1. Listening to the patient’s heart with stethoscope reveals a high pitched, blowing systolic murmur heard directly under the left nipple. The patient has no prior history of heart murmur. Explain what is causing this new murmur.



2. Is the cause of murmur in any way related to the patient’s heart attack?



3. While listening to the patient’s breathing with a stethoscope, you hear some wheezing and inspiratory rales (crackling noises). Explain these findings.



4. A chest X-ray taken two weeks after his collapse showed markedly enlarged cardiac silhouette and generalized haziness at the bases of the lungs. Explain why the heart is enlarged and lungs “hazy” on the chest X-ray.


5. The patient is stabilized and ultimately discharged from the hospital. Three months after the heart attack, he comes back to his physician for a checkup. He complains of dyspnea (shortness of breath) at rest and difficulty breathing while lying down (orthopnea). He says he can only sleep when he is propped up by two large pillows. Explain why is the patient having these symptoms.

· When Roger lays down at night, he eliminates the effect of gravity.

· rate of venous blood flow returning to right atrium increases.

· rate of venous blood flow returning to the left atrium is also increased.

· increases the pre-load placed upon left ventricle.

· Fluid begins to collect in lungs – difficulty breathing


· Raises heart above the majority of his systemic circulation

· Lowers rate of venous return

· Relieves shortness of breath


6. Discuss what other organs were affected by Roger’s illness, and how these organs are interconnected with each other.

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