Congestive Heart Failure

    Chief Complaint:68-year-old man who collapsed during exertion.History: Roger Crockett, a 68-year-old man with a 40-pack-year smoking history and recent complaints of angina (sub-sternal chest pressure) upon exercising, collapsed while mowing his lawn. Paramedics arriving at the scene found him unconscious, not breathing, and without a pulse. CPR was successfully performed and Roger was transported to the hospital. An ECG was suggestive of an anterior wall myocardial infarction, and he was given an intravenous solution of tissue plasminogen activator (TPA). Elevated blood creatine phosphokinase (CPK) levels measured over the next 2 days confirmed the diagnosis. Coronary angiography was performed a week later, revealing the following results:Circumflex artery: 20% blockedRight coronary artery: 15% blockedLeft anterior descending artery (LAD): 95% blocked("Anterior intraventricular artery")   1. Listening to the patient’s heart with a stethoscope reveals a high-pitched, blowing systolic murmur heard directly under the left nipple. The patient has no prior history of a heart murmur. Explain what is causing this new murmur. Cite your reference/s (NOT your textbook)2. Is the cause of the murmur in any way related to the patient’s heart attack? Explain. Cite your reference/s. (NOT your textbook)3. While listening to the patient’s breathing with a stethoscope, you hear some wheezing and inspiratory rales (crackling noises). Explain these findings. Cite your reference/s (NOT your textbook)4. A chest X-ray taken two weeks after the patient collapsed showed markedly enlarged cardiac silhouette and generalized haziness at the bases of the lungs. Explain why the heart is enlarged and lungs “hazy” on chest X-ray. Cite your reference/s5. The patient is stabilized and ultimately discharged from the hospital. Three months after the heart attack, he comes back to his physician for a check-up. 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 the patient is having these symptoms. Cite your reference/s.6. Discuss what other organs were affected by Roger’s illness, and how these organs are interconnected with each other. Cite your reference/s.