Crimes of the Heart: A Case Study on Cardiac Anatomy Essay Assignment paper

Tiffany 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 breastfeeding 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. Crimes of the Heart: A Case Study on Cardiac Anatomy Essay Assignment paper.

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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 breastfeeding 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. Crimes of the Heart: A Case Study on Cardiac Anatomy Essay Assignment paper. I want to use an echocardiogram and an ECG to get a good picture of all the parts of his heart.”

After a full day of tests, Tiffaney meets with Dr. Baker in his office. He explains, “After a careful review of all the information, I have discovered that Caleb has a hole in the heart muscle wall between his right and left ventricles. We call it a ventricular septal defect. That is probably why he has been so irritable and hard to feed. The hole is not very big, but he will still need to have surgery to repair it.” Although the thought of her tiny son having surgery is terrifying, Tiffaney is relieved to know why things have been so tough at home.

Crimes of the Heart: A Case Study on Cardiac Anatomy Short Answer Questions:

1. Dr. Baker spends a long time listening to (auscultating) Caleb’s heart. Where do you think would be the best place to auscultate Caleb’s abnormal heart sound? Explain your answer.

2. Caleb has abnormal heart sounds that tipped the doctor off to a problem. In relation to the normal heart sounds, when would you expect to hear the abnormal sound Dr. Baker heard? Explain your answer Crimes of the Heart: A Case Study on Cardiac Anatomy Essay Assignment paper.

3. The defect in Caleb’s heart allows blood to mix between the two ventricular chambers. Due to this defect would you expect the blood to move from left-to-right ventricle or right-to-left ventricle during systole? Explain your answer.

4. What happens to Caleb’s systemic cardiac output as a result of his ventricular septal defect (VSD)? Explain your answer.

5. Based on the location of Caleb’s defect, what part of the conduction system might be at risk for abnormalities? Explain your answer.

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Crimes of the Heart: A Case Study on Cardiac Anatomy

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  • 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?

The aortic valve is heard at the 2nd intercostal space at the right sternal border, the pulmonary valve is heard at the 2nd intercostal space at the left sternal border, the mitral valve is heard over the heart apex which is in the 5th intercostal space midclavicular line, and the tricuspid valve is heard in the right sternal border of the 5th intercostal space.

  • Where do you think would be the best place to auscultate Caleb’s abnormal heart sound? Explain your answer.

I think it would be would be from the lower left sternal border to the right lower sternal border because this would be right over where the murmur is happening.

  • Caleb has abnormal heart sounds that tipped the doctor off to a problem.
  • Name the normal sounds of the heart and indicate what causes these sounds.

The two normal heart sounds are lub which is S1 and dub which is s2. S1 is caused by the closure of mitral and tricuspid valves at the start of systole. S2 is caused by the closure of aortic and pulmonic valves, marking the end of systole (Stethographics.com, 2015).

  • In relation to the normal heart sounds, when would you expect to hear the abnormal sound Dr. Baker heard? Explain your answer.

You would expect to hear a swooshing noise in between S1 and S2. Crimes of the Heart: A Case Study on Cardiac Anatomy Essay Assignment paper.

  • The defect in Caleb’s heart allows blood to mix between the two ventricular chambers.
  • Due to this defect would you expect the blood to move from left-to-right ventricle or right-to-left ventricle during systole?

Left-to-right

  • Based

    on your understanding of blood pressure and resistance in the heart and great vessels, explain your answer to question 3a.


Oxygenated blood is usually pushed out through the left ventricle to the other parts of the body under high pressure. But as a result of the defect some blood will be pushed through the hole to the right ventricle.

  • When an echocardiogram is performed, the technician color-codes oxygenated blood (red) and deoxygenated blood (blue).
  • In a healthy baby, what color would the blood be within the right and left ventricles, respectively?

The blood in the right ventricles has less oxygen and is therefore blue in color whereas blood on the left ventricles is rich in oxygen and is red in color (Kidshealth.org, 2015).

  • In Caleb’s heart, what color would the blood be within the right and left ventricles, respectively?

In Caleb’s situation, the red blood in the left ventricle which is rich in oxygen flows through the hole in the septum to mix with blue blood in the right ventricle which is deoxygenated (Kidshealth.org, 2015). Crimes of the Heart: A Case Study on Cardiac Anatomy Essay Assignment paper.

