Chap 18 Case Study 
1. Dr. Baker spends a long time listening to (auscultating) Caleb’s heart.
a. Where on the thoracic surface do you auscultate to the tricuspid, mitral (bicuspid), pulmonary, and aortic valves? Auscultation for the tricuspid valve would be in the left sternal margin of the 5th intercostal space. The mitral valve sounds are heard over the apex of the heart (5th intercostal space) in line with the middle of the clavicle. Pulmonary valve sounds are auscultated at the 2nd intercostal space at the left sternal margin. The aortic valve is heard at the 2nd intercostal space of the right sternal margin.
b. Where do you think would be the best place to auscultate Caleb’s abnormal heart sound? Explain your answer. The abnormal heart sounds would best be heard over the tricuspid area – the lower left sternal border. This is the area which overlies the defect.
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. The normal sounds of the heart are “lub-dup” are caused by the opening and closing of the heart valves. The first sound – lub- is from the closing of the mitral and tricuspid heart valves. The second sound -dup- is from the closure of the pulmonary and aortic valves.
b. In relation to the normal heart sounds, when would you expect to hear the abnormal sound Dr. Baker heard? Explain your answer. A ventricular septal defect is a systolic murmur. The abnormal sounds can be heard during or after the first heart sound and ends before or during the second heart sound.
3. The defect in Caleb’s 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? I would expect the blood to move from the left to the right ventricle.
b. Based on your understanding of blood pressure and resistance in the heart and great vessels, explain
a. Where on the thoracic surface do you auscultate to the tricuspid, mitral (bicuspid), pulmonary, and aortic valves? Auscultation for the tricuspid valve would be in the left sternal margin of the 5th intercostal space. The mitral valve sounds are heard over the apex of the heart (5th intercostal space) in line with the middle of the clavicle. Pulmonary valve sounds are auscultated at the 2nd intercostal space at the left sternal margin. The aortic valve is heard at the 2nd intercostal space of the right sternal margin.
b. Where do you think would be the best place to auscultate Caleb’s abnormal heart sound? Explain your answer. The abnormal heart sounds would best be heard over the tricuspid area – the lower left sternal border. This is the area which overlies the defect.
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. The normal sounds of the heart are “lub-dup” are caused by the opening and closing of the heart valves. The first sound – lub- is from the closing of the mitral and tricuspid heart valves. The second sound -dup- is from the closure of the pulmonary and aortic valves.
b. In relation to the normal heart sounds, when would you expect to hear the abnormal sound Dr. Baker heard? Explain your answer. A ventricular septal defect is a systolic murmur. The abnormal sounds can be heard during or after the first heart sound and ends before or during the second heart sound.
3. The defect in Caleb’s 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? I would expect the blood to move from the left to the right ventricle.
b. Based on your understanding of blood pressure and resistance in the heart and great vessels, explain