Case Study Of Joe Lombardy

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Case Introduction Joe Lombardy is an 82-year old retired carpenter who still does “odd jobs” for friends and neighbors. His wife has pleaded with him to relax, but he ignores her. Despite having chest pains (angina) and periods of confusion, Joe doesn’t trust doctors and has stubbornly refused to have a check-up. Recently, though, after several episodes of syncope (fainting) while he was hauling lumber, Joe grudgingly agreed to see a physician. On physical examination, the physician noted a murmur during systole (described as systolic ejection murmur). An ECG was consistent with left ventricular hypertrophy. His carotid pulse was weak and had a delayed upstroke. The physician ordered a cardiac catheterization, which showed a pressure gradient
In a normal human, the aortic valve contains three cusps which allow blood to quietly and smoothly pump out of the heart. People with congenital birth defects have more or less than three cusps (Mayo Clinic, 2014). As these patients become older, complications can arise due to the combination of structural deformity and calcium up build that occurs with age. The valve loses its ability to open completely because of the calcium which thickens the structure of the valve (Mayo Clinic, 2014). Lastly, the aftermath of rheumatic fever can affect the heart. As the human body attempts to fight off the fever, it indirectly attacks the valves of the heart. The valves become inflexible from the scarring that takes place (Cleveland Clinic,
The heart pumps blood from the left ventricle through the semilunar aortic valve and into the aorta. The narrowed aortic valve causes increased pressure in the left ventricle. Typically, muscles in the ventricles called papillary muscles contract during ventricular contraction, pushing blood through the valves. The left ventricle of a heart having aortic stenosis would have to work harder to pump blood through the narrower valve. The harder the muscles have to work, the thicker they become, explaining why left ventricular hypertrophy occurs in aortic stenosis (Klabunde, 2012, para.

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