Crimes of the Broken Heart Case Study

Crimes of the Broken Heart

Michael Jacquay

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23 January 2016

1-A) To listen to the tricuspid valve during auscultation you would need to place the stethoscope on the fourth intercostal space just slightly to the left of the top of the sternum. For the mitral valve you would be positioned at the fifth intercostal space about 1 centimeter towards the midclavicular line (apex of the heart). The locations for the pulmonary valve and aortic valve are the second left intercostal space and the second right intercostal space respectively.

1-B) Since Caleb has been diagnosed with a ventricular septal defect, I believe the best location to hear this defect with a stethoscope would be the fourth intercostal space or tricuspid. I came to this conclusion because the point at which you listen is slightly to the left off the center of the heart and since the heart is not positioned directly midline in the body, this position lines up in or near the middle of the heart. More specifically it lies at the midline section of the heart that, if cut into two pieces, would split the ventricles in half vertically. Since Caleb’s defect is between the ventricles it would make the best position to hear his particular problem.

2-A) According to our book, there are four sounds the heart makes termed S1 to S4 and more commonly referred to as “lubb” “dupp”. S1 is the beginning of ventricular contraction and atrioventricular valves (AV) close and the semilunar valves open. S2 sounds off when the ventricles begin to fill after the semilunar valves close and the AV valves open. S3 and S4 are not as loud as the first two sounds. S3 happens when blood starts to flow into the ventricles. S4 occurs during the contraction of the atria.

2-B) Since the condition involves a “hole” between the right and left ventricles I would believe the abnormal sound would come at S3 since that is the time in which the ventricles fill with blood. Murmurs are typically noted with a “whooshing” sound....