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Anyone Who Had A Heart Case Study

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Raegan Kilgore

on 24 April 2015

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Transcript of Anyone Who Had A Heart Case Study

Jen, 37 year old woman pregnant with twins at 28 weeks. Doctor tells Jen he would like her to carry the twins out as long as she can because of her age. Jen was inpregenanted with a fertility procedure.
Nurse states that both babies seem to be very active and both hearts are beating. Doctor monitors heart rates of 130-160 bpm.
Doctor observes he hears a heart murmur in one of the babies.
Questions
1. Draw a diagram of the heart of a human adult Show the circulation of the blood through the heart and to and from the body and the lungs

2. Draw a diagram of the heart of a human fetus. show the circulation of the blood through the heart and to and from the body and the lungs

3. What are the major structural differences between the fetal and the adult human heart? Draw and label these differences on your diagram of the fetal heart. How do these structures alter the circulation of blood?
in a fetal heart, the atria is connected by a hole called the foramen ovale. Normally, the RA pumps blood to the RV to send to the lungs to get oxygenated. Babies however do not breath on their own, so their lungs are not taking in oxygen. Blood goes directly from RA to LA instead of to the lungs.
Questions 2
4. Why is the pulmonary circulation reduced in the human fetus?
Pulmonary circulation is reduced in the human fetus because the baby gets oxygen from its mother and does not breath on its own.
5. Are heart rates of 130 to 160 normal in a human fetus?
Yes, a normal fetal heart rate is anywhere between 120-160 bpm.

Part I Summary
Questions
1.What additional signs and symptoms do the babies exhibit?
Brianna: cyanotic, rapid breathing, coughing, HR-160 bpm with a heart murmur
Christopher: has changed to pink color, normal heart rate and sounds, HR: 120 bpm
2. What creates the lub heart sound?
The closing of the atrioventricular valves.
3. What creates the dub heart sound?
The closing of the semilunar valve.
4. What is a heart murmur?
A continuous sound that is audible. Produced when blood passes through particular areas of the heart
Questions 2
5. Do murmurs have different sounds and are they correlated with different problems?
Yes, heart murmurs have different sounds and are measured by grades. Each grade is correlated with different problems.
6. What creates the whirring sound between the lub and dub in Brianna's heart?
The blood back flowing into the atrium.
7. What are the possible diagnoses for Brianna's condition at this time? For each diagnosis that you come up with, describe the signs or symptoms that relate to that diagnosis.
Cyanotic Heart Disease:
Signs and Symptoms: blue color to the skin on fingers, toes, and lips, rapid breathing, fatigue, puffiness to the eyes and face, feeding problems
Congenital Heart Disease:
abnormal heart rhythms
blueish tint to skin
shortness of breath
tiredness
swelling


Summary
The babies are being moved to the viewing room. A second doctor and student observe Brianna and Christopher to listen for a heart rates. The student confirms Christopher's heart rate is 120 bpm and Brianna's is 160 bpm and has a heart murmur. He also states that there is a whirring sound between the lub and dub sounds of the heart.
The doctors send Brianna to the neonatal intensive care unit.
Questions
1. What new signs or symptoms do the two babies exhibit?
Both babies blood pressure have now been observed and Christopher's BP seems to be normal and Brianna's BP seems to be low. Also, Brianna seems to be uninterested in eating, is very sleepy, and is congested.
2. What are the possible diagnoses for Brianna's condition at this time?
For each diagnosis that you come up with, describe the signs and symptoms that relate to that diagnosis.
Cyanotic Heart Disease is still a possibility, signs and symptoms include: blue skin, rapid breathing, disinterest in eating, tiredness, heart murmur
Ventricular Septal Heart Defect- signs and symptoms: fast breathing, short of breath, paleness, unable to gain weight
3. If you were the pediatrician, what tests would you perform to help you narrow the possible diagnoses for Brianna's condition?
I would use a chest x ray to see if there is a blockage in the heart valves and an ECG also.

