Assignment Problem 1: Cardiac Involvement
Mr. Smith, a 72 year-old male with a history of heart disease, was admitted to the hospital with chest pains and shortness of breath. After examination and an echocardiogram, Dr. Ali spoke with Mrs. Smith. "I'm very sorry, but your husband has had another heart attack resulting in valve failure. A papillary muscle that controls a valve in his heart has been severely damaged and is no longer working."
Answer the following questions:
Question 1: What is the main purpose of the circulatory system?
Question 2: Describe blood flow through the heart starting with blood entering the right side of the heart and including all chambers and valves. Indicate if the blood is oxygenated or de-oxygenated at each step.
Question 3: What is the function of heart valves?
Question 4: What is the function of papillary muscles and the chordae tendineae?
Question 5: Which valve is affected with damage to the papillary muscle in the left ventricle?
Assignment Problem 2: Cardiovascular Involvement
Dr. Ali called Nurse Tan from the patient's room and confided, "Mr. Smith is in bad shape. His left posteromedial papillary muscle was damaged from his heart attack. The papillary muscle is no longer able to maintain closure of the valve, and this has resulted in mitral valve prolapse. With decreasing cardiac output, this patient is in for a fight for his life." Nurse Tan knew that maintaining cardiac output was necessary for adequate blood flow through the body. As Dr. Ali walked away, Nurse Tan composed herself to tell Mrs. Smith the bad news and returned to the patient's room. Nurse Tan explained to Mrs. Smith that her husband had left-sided heart failure and that his blood pressure was slowly and steadily decreasing.
Answer the following questions:
Question 1: In general, how is the direction of blood flow disrupted because of sever mitral valve prolapse?
Question 2: Does the mitral valve prolapse increase, decrease, or not change stroke volume (the amount of blood exiting the ventricle with each ventricular contraction)?
Question 3: How does mitral valve prolapse decrease cardiac output (the amount of blood exiting the ventricle per minute)?
Question 4: Explain how cardiac output determines blood pressure.
Question 5: Why is Mr. Helms' heart rate higher than normal?
Assignment Problem 3: Pulmonary Involvement
Mrs. Smith was very upset with the news of her husband's condition. As the day progressed, she noticed that Mr. Smith's breathing was increasingly difficult. He could barely speak without losing his breath. Mrs. Smith 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 Tan auscultated the patient's chest listening to Mr. Smith's respirations, which were rapid and wet, producing rales or crackling sounds. Nurse Tan calmly informed Mrs. Smith, "I'm sorry. Your husband's condition is worsening. The damage to his heart is causing his respiratory problems."
Answer the following questions:
Question 1: The left side of the heart receives blood from which part of the body?
Question 2: If the bicuspid (mitral) valve is not fully closing, does pulmonary circulation increase, decrease, or not change?
Question 3: Does pulmonary blood pressure increase or decrease with left-sided heart failure? Explain.
Question 4: Does this change in pulmonary blood pressure increase or decrease capillary filtration in the lungs? Explain.
Question 5: How does change in pulmonary blood pressure and capillary filtration cause Mr. Helms' rales (wet breath sounds)?
Question 6: Why is Mr. Helms breathing rapidly?
Assignment Problem 4: Renal Involvement
The next morning when Nurse Tan started her shift, she immediately checked on Mr. Smith. His cardiovascular and respiratory conditions were still deteriorating, but Nurse Tan discovered something new. Mr. Smith's urine output was almost nonexistent. Nurse Tan informed Dr. Ali, who was gravely concerned. Dr. Ali met with Mrs. Smith to tell her that her husband could not survive kidney failure. Mrs. Smith looked shocked. She then became very upset and angry. "What did you do, Dr. Ali? My husband had a heart attack, but his kidneys were fine; he's never had a kidney problem! How could you let this happen?" Nurse Tan put her arm around Mrs. Smith's shoulders and Dr. Ali handed her a tissue. Dr. Ali explained, "The damage to your husband's heart is very serious. The kidneys rely on blood pressure to work and his heart failure is causing the kidney failure."
Answer the following questions:
Question 1: List five functions of the kidneys.
Question 2: Does left-sided heart failure increase, decrease, or not affect kidney filtration? Explain.
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