Crimes of the Heart: A Case Study on Cardiac Anatomy

Tiffaney is worried about her newborn son. Ever since she brought Caleb home from the hospital
it has been so hard to get him to eat and he seems to be breathing too hard all the time. She
stopped breast-feeding and tried every bottle and formula on the market, but nothing has worked.
So, at his one month check-up, her stomach is in knots as they place Caleb on the scale. The
nurse says, 9 pounds, 7 ounces. Tiffaney realizes Caleb has only gained one pound since he
was born and she breaks into tears.
Dr. Baker checks over Caleb in the exam room, taking extra time feeling and listening to his
chest. During the exam, Tiffaney explains her struggle with trying to get her son to eat and how
he cries almost the entire day. After the exam Dr. Baker says, When I listen to Calebs heart I
hear an extra sound called a murmur. I want to use an echocardiogram and an ECG to get a good
picture of all the parts of his heart.
After a full day of tests, Tiffaney meets with Dr. Baker in his office. He explains, After a careful
review of all the information, I have discovered that Caleb has a hole in the heart muscle wall
between his right and left ventricles. We call it a ventricular septal defect. That is probably why
he has been so irritable and hard to feed. The hole is not very big, but he will still need to have
surgery to repair it. Although the thought of her tiny son having surgery is terrifying, Tiffaney is
relieved to know why things have been so tough at home.
Short Answer Questions:
1. Dr. Baker spends a long time listening to (auscultating) Calebs heart.
a. Where on the thoracic surface do you auscultate to the tricuspid, mitral (bicuspid),
pulmonary, and aortic valves?
b. Where do you think would be the best place to auscultate Calebs abnormal heart
sound? Explain your answer.
2. Caleb has abnormal heart sounds that tipped the doctor off to a problem.
a. Name the normal sounds of the heart and indicate what causes these sounds.
b. In relation to the normal heart sounds, when would you expect to hear the
abnormal sound Dr. Baker heard? Explain your answer.
3. The defect in Calebs heart allows blood to mix between the two ventricular chambers.
a. Due to this defect would you expect the blood to move from left-to-right ventricle
or right-to-left ventricle during systole?
b. Based on your understanding of blood pressure and resistance in the heart and
great vessels, explain your answer to question 3a.
4. When an echocardiogram is performed, the technician color-codes oxygenated blood
(red) and deoxygenated blood (blue).
a. In a healthy baby, what color would the blood be within the right and left
ventricles, respectively?

b. In Calebs heart, what color would the blood be within the right and left
ventricles, respectively?
5. Calebs heart allows oxygenated and deoxygenated blood to mix. Based on your
knowledge of the heart and the great vessels, describe other anatomical abnormalities that
cause the mixing of oxygenated and deoxygenated blood.
6. What happens to Calebs systemic cardiac output as a result of his ventricular septal
defect (VSD)? Explain your answer.
7. One of the problems that worried Tiffaney was that Caleb seemed to be breathing too
hard all the time. Lets consider how this symptom is related to his heart defect.
a. Describe what would happen to the blood volume and pressure entering the
pulmonary circuit as a result of his VSD.
b. Describe what would happen to the myocardium of Calebs right ventricle as a
result of his VSD.
8. Based on the location of Calebs defect, what part of the conduction system might be at
risk for abnormalities?