Case History- An 11-month old Boy who\'s blue and short of breath Chief Complaint: An 11-month old boy brought to the pediatric clinic with difficulty breathing. History: Austin Green, an 11-month old Caucasian boy was brought by his foster parents to the Pediatric clinic with comnplaint of dyspnea (i.e difficulty breathing) and fatigue. These episodes last for several minutes, occur daily, and happen most copmmonly during exertion (i.e exercise). Austin spent the first 9 months of his life with hisbiological parents, but recent social problems have necessitated that he receive foster care.His foster parents have had him for the past month, and they have note that these \"breathing spells\" have become more frequent and severe over period of time. They also note that Austinb\'s shortness of breath diminishes somewhat if he lies down. Interestingly, he frequently assumes a squatting position during these episodes, and this seems to reduce hsi symptoms as well. His foster parents report that Austin has had no nausea, vomiting, change in appetie, or change in bowel or bladder habits. He is currently on no medications and no known allergies. There is no medical information available about any othefr member of Austin\'s biological family. Lab. test results: Hematocrit 43% normal (37-47%) Hemoglobin 14mg/dl (normal 12-16ml/dl) PH =7.21 (normal range=7.35 to 7.45) [HCO^-3]=18meq/L (normal range=22 to 26 me=Eq/L) 1. The cardiologist ordered X-ray that showed decreased blood flow to the lungs. A follow-up echocardiogram revealed the following abnormalities in Austin\'s heart. (A) a narrowing of pulmonic valve, (B) a thickening of right ventriclewall, (C) a ventricular septal hole allowing direct exchange of blood between the right and the left ventricles, (D) an aorta that was shifted in position so that it was over-riding the right venbtricl, allowing it to recieve blood from both the left and the right ventricle. What is the name of Austin\'s condition? 2. What is specifically causing the heart murmur? 3. Why did the chest X-ray show freduced pulmonary blood flow? 4. Austin has a thickening right ventriclewall. what type of hypertropy is this? Why does Austin have this particular type of ventricular hypertrophy? BE SPECIFIC 5. Why di Austin\'s EGG show a right-shufted ventricular depolarization axis? 6. Which way will blood typically flow through Austin\'s ventricular septal defect(i.e from the left ventricle to the right ventricle, or vice versa? explain your answer in detail 7. Why is Austin cyanotic? BE SPECIFIC 8. Why does supplemental oxygen therapy did not correct Austin\'s cyanosis? BE SPECIFIC 9. How might the squatting position help relieve Auatin\'s dyspnea? 10. Why is Austin\'s... (a) arterial pCO2 higher than normal? (b). arterial [HCO^-3] lower than normal? (c). arterial PH lower than normal? 11. Describe treatments for Austin\'s condition? Solution 1. Cyanosis 2. Murmurs casues: problem with heart valve close and open to let blood flow.

1. Case History- An 11-month old Boy who's blue and short of breath
Chief Complaint: An 11-month old boy brought to the pediatric clinic with difficulty breathing.
History: Austin Green, an 11-month old Caucasian boy was brought by his foster parents to the
Pediatric clinic with comnplaint of dyspnea (i.e difficulty breathing) and fatigue. These episodes
last for several minutes, occur daily, and happen most copmmonly during exertion (i.e exercise).
Austin spent the first 9 months of his life with hisbiological parents, but recent social problems
have necessitated that he receive foster care.His foster parents have had him for the past month,
and they have note that these "breathing spells" have become more frequent and severe over
period of time. They also note that Austinb's shortness of breath diminishes somewhat if he lies
down. Interestingly, he frequently assumes a squatting position during these episodes, and this
seems to reduce hsi symptoms as well. His foster parents report that Austin has had no nausea,
vomiting, change in appetie, or change in bowel or bladder habits. He is currently on no
medications and no known allergies. There is no medical information available about any othefr
member of Austin's biological family.
Lab. test results:
Hematocrit 43% normal (37-47%)
Hemoglobin 14mg/dl (normal 12-16ml/dl)
PH =7.21 (normal range=7.35 to 7.45)
[HCO^-3]=18meq/L (normal range=22 to 26 me=Eq/L)
1. The cardiologist ordered X-ray that showed decreased blood flow to the lungs. A follow-up
echocardiogram revealed the following abnormalities in Austin's heart. (A) a narrowing of
pulmonic valve, (B) a thickening of right ventriclewall, (C) a ventricular septal hole allowing
direct exchange of blood between the right and the left ventricles, (D) an aorta that was shifted in
position so that it was over-riding the right venbtricl, allowing it to recieve blood from both the
left and the right ventricle.
What is the name of Austin's condition?
2. What is specifically causing the heart murmur?
3. Why did the chest X-ray show freduced pulmonary blood flow?
4. Austin has a thickening right ventriclewall. what type of hypertropy is this?
Why does Austin have this particular type of ventricular hypertrophy? BE SPECIFIC
5. Why di Austin's EGG show a right-shufted ventricular depolarization axis?
6. Which way will blood typically flow through Austin's ventricular septal defect(i.e from the
left ventricle to the right ventricle, or vice versa? explain your answer in detail
7. Why is Austin cyanotic? BE SPECIFIC
8. Why does supplemental oxygen therapy did not correct Austin's cyanosis? BE SPECIFIC

2. 9. How might the squatting position help relieve Auatin's dyspnea?
10. Why is Austin's...
(a) arterial pCO2 higher than normal?
(b). arterial [HCO^-3] lower than normal?
(c). arterial PH lower than normal?
11. Describe treatments for Austin's condition?
Solution
1. Cyanosis
2. Murmurs casues: problem with heart valve close and open to let blood flow through the heart
two upper chamber called atria and the two lower chamber ventricle valve
3. Congential heart diseases
4. Right ventricular hypertrophy is form of ventricular hypertrophy affecting right ventricle
5. Right ventricular hypertrophy
6. Ventricular septal defect : it is a hole in the wall separating the two lower chamber of the
heart.
Blood flow : it can travel across the hole left ventricle to the right ventricle ( right pumping
chamber ) and out into the lungs arteries makes heart and lung work harder and the lungs can
become congested.
7. Cyanotic heart dieases refers to group of many different heart defects that are present birth .
They result in low blood oxygen level. or blueness of the skin as form imperfectly oxygenated
blood.
8. oxygen saturation for patients with central cyanosis is usually below 85%. if oxygen saturation
doest not increase to above 95% while patient inhales 100%oxygen.
9. tetrology of fallot.
10.
a) arterial pC02 higher than normal : pulmonary edema
b) arterial HC03 lower than normal : low indicates metabolic condition causing blood to be
acidic
c) arterial PH lower than normal : pulmonary edema
11.surgery