Question

Part I—Prenatal Visit It had been a hectic day for the doctor, and his last patient was on time for her appointment. “Hi. Sis.” “Hi, Jim. How’s my kid brother?” “Tired—how’s the first-time mom? Have you stopped work yet?” “Come on, Jim, I’m a career woman. Te chemical industry needs me. It’s tough to go cold turkey. When Dave and I decided to have a family, we agreed that I should work as long as I could.” “You’re the size of a house, Jen. You’re 37 years old, you have twins that are 28 weeks, and I really would like you to carry them as long as you can.” “Oh, oh, here comes the lecture again. I know you didn’t like the fertility procedure we did, but I just couldn’t get pregnant. Anyway, as you so tactfully pointed out, doctor, I am not getting any younger. Look at it this way; we’re having our family all at once.” Tere was a knock at the door and the nurse entered. “How did the ultrasound go?” “It’s like Times Square,” replied the nurse. “Arms and legs everywhere—it’s almost impossible to see anything, and those kids are so active. I just hope they slow down after they’re born, otherwise you’ll get no rest until they go to college. It’s crazy in there, with two hearts beating. And with yours in the background, it’s tough to isolate one. As best as I can tell, the rates are around 130 to 160 beats a minute.” “OK, well let’s see if the expert can hear anything.” Both women glared at the doctor. “Do you need the crane or can you get up on the table by yourself?” Jen looked at the nurse and said, “Is he like to this to all his patients?” “No comment; I need this job.” Tey laughed and Jim went to work. Moving the head of his stethoscope to different locations, he tried to isolate the sounds from one heart. His expression changed as he listened intently. Jen began to worry as her brother took longer than usual with his stethoscope. “Is everything OK?” she asked. “Anyone Who Had A Heart” by Phil Stephens Page 1 Jim looked concerned. He was reluctant to tell his sister that he thought he had heard a heart murmur. Like his nurse had said, it was difficult to hear just one heart. He didn’t want to alarm his sister, so he made a joke of the situation. “Must be a girl in there, she won’t stop talking. I think she said something about not leaving the hospital in just any outfi t.” Jen went to hit her brother, but he easily evaded the playful smack. “It’s tough to predict when the babies will arrive, so I think you should start coming to see me every week, Jen.” “Is there a problem? You did all of the tests, and you said that I’m not diabetic. Te alpha-fetoprotein levels indicate no neural tube defects, and that horrible amniocentesis procedure showed no birth defects or Rhesus problems.” “It’s OK, Sis. It’s quite normal for women who are close to delivery to visit their OB-GYN every week. It’s tough to predict delivery with multiple births, because they rarely go full term. So, to be on the safe side, let’s get together every week from now on. In that way I can see your lovely smiling face more often.” Jen scowled at her brother. “For once in your life, do what I ask,” Jim said. “And bring Dave with you next time.” A little later, as Jim was finishing his paper work for the day, the nurse returned to his office. “Everything OK with Jen?” “I can’t stop thinking about that vague sound I heard. It sounded like a heart murmur, but it’s so tough to single out with two kids in there.” “I thought I heard it too. Te babies seem active and are about the same size. No history of birth heart defects in either family, but I guess you never know with twins in an older mom.” “My thoughts exactly. I don’t want to worry her because you know how hyper she can be. I guess we’ll need to keep a close eye on her, and on my nephew and niece.” “Does Jen know the sexes?” “She and Dave don’t want to know. Tey want to be surprised.” 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? 4. Why is the pulmonary circulation reduced in the human fetus? 5. Are heart rates of 130 to 160 normal in a human fetus? “Anyone Who Had A Heart” by Phil Stephens Page 2 Part II—The Arrival Te ambulance that carried Jen sped through the crowded streets with its sirens blasting and lights fl ashing. T e traffic parted, and people watched as the vehicle made its way to the hospital. “My water had to break right in the middle of a meeting.” “Don’t worry, Jen. I’m sure they understand.” Her husband, Dave, was trying to comfort her, but then, true to form, he said something wrong. “Anyway, it’ll give them something to talk about around the coff ee machine.” Jen thought how lucky she was that her husband worked in the same office, but she didn’t like the idea of being the topic of office gossip. She was beginning to feel motion sickness from lying on a stretcher in a moving vehicle. Just then the ambulance stopped, its doors opened, and she was being wheeled down a long corridor. Finally, the stretcher turned a corner and she felt Dave leave her side as she entered a delivery room. She felt the sting of a needle in her left hand. Ten she felt Dave’s hand slip into hers and saw his eyes like slits between the cap and the surgical mask he had put on. Jen felt a needle go into her back and almost immediately the lower half of her body felt numb; the epidural had taken effect. She looked up into the mirror and saw the surgeon with a child in his hands. Te noise of first one crying baby and then another filled the room. Jen held the babies and everyone, except Dave and the nurse, left the room. Te babies were passed between the two of them as the nurse performed various tests. “I came as quickly as I could,” Jim said as he entered the room like a hurricane. Jen thought that he had been late for almost everything in his life, but she would forgive him this time. Jim kissed his sister, smiled at his brother-in-law, and then went over to the nurse. Jen and Dave could hear them talking softly. “No problem, doctor.” Jim came over to the new parents. “So, one of each. Any names picked out?” “Brianna and Christopher,” said Jen. “OK, Doc.” Dave smiled because he knew that Jim hated being called Doc. “Why were they blue when they were born?” “Tat’s quite normal, but they should have changed to pink a minute or so after they were born.” “So why does Brianna still have blue finger tips and lips?” asked Jen. “It’s called cyanosis; it’s not uncommon. Don’t worry. One advantage of being related to a doctor is that all three of you will get first-class treatment.” “I hope so, because Chris has pink lips, and he’s breathing at a much slower rate than his sister.”

Questions 1. What vital signs or symptoms do the two babies exhibit?

2 What is cyanosis?

3. Would you be alarmed that Brianna has cyanosis and Christopher does not?

Why? 4. Why would the cyanotic baby have a faster breathing rate?

5. 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.

Answer 1

1.

2.

3. In the fetal heart there is an opening between the right atrium and left atrium through which the pure blood brought from the placenta is carried to the left atrium. From left atrium blood passes in to the aorta through left ventricle and from there it goes in to the tissues. Blood bypasses the right ventricle and the pulmonary artery. Any blood that enters the pulmonary artery is redirected to the aorta through ductus arteriosus. The bllod in fetus is oxygenated by the placenta where as in the adult the blood is oxygenated in the lungs. There are no ductus arteriosus and foramen ovale in the adult. The differences in blood circulation is only to prevent blood going in to the lungs.

4. Pulmonary circulation is reduced in human fetus because, the lungs are deflated and there is no air in the lungs. Oxygenation can't occur in the lungs. It is the placenta where exchange of gases occurs.

5. Yes, 130 to 160 beats per minute is normal in the human foetus.