  • Caleb’s heart allows oxygenated and deoxygenated blood to mix. Based on your knowledge of the heart and the great vessels, describe other anatomical abnormalities that cause the mixing of oxygenated and deoxygenated blood.

The other anatomical abnormalities that cause the mixing of oxygenated and deoxygenated blood includes valve defects and transposition of the great arteries. The valve defect causes valvular insufficiency whereas transposition of the great arteries affects the aorta and the pulmonary artery (Encyclopedia Britannica, 2015). Crimes of the Heart: A Case Study on Cardiac Anatomy Essay Assignment paper.

  • What happens to Caleb’s systemic cardiac output as a result of his ventricular septal defect (VSD)? Explain your answer.

Children with ventricular septal defect (VSD) often demonstrate failure to thrive. Such patients usually have reduced systemic cardiac output which has been postulated as a

cause for their growth retardation (Corin et al., 1988).

  • 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.
  •   Describe what would happen to the blood volume and pressure entering the pulmonary circuit as a result of his VSD. Crimes of the Heart: A Case Study on Cardiac Anatomy Essay Assignment paper.

The back leak of blood from the systemic to the pulmonary circulation increases the volume of blood that the pulmonary circulation carries and as a result the blood volume and pressure becomes high. If this condition progresses, it causes damage to the pulmonary vasculature and development of irreversible pulmonary hypertension (Utmb.edu, 2015).

  • Describe what would happen to the myocardium of Caleb’s right ventricle as a result of his VSD.

As a result of being overworked, the myocardium enlarges and eventually gets damaged.

  • Based on the location of Caleb’s defect, what part of the conduction system might be at risk for abnormalities? Crimes of the Heart: A Case Study on Cardiac Anatomy Essay Assignment paper.

The ventricular septum

References

Corin, W., Swindle, M., Spann, J., Nakano, K., Frankis, M., & Biederman, R. et al. (1988). Mechanism of decreased forward stroke volume in children and swine with ventricular septal defect and failure to thrive. Journal Of Clinical Investigation82(2), 544-551. doi:10.1172/jci113630

Encyclopedia Britannica,. (2015). congenital heart disease | pathologyEncyclopedia Britannica. Retrieved 2 July 2015, from http://www.britannica.com/science/congenital-heart-disease

Kidshealth.org,. (2015). Ventricular Septal DefectKidshealth.org. Retrieved 2 July 2015, from http://kidshealth.org/parent/medical/heart/vsd.html

Stethographics.com,. (2015). Basic Heart SoundsStethographics.com. Retrieved 2 July 2015, from http://www.stethographics.com/main/physiology_hs_introduction.html. Crimes of the Heart: A Case Study on Cardiac Anatomy Essay Assignment paper.

Utmb.edu,. (2015). Left to Right ShuntsUtmb.edu. Retrieved 2 July 2015, from http://www.utmb.edu/pedi_ed/core/cardiology/page_05.htm

Crimes of the Heart: A Case Study on Cardiac Anatomy

 

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 an echocardiogram and an ECG to get a good picture of all the parts of his heart.”

After a full day of tests, Tiffaney meets with Dr. Baker in his office. He explains, “After a careful review of all the information, I have discovered that Caleb has a hole in the heart muscle wall between his right and left ventricles. We call it a ventricular septal defect. That is probably why he has been so irritable and hard to feed. The hole is not very big, but he will still need to have surgery to repair it.” Although the thought of her tiny son having surgery is terrifying, Tiffaney is relieved to know why things have been so tough at home.

Short Answer Questions:

 

  1. Dr. Baker spends a long time listening to (auscultating) Caleb’s heart.
    1. Where on the thoracic surface do you auscultate to the tricuspid, mitral (bicuspid), pulmonary, and aortic valves?

You hear the tricuspid in the right sternal margin of the 5h intercostal space, the mitral valve in the 5th intercostal space in line with the middle of the clavicle (over the heart apex), the pulmonary semilunar valve in the 2nd intercostal space at the left sternal margin, and the aortic semilunar valve in the 2nd intercostal space at the right of the sternal margin. Crimes of the Heart: A Case Study on Cardiac Anatomy Essay Assignment paper.

