Next, Roger's physician orders a chest X-ray to examine the heart and lungs. Normal Roger Normal The X-ray shows a significant enlargement of the heart (ventricular hypertrophy). 12. Why would Roger's condition lead to ventricular hypertrophy? 13. What is the cause of the haziness, and what does it have to do with Roger's abnormal lung sounds? Rogur's conditon severely compromises his candiac output and his pulmeonary function o bring in damagu annd failure, fver damage, heart aftack and stroke. 14. Explain how poor cardiac output can lead to organ and tissue failure. To examine this abnormality further, his physician orders a Doppler echocardiogram. The results of this test are shown below. Apical four chamber view showing LV (left ventricle), RV (right ventricle), RA (right atrium), LA (left atrium) and AML (anterior mitral leaflet) with a mitral regurgitation (MR) jet into the LA. Valvular insufficiency (prolapse) results when the valve doesn't close tightly. If a valve doesn't close tightly, blood may leak backward (regurgitation). These problems may mean the heart has to work harder to pump the same amount of blood. In addition, blood may back up in the lungs or body because it is not moving efficiently through the heart. 9. How could a myocardial infarction cause mitral valve insufficiency? Roger is stabilized and ultimately discharged from the hospital. Six months aftor the heart attack, he comes back to his physician for a checkup, He complains of shortness af breath at res (dyspnea), difficulty breathing while lying down ("orthopnea"), and swelling of his foet and ankles. Ho says he can While listening to his breathing with a stethoscope, his physician hears some whoozing and inspiratory rates ("crackling noises"). His lungs do not sound clear, but instoud havo a bubbling, crackling sound. Given Roger's history and physical exam, his physician orders a blood test for B-type Natriuretic Peptide (BNP). BNP is a hormone socretod from the ventricles in response to changes in pressure that oCcur when heart failure develops and orsens. The lovel of BNP in the blood increases when heart failure symptoms worsen, and decreases when the heart failure condition is stable. The results of Roger's test is shown bulow Roger's value 2421 pg/ml Normal value BNP levels