Problem: A 14-month-old girl is brought to the emergency department. When the child woke from her afternoon nap, the mother noted that she did not use her left arm and had difficulty standing without falling. The staff attaches the child to a cardiorespiratory monitor and a pulse oximeter to monitor the oxygen saturation of the hemoglobin. Although all vital signs are normal, the child is listless and barely responds to the staff's interventions. An emergency computed tomographic (CT) scan is ordered, and the child is noted to have suffered a small stroke. The child is transferred to the pediatric intensive care unit for close monitoring. By the next morning, the child has begun to use her left arm; although a little wobbly, she keeps pulling herself up to stand while in the crib. A neurologist examines the little girl and orders some laboratory tests and an echocardiogram. Once the tests are complete, the neurologist meets with the mother and explains that the child has a congenital cardiac anomaly, patent foramen ovale.
1. Discuss the four chambers of the heart.
2. Describe a patent foramen ovale. Where is the valvular opening located?
3. Discuss the opening that has no effect on the normal electrical impulses in the heart.
4. Describe the usual pacemaker of the heart and its location.