Score for this quiz: 12 out of 15 *
Introduction
Eva made plans to visit her Grandpa one day, but when she rang the doorbell, he didn’t respond. Grandpa lives by himself these days and Eva likes to stop by regularly to make sure he’s doing okay. She decides to use the spare key to let herself into the house and when she walks into the kitchen, she’s shocked to find Grandpa lying on floor. Clutching at his chest, he was to respond weakly, and Eva called 911 and EMS arrived in just a few minutes.
At the hospital, Grandpa’s vital signs were recorded as follows:
| Grandpa | Normal |
Systolic BP (mm Hg) | 90 | 120 |
Diastolic BP (mm Hg) | 52 | 80 |
Oral temperature (F) | 98.9 | 97.8-99.1 |
Heart rate (bpm) | 120, irregular | 60-80 |
Respiratory rate (bpm) | 33, labored | 12-20 |
Oxygen saturation | 89% | 95-100 |
Which of Grandpa’s vitals signs and lab values were abnormal?
order ECG/EKG test and echo cardiogram
since oxygen saturation low to do blood test PH level
The cardiologist reviews one additional test, an echocardiogram. To help, I’ve labeled the 4 chambers to orient you to what you are looking at (note the heart is upside down!) Panel A shows an arrow pointing at the likely defect that’s causing Grandpa’s symptoms. Panel B shows blood flow (the warmer the color like yellow-red, the more blood). This image was taken during ventricular systole. The results are below.
Review your heart structure & function lab for some clues. You should also think about blood flow (direction and timing) through the heart (where should blood be during ventricular diastole?)
Based on the echocardiogram results, where do you think the defect is (left or right side of the heart)? Is the defect in the atria, ventricle, aorta, pulmonary vein, pulmonary artery, or valve?
Grandpa needs surgery: Reviewing blood flow
The cardiologist sits down with Grandpa and Eva to discuss Grandpa's situation. "Your grandfather is 72 years old and has a history of heart disease. I'm very sorry, but it's clear that he has had another heart attack which has resulted in valve failure. A small muscle called a papillary muscles that regulates a valve in his heart has been severely damaged and is no longer working. Specifically, his mitral valve has prolapsed, or inverted, and is no longer working properly. We are going to get him on our schedule for a surgery to fix this issue as soon as we can get him into an OR."
The cardiologist further explained that Grandpa's cardiac output was slowly decreasing, blood pressure was also decreasing, and all of these signs are outcomes of left-sided heart failure.
In general, how is the direction of blood flow disrupted because of mitral valve prolapse?
Based on what you understand about cardiac output and blood pressure, why might Grandpa's blood pressure be low? In other words, what does low volume leaving the heart do to blood pressure?
Select the statements that are true!
Connecting the systems: Cardiovascular and Respiratory
Eva was so upset with the news of her grandpa's condition. As the day progressed with no news of when the surgery would be scheduled (it was a very booked OR day), she noticed Grandpa's breathing getting increasingly difficult. Now he could barely speak without losing his breath.
She called a nurse named Mariah into the room. "My grandpa can't breathe! What is wrong? You told me he had a heart attack not a problem with his lungs!!"
Mariah tried her best to comfort Eva and proceeded to ascultate Grandpa's chest while listening to his respirations. She noted that they were rapid and producing wet sounds. She turned to Eva and said, "I'm so sorry. Your grandfather's condition is worsening. The damage to his heart is causing these respiratory problems with his lungs."
If the bicuspid (mitral) valve is not fully closing, does pulmonary circulation increase, decrease, or not change?
Does pulmonary blood pressure increase or decrease with left-sided heart failure?
Does this change in pulmonary blood pressure increase or decrease capillary filtration in the lungs?
Take your best guess. How do these changes in pulmonary blood pressure and capillary filtration lead to wet breath sounds? And why is Grandpa breathing more rapidly?
(Be sure to answer both!)
Damage of mitral valve caused blood flows backwards from the left atria to left ventricle that leading decrease stroke volume decrease and decrease cardiac output.
Low cardiac output - caused in reduced oxygen delivery to tissues
Thus, the sympathetic nervous system response to pumps more blood that caused faster heart rate and increases respiration rate to improve oxygen uptake.