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Due March 13, 2018 at 6 pm

Azia Akers A&P2 09/15/2019 Case Study: Crimes of the Heart: A Case Study on Cardiac Anatomy (5 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 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. Caleb has abnormal heart sounds that tipped the doctor off to a problem. (2 Points) a. Name the FOUR normal sounds of the heart and indicate what causes these sounds. S1 is the 1st sound known as the “lub” and occurs with the closure of the atrioventricular valves. S2, is the 2 nd heart sound known as the “dup” which occurs with the closure of the pulmonary and aortic valves. The 3 rd sound is only considered normal in youths. This is the S3 this occurs at the beginning of diastole after S2. The 4 th heart sound is S4 and can be heard right after atrial contractions.

b. In relation to the normal heart sounds, when would you expect to hear the abnormal sound Dr. Baker heard? Explain your answer. “Ventricular septal defect is an opening the interventricular septum, causing a shunt between ventricles”. (Baffa. J, 2018) Typically a holosystolic murmur is heard at the left sternal border, between S1 and S2. During this time the atrioventricular valves close, the ventricular contract and blood shunts from left ventricle to right ventricle. At the end of systole the semilunar valves close. Systolic murmurs, diastolic murmurs, and extra heart sounds - Part 1. (2014). Retrieved from https://www.khanacademy.org/science/health-and-medicine/circulatory-system-

2. 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. (1 point) Another abnormality that causes the mix of oxygenated blood with deoxygenated blood is Patent ductus arteriosus. PDA is an opening between the major two blood vessels leading from the heart 9pulminary artery and the aorta). This opening allows poorly oxygenated blood to flow into the wrong direction. Patent ductus arteriosus (PDA). (2018, January 25). Retrieved from https://www.mayoclinic.org/diseases-conditions/patent-ductus-

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Due March 13, 2018 at 6 pm

3. What happens to Caleb’s systemic cardiac output as a result of his ventricular septal defect (VSD)? Explain your answer. (1 point) Because the blood moves left to right through a shunt the left ventricular volume falls during systole. This shunt decrease stroke volume and cardiac input.

4. Based on the location of Caleb’s defect, what part of the conduction system might be at risk for abnormalities? (1 Point) Based on Caleb’s defect location the part of the conduction system that might be at risk for abnormalities are the atrioventricular bundle and the bundle branches along the interventricular septum. The bundles would become blocked and cause the lungs and heart to work harder due to congestion. Ventricular Septal Defect (VSD). (n.d.). Retrieved from https://www.heart.org/en/health-topics/congenital-heart-defects/about-congenital-heartdefects/ventricular-septal-defect-vsd...