left ventricles, respectively? (1 point) 5. One of the problems that worried Tiffaney was that Caleb seemed to be breathing too hard all the time. Let’s consider how this symptom is related to his heart defect. f. Describe what would happen to the blood volume and pressure entering the pulmonary circuit as a result of Caleb’s condition (2 points) and how this affects the right ventricle of Caleb. (1 point) 6. What is the clinical name for Caleb’s condition? (1 point) …
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