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Congestive Heart Failure.

Listening to the patient’s heart with stethoscope reveals a high pitched, blowing systolic murmur heard directly under the left nipple. The patient has no prior history of heart murmur. Explain what is causing this new murmur.

high-pitched, blowing heart murmur suggests that the patient has regurgitant heart valve – i.e. blood flows backward through the valve due to inadequate closure of valve; the fact that it’s under the left nipple suggests its the bicuspid valve is not closing appropriately

From this location, Roger’s systolic murmur is most likely from the mitral valve. During systole, the mitral valve should be closed, therefore if we are hearing a murmur, the valve must be insufficient, or not closing properly. If we were viewing this valve via Doppler echo, we would see a large blue plume of color moving from the left ventricle into the left atrium.

2. Is the cause of murmur in any way related to the patient’s heart attack?

the anterior intraventricular artery is also blocked; this causes ischemia and ultimately infarction of the the left ventricular wall

From this location, Roger’s systolic murmur is most likely from the mitral valve. During systole, the mitral valve should be closed, therefore if we are hearing a murmur, the valve must be insufficient, or not closing properly. If we were viewing this valve via Doppler echo, we would see a large blue plume of color moving from the left ventricle into the left atrium.

3. While listening to the patient’s breathing with a stethoscope, you hear some wheezing and inspiratory rales (crackling noises). Explain these findings.

the patient has a 40-pack-year smoking history that puts him at increased risk of developing chronic bronchitis and emphysema; both which alters the breath sounds heard w/ stethoscope; left ventricular heart failure slows rate of venous return of blood from pulmonary vein to left atrium

4. A chest X-ray taken two weeks after his collapse showed markedly enlarged cardiac silhouette and generalized haziness at the bases of the lungs. Explain why the heart is enlarged and lungs “hazy” on the chest X-ray.

A. in order to stabilize cardiac output, left ventricle must fill with more blood during ventricular diastole to make up for all the blood that is being pumped backwards into the left atrium B. hazy appearance is due to the fluid/pulmonary edema in the lungs; fluid appears lighter on Xray

5. The patient is stabilized and ultimately discharged from the hospital. Three months after the heart attack, he comes back to his physician for a checkup. He complains of dyspnea (shortness of breath) at rest and difficulty breathing while lying down (orthopnea). He says he can only sleep when he is propped up by two large pillows. Explain why is the patient having these symptoms.

The heart is still performing at sub optimal level; when lying down blood rushes to lungs and makes his heart failure worse; patient is also experiencing poroxysmal nocturnal dyspnea which involves shortness of breath when laying down asleep; elevating the head with pillows helps the patient sleep

· When Roger lays down at night, he eliminates the effect of gravity.

· rate of venous blood flow returning to right atrium increases.

· rate of venous blood flow returning to the left atrium is also increased.

· increases the pre-load placed upon left ventricle.

· Fluid begins to collect in lungs – difficulty breathing

·

· Raises heart above the majority of his systemic circulation

· Lowers rate of venous return

· Relieves shortness of breath

6. Discuss what other organs were affected by Roger’s illness, and how these organs are interconnected with each other.

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