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The turbulent flow of blood in the heart and surrounding blood vessels generates additional sounds apart from heart sounds which are referred to as murmurs. These sounds may be described as systolic, diastolic or continuous. The grading of systolic murmurs reveals the extent to which they may be audible. While grade I/VI murmurs may be barely audible even with a stethoscope, grade VI/VI are so loud that they can be heard even without a stethoscope (Chen, Shen, Wang, Choy & Cutler, 2014). The most common type of murmurs in children are the systolic murmurs; which could also occur as holo-systolic or crescendo-decrescendo. The latter result from the sound heard due to the turbulent flow of blood through the aortic and pulmonary valves. For blood to pass through these valves, enough pressure has to be created in the ventricles such that it us higher than the pressure in the aorta or pulmonary artery (Chen et al., 2014). Identification of murmurs is essential because it helps in the identification of heart problems such as leaking of valves. Additionally, it is through heart murmurs that a physician ascertains whether there are other openings through which blood is flowing into the heart or within the heart’s proximity. Murmurs that cause such abnormalities are referred to as pathologic murmurs and should be correctly diagnosed to solve the problem that could be existing in the heart. (Safara, 2015).
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Newborns are at risk of experiencing problems with the heart due to murmurs that result from a structurally abnormal heart. Before they are born, babies have an opening known as the ductus arteriosus between two major blood vessels leading to the heart. Due to this anatomical feature, the fetus’s blood does not need to flow to the lungs for oxygenation. Hence blood circulation to the lungs is skipped. Although it works for the fetus, the opening has to close once the baby is born or a few days after birth so that blood receives oxygen from lungs before circulating to the entire body organs. Therefore a patent ductus arteriosus develops when the ductus arteriosus fails to close after the birth of the fetus. Although PDAs close by themselves over time, treatment is needed when the opening has been open for a long period of time; just as in this case. The aim of the treatment process is usually to ensure that the PDA is closed although it could be left open if the baby is found to be having other problems affecting the heart (Nanyang Technological University, 2014). Medical interventions include the use of indomethacin and ibuprofen with the proper management of adverse effects. A transcatheter device may also be used to direct a small metal coil or any other preferred blocking device to the position where the PDA is located. Resultantly, blood flow through the vessel is blocked without the baby having to go through surgery. However, some reasons such as a small size of the baby and ineffective catheter protocol make surgery a better solution. A surgical procedure is accomplished by making in between the ribs so as to repair the PDA (Nanyang Technological University, 2014).
It is a condition whereby the heart muscles experience oxygen starvation due to the blockage of the vessels that supply the heart with blood. The heart receives a constant supply of blood rich in oxygen through the coronary arteries. As the heart is nourished through this function, it also gets to supply the rest of the body with blood properly. However, some instances such as the occurrence of a coronary heart disease cause these arteries to narrow down hence compromising blood flow (Yahia, 2013). Narrowing is accomplished by the accumulation of fats, calcium, proteins, and inflammatory cells in the lumen of these vessels hence reducing the available area for blood flow. The result of such an occurrence leads to the manifestation of symptoms that have been reported by the patient in the case. For instance, discomfort is experienced in the chest and the region below the breastbone due to accumulating pressure which causes heaviness. Jesse also experiences extreme weakness and fatigue as well as shortness of breath. The patient in the case further experiences shortness of breath while lying on the back due to the aforementioned discomfort. The heartbeats may also be rapid or irregular, and they are rapid for the patient in the case (88). Effect on the GIT leads to symptoms such as heartburn, choking, and nausea. Tests that can be ordered to confirm this differential include an ECG, blood tests to assay for spilled cardiac enzymes, and echocardiography (Yahia, 2013). Immediate drugs will be those preventing the formation of clots, and they include Aspirin, Brilinta, or Plavix. Home treatment will include drugs that will aid in the dilation of blood vessels, prevent life-threatening heart rhythms and pain killers (Yahia, 2013).
Some of the reasons that could cause kidney failure are an elevated blood pressure and diabetes. The patient also presents some of the symptoms that are associated with chronic kidney damage such as nausea, fatigue, and weakness. Jesse is also at risk due to an already elevated blood pressure. The discomfort experienced while lying on the back could also be as a result of chest pain that arises when there is a build-up of fluids around the lining of the heart (Panhwar et al., 2015). A patient suffering from kidney failure also experiences shortness of breath which is caused by a build-up of fluids in the lungs. Additionally, swelling of feet and ankles is a common occurrence for such patients. However, they have an exception of experiencing changes in their frequency of urination which was not reported in the case (Panhwar et al., 2015).
The fact that Jesse reported difficulty in breathing would have led one to the conclusion of asthma which is a condition affecting the airways by making them narrow and swollen. Resultantly, the patient finds it hard to breathe hence triggering wheezing, coughing, and shortness of breath. However, asthma is a long-term inflammatory disease. Its symptoms are recurrent and are triggered by various genetic and environmental factors (Van et al., 2014).
It is a heart condition associated with a sharp pain and discomfort in the chest which victims describe as some sort of pressure or squeezing. It feels like a heavy weight acting on the chest while some victims reveal that it presents as indigestion (Kourlaba et al., 2016). The most common form of angina is stable angina, and it occurs with exertion and slowly fades away as the victim obtains some rest. Stable angina occurs when the heart has to work harder to meet bodily requirements, especially during physical activities hence making it the most lily differential for this case. The pain does not last long since it disappears when rest is achieved (Kourlaba et al., 2016).
The severity of the symptoms depends on the size of the clot that is present in the lungs. However, this diagnosis could have been the most preferred if shortness of breath was reported as a primary symptom. However, other symptoms demonstrated by the victim are also characteristic of PE. They include chest pain, rapid pulse, and bluish skin (Tavoly et al., 2015).
This diagnosis would fit the symptoms of jaundice and abdominal pain. Abdominal pain which occurs in the upper abdominal quadrant presents as the common symptom of gallstones. The patient also experiences fever and a yellowish tint to the skin or eyes just as reported in the case. The pain associated with this condition lasts for up to two hours, and it occurs due to blockage of the movement of bile from the gall bladder by gallstones. However, this process occurs gradually, and it involves three distinct stages (Akhtar, A. J., Akhtar, A. A., & Padda, 2014). Presentation with stroke-like symptoms would not change the differentials although it is a condition closely associated with angina. In both conditions, arteries are blocked. However, in angina, arteries leading to the heart are blocked while those that lead to the brain are blocked in stroke. Also, stroke is associated with paralysis (Akhtar, A. J., Akhtar, A. A., & Padda, 2014).
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