Anyone Who Had A Heart: A Case Study in Physiology 3

Part III—The Babies





A wave of exhaustion washed over Jen as a second nurse entered the
delivery room.

“OK, it’s time for Mom to check into her room. The pediatric nurse
will take the babies to the greenhouse where you can show them off to
your family.”

“Don’t worry, they call it the greenhouse because of all of the
windows where friends and relations can come and see the babies,”
explained Jim. “You will be here a few days because of your surgery,
Jen, and you’ll need to get some rest. Dave, why don’t you go up with
Jen and settle her in? I’ll stay here with the nurse and make sure the
kids don’t get lost. I’ll be up soon.”

The new parents smiled and left the delivery room.

“Nice job, Doc.”

At that moment, Dr. Penny Smothers entered the room with a
fresh-faced medical student.

“No sense in worrying the new parents. Hi, Penny. I am afraid we may
have problems with the new arrivals.”

“Hi, Jim, nurse, this is Sam Jones. He’s a medical student interested
in becoming a pediatrician. He’ll be following me around for the next
few weeks. Now, the babies, were there any prenatal indications of
problems?”


“I thought I heard a heart murmur, as I told you when Jen selected
you to be the kids’ doctor, but it was tough to get a clear handle with
twins.”

“OK, Sam, you’re up. Go listen to each child’s heart and tell us what
you think. Please remember your bed-side manners. Their names are on
the plastic ring around their ankle, so please remember how you upset
the last set of parents with twins. Get into the habit of using their
names rather than referring to them as that one!”

Sam listened to the heart of each child with a stethoscope.

“Christopher has a heart rate of about 120, his heart sounds are
normal, and his color is pink. Brianna is cyanotic. Her breathing is
much faster and deeper than Christopher’s, and she is beginning to
cough. She has a heart rate of 160 and a heart murmur; there is a
whirring sound between the lub and the dup.”

“Well, let’s hope that’s an exaggeration,” Penny whispered to Jim as
they went over to examine the children.”

“Oh, my gosh, he’s right!” Penny exclaimed. “Nurse, get Brianna into
the neonatal intensive care, stat. If there’s room, try to get
Christopher in there too.”

She turned to her student.

“OK, Mr. Hotshot, what tests do you think we should do?”

Even though the tension was high and Jim had a personal interest in
the health of his newly arrived nephew and niece, he couldn’t help but
smile as Penny rewarded her student’s good work with more pressure.


Questions

1. What additional signs or symptoms do the two babies exhibit?
   
2. What creates the lub heart sound?
   
3. What creates the dup heart sound?
   
4. What is a heart murmur?
   
5. Do murmurs have different sounds and are they correlated
   with different problems?
   
6. What creates the whirring sound between the lub and the
   dup in Brianna’s heart?
   
7. What are the possible diagnoses for Brianna’s condition
   at this time? For each diagnosis that you come up with, describe the
   signs or symptoms that relate to that diagnosis.
   
8. If you were the pediatrician, what tests would you
   perform to help you narrow
   the possible diagnoses for Brianna’s condition?