Congested Heart Failure
(adapted from McGraw Hill Case Studies)
Chief Complaint: 74-year-old woman with shortness of breath and swelling.
History: Martha Wilmington, a 74-year-old woman with a history of rheumatic fever while in her twenties, presented to her physician with complaints of increasing shortness of breath ("dyspnea") upon exertion. She also noted that the typical swelling she's had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day. In the past week, she's had a decreased appetite, some nausea and vomiting, and tenderness in the right upper quadrant of the abdomen.
On physical examination, Martha's jugular veins were noticeably distended. Auscultation of the heart revealed a low-pitched, rumbling systolic murmur, heard best over the left upper sternal border. In addition, she had an extra, "S3" heart sound.
Using the internet, do any applicable searches to give a reasonable scientific explanation to the questions below. Understanding figure 20-13 in your textbook also may add some insight to these questions.
You may find the following links useful to aid you answering these questions:
Congested Heart Failure Paper
ABC of Heart Failure
What is causing this murmur? Perhaps there has been narrowing of Martha’s pulmonary semilunar valve which is located between the right ventricle and the pulmonary artery. The closing of this valve is heard best over the left upper sternal border. As stated above, this is where auscultation of the heart revealing a low-pitched, rumbling systolic murmur. A murmuring sound is heard due to the high resistance to blood being pumped through.
2) What is causing her "S3" heart sound? An S3 sound is an extra sound indicating abnormal blood pressure within the heart, namely against the ventricle walls during diastole (relaxation). Blood seems to be flowing too rapidly into the ventricles during...
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