    1. Where do you think would be the best place to auscultate Caleb’s abnormal heart sound? Explain your answer.

Calebs defect is in the interventricular septum so the best place to auscultate would be the lower left sternal border because it is above the defect.

  1. Caleb has abnormal heart sounds that tipped the doctor off to a problem.
    1. Name the normal sounds of the heart and indicate what causes these sounds.

You normally hear two thumps. The first is lower and is caused by the closing of the atrioventricular valves- the tricuspid and bicuspid Crimes of the Heart: A Case Study on Cardiac Anatomy Essay Assignment paper. The second is due to the closing of the pulmonary semilunar and the aortic semilunar valve.

    1. In relation to the normal heart sounds, when would you expect to hear the abnormal sound Dr. Baker heard? Explain your answer.

You would expect to hear the abnormal heart sounds between the sound made by the atrioventricular valve closing and the semilunar valve closing.

  1. The defect in Caleb’s heart allows blood to mix between the two ventricular chambers.
    1. Due to this defect would you expect the blood to move from left-to-right ventricle or right-to-left ventricle during systole?

We would expect the blood to flow from the left ventricle to the right ventricle during systole.

    1. Based on your understanding of blood pressure and resistance in the heart and great vessels, explain your answer to question 3a.

The blood moves from the left to the right because it is moving from a high pressure area to an area of lower pressure. The right side has higher pressure because it is coming from the lungs and that side of the heart is stronger. The right side is lower because the pulmonary veins that lead into it do not create as high a pressure as the veins leading into the left side of the heart. Crimes of the Heart: A Case Study on Cardiac Anatomy Essay Assignment paper.

  1. When an echocardiogram is performed, the technician color-codes oxygenated blood (red) and deoxygenated blood (blue).
    1. In a healthy baby, what color would the blood be within the right and left ventricles, respectively?

In a healthy baby the right ventricle would have deoxygenated blood that is dark red and the left ventricle would have bright red oxygenated blood.

    1. In Caleb’s heart, what color would the blood be within the right and left ventricles, respectively?

In Caleb’s heart, his left side would have normal red colored, oxygenated blood, while the right side would contain a mix of both deoxygenated (blue) and oxygenated (red) blood. Crimes of the Heart: A Case Study on Cardiac Anatomy Essay Assignment paper.

  1. Caleb’s heart allows oxygenated and deoxygenated blood to mix. Based on your knowledge of the heart and the great vessels, describe other anatomical abnormalities that cause the mixing of oxygenated and deoxygenated blood.

One anatomical abnormality that could cause deoxygenated and oxygenated blood to mix would be if there was a hole in the interventricular septum between the left and right atrium. This condition is called atrial septal defect. Another anatomical condition that could cause the mixing of blood is called ductus arteriosus. This is when the ductus arteriosus does not close after birth and allow blood from the aorta to flow back to the pulmonary trunk.

  1. What happens to Caleb’s systemic cardiac output as a result of his ventricular septal defect (VSD)? Explain your answer.

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Caleb’s systemic cardiac output would be much lower because instead of exiting the left atrium normally, much of the blood is leaking through the hole in his septal muscle.

  1. 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.
    1. Describe what would happen to the blood volume and pressure entering the pulmonary circuit as a result of his VSD.

Caleb has an increase in the amount of blood volume being pushed into the pulmonary circuit. This creates a higher blood pressure or pulmonary hypertension which can cause pulmonary edema.

    1. Describe what would happen to the myocardium of Caleb’s right ventricle as a result of his VSD.

The myocardium in the right ventricle is experiencing extra pressure which leads to stretching of the myocardium (called hypertrophy). This is because of the left to right passage of blood that is putting extra pressure on the right side of the heart.

  1. Based on the location of Caleb’s defect, what part of the conduction system might be at risk for abnormalities?

The atrioventricular bundle and the bundle of branches are along the interventricular septum so, if Caleb’s defect includes a large portion of the septum to win then the whole area could be at risk for abnormalities. Crimes of the Heart: A Case Study on Cardiac Anatomy Essay Assignment paper.

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