Question

Mrs. Watson came in through the front door of her house with an armful of groceries. She put the bag down on the kitchen counter and called to her husband. “Herb, I’m home! Are you ready for lunch?” She didn’t get an answer,
so she walked to the living room and found Mr. Watson lying on the floor. “Herb! Are you okay?” she asked as she grabbed his shoulder. Mr. Watson responded weakly while clutching his chest. Mrs. Watson frantically called 911. It only took EMS a few minutes to arrive and the paramedics transported Mr. Watson to the hospital. Upon admission to the hospital, Mr. Watson’s vital signs were recorded as follows:

	Mr. Watson	Normal
Systolic blood pressure (mm Hg)	90	120
Diastolic blood pressure (mm Hg)	52	80
Oral temperature (°F)	98.9	97.8 to 99.1
Heart rate (beats per minute)	120, irregular	60–80
Respiratory rate (breaths per minute)	33, labored	12 to 20
Oxygen saturation	89%	95–100%

1. Which of Mr. Watson’s vital signs and lab values are abnormal? Are the levels above or below normal?

2. What is cardiac output? Use Mr. Watson’s vitals above to determine what is happening to his cardiac output.

Mr. Watson was admitted to the hospital with chest pains and shortness of breath. His wife was panicked since her 72 year-old husband has a history of heart disease. After examination and an echocardiogram, Dr. Collins determines that Mr. Watson’s left posteromedial papillary muscle is damaged, resulting in valve prolapse.   

3. What is an echocardiogram?

4. Explain why valves are critical to proper blood flow through the heart.

5. What is the function of papillary muscles? Which of Mr. Watson’s valves is affected by this damage?   How does this damage disrupt blood flow?

6. Revisit your answer to question #2. Specifically, how does Mr. Watson’s valve prolapse affect his cardiac output? How does this impact his BP and heart rate?

Mrs. Watson was very upset with the news of her husband’s condition. As the day progressed, she noticed that Mr. Watson’s breathing was increasingly difficult. He could barely speak without losing his breath. Mrs. Watson called the nurse to her husband’s room. “My husband can’t breathe! What is wrong? I thought he had a heart attack not a respiratory condition!” Nurse Dan auscultated the patient’s chest listening to Mr. Watson’s respirations, which were rapid and wet, producing rales (wet breath sounds) or crackling sounds. Nurse Dan calmly informed Mrs. Watson, “I’m sorry. Your husband’s condition is worsening. The damage to his heart is causing his respiratory problems.”

7. The circulatory system consists of two circuits. The left side of the heart receives blood from which circuit?

8. How is the pulmonary circuit affected by Mr. Watson’s valve prolapse? Is pressure in the pulmonary circuit increasing, decreasing or staying the same?

9. Explain how this change in pulmonary blood pressure affects capillary filtration in the lungs.

10. If Mr. Watson’s tricuspid valve had failed instead, what symptoms would be different and why?

Mr. Watson underwent valve replacement surgery successfully and was discharged from the hospital with no further complications. Often, patients’ valvular deficiencies don't require surgery, only medications to control their symptoms and alleviate stress on the heart. Three possible medical treatments are listed below. Please discuss the mechanism of action for each medication and why it might be a useful medication for mitral valve deficiency.   Please also discuss at least one side effect of each medication. Explain why the drug causes that side effect.

a. beta blockers

b. ACE Inhibitors

c. anticoagulants “blood thinners” (warfarin)

Answer 1

answer 1) Mr. watson,s diastolic presuure, heart rate, respiratory rate and oxygen saturation values are abnormal. diastolic pressure andoxygen saturation is below the normal range and heart rate and respiratory rate is above the normal.

answer 2) cardiac output is the amount of blood pumped out by each ventricle per minute. cardiac out put = stroke volume * heart rate. therefore increase in heart rate leads to an increase in cardiac output.

answer 3) the electrocardiogram is a diagnostic tool that is used to know the muscular and electrical heart functions .

answer 4) valves facilitate the flow of blood and also prevent the backward flow of blood and act as a "one way door". it also prevents any leakage of blood.

answer 5 and 6) papillary muscles attached to the AV valves via chordae tendineae. it prevent the prolapse of AV valve during systole. it contracts with the contraction of ventricular wall and helps in the closing of valves. its rupture causes lack of blood blow in ventricles, blood pressure and heart rate is also effected.

answer 7) left side of heart follows systemic circuit in which oxygenated blood is distributed in the body and collection of deoxygenated blood back to the heart takes place.

answer 8) valve prolapse may causes:

pulmonary hypertension, congenital heart diseases, rheumatic fever, cacinoid syndrome,etc. and the pressure of puulmonary circuit cause increase in pulmonary venous and capillary pressure also flooding of alveoli takes place.

answer 10)  affect of the tricuspid valve failure are: infective endocarditis, Marfan syndrome,injury, carcinoid tumors, and myxomatous degeneration.

medication:

ACE inhibitors  drug used for the hypertension as well as congestive heart failure treatment

β-blockers,are used to manage abnormal heart rhythms, also protect t from a second heart attack after a first heart attack.

warfarin is used as an anticoagulent.