Summary
Christopher:
Pink skin
Heart Rate: 120
Heart Sounds: normal
blood pressure: 110/70
Arterial Po2: 100
Behavior: Normal
Breathing: Normal
Feeding: Normal
Part I
Part III
Part IV
Anyone Who Had A Heart Case Study
Raegan Kilgore

Part II
Summary
Jen is ready to deliver the babies.
Both twins are born, one is a girl and one is a boy. They were named Brianna and Christopher.
Christopher was crying when delivered, blue skinned that turned pink within normal time of birth, has a steady breathing rate.
Brianna did not cry during delivery and was blue but finger tips and lips continued to be blue even after a considerable amount of time. Baby has a rapid breathing rate
Questions
1.What are the vital signs or symptoms do the two babies exhibit?
Christopher- crying, blue at birth, turned pink, pink lips, breathing slower rate, normal vital signs, no signs of distress
2nd baby- no crying, blue at birth, rapid breathing, blue fingertips and lips
2. What is cyanosis
Lack of oxygen in the blood. Is a heart defect. Causes blueish colored skin
3. Would you be alarmed if Brianna has cyanosis and Christopher does not?
No, there would be no need to be alarmed if one baby has cyanosis and the other does not because it is a heart defect. Typically, if one twin has a defect the other baby is not going to exhibit the same.
Questions 2
4. Why would the cyanotic baby have a faster breathing rate?
By increasing the breathing rate, oxygen is being taken in and replacing the oxygen that is lacking. The baby is having to work harder for oxygen in her body. The body is trying to meet oxygen needs for cells.
5. What are the possible diagnoses for Brianna's condition at this time? For each diagnosis that you come up with, describe the signs and symptoms that relate to the diagnosis.
At this time Brianna shows symptoms for
Congenital Heart Disease-
Signs and Symptoms:
rapid breathing
cyanosis(blueish color to skin on fingers, toes, and lips)
fatique
poor blood circulation
Questions 3
8. If you were the pediatrician, what tests would you perform to help you narrow the possible diagnoses for Brianna's condition?
I would order a chest x ray to see if there is an abnormality in the heart or a valve that is not fully opened or a valve that is missing. I would want to do an echocardiogram to see the structure of the heart and the blood vessels.
Brianna:
Blue skin (cyanotic)
Heart rate: 160
Heart sounds: Lub whirrr dup
Blood pressure: 85/55
Arterial Po2: 100
Behavior: Lethargic; sleepy
Breathing: heavy, rapid, congested
Feeding: Disinterested
Part V
1. What are the possible diagnoses for Brianna's condition at this time? For each diagnosis that you come up with, describe the signs and symptoms that relate to that diagnosis. Try to think logically-sometimes the line of reasoning and the correct questions are more important than the answer.
Since the ECG ruled that the valves are normal, I believe that the diagnosis is a Ventricular Septal Defect. In a VSD, there is a hole in the wall between the left and right ventricles of the heart. Since this hole is there, the symptoms include heavy breathing, shortness of breath, paleness and fast heart rate.
2. Does a heart murmur necessarily indicate a dysfunctional valve? What other defects could produce the murmur heard through the stethoscope?
No a dysfunctional valve is not always the answer. A hole in the heart could also cause a murmur found by listening through the stethoscope.
Part VI

the echocardiogram reveals that blood is flowing between Brianna's left and right ventricle due to a ventricle septal defect
1. Does the diagnosis fit Brianna's vital signs?
Yes. VSD causes increased heart rates which Brianna exhibited, fast breathing, and paleness (blueness)
2. What created Brianna's heart murmur?
The hole in her heart between the right and left ventricles. The blood flowing between the hole gave off the murmur.
3. Why is Brianna's blood pressure lower than Christopher's?
Brianna's heart is not pumping the same amount of blood as Christopher's heart is because of the hole. The pressure is lower because of the lack of flowing blood.
4. Is it reasonable that Brianna's arterial Po2 is the same as Christopher's?
Yes. Brianna is still recieving oxygenated blood.
5. Why is Brianna breathing rapidly and deeply?
Full transcript