9. cardiovascular auscultation

Question 1

Methods of cardiovascular

examination: (physical examination)

Answer 1

• Inspection (heart, vessels)
• Palpation (heart, vessels)
• Percussion (heart)
• Auscultation (heart)

Question 2

What instruments are used for the cardiovascular auscultation:

Answer 2

Plessimeter and stethoscope (fonendoskop)

Question 3

Normal heart sounds:

Answer 3

1. 2. 3. 4. heart sounds

Question 4

Alterations of the cardiac sounds: FRIDA

Answer 4

Frequency, Rhythm, Intensity, Demarcation, Adventitious sounds

Question 5

Pulse deficit: Physiological or pathological?

Answer 5

Always pathological

Question 6

Examination of pulse deficit:

Answer 6

Simultaneous auscultation and palpating the pulse.

Question 7

Explain arrhytmia:

Answer 7

pathological rhythm, often with pulse deficit

Question 8

Is respiratory arrhytmia slower or faster during expiration?

Answer 8

Slower: vagus effect

Question 9

Normal intensity of the cardiac sound:

Answer 9

normally strong and even (uniform strength)

Question 10

Explain pounding heart beat:

Answer 10

increasing of the first and/or second sound (slight variation over different valve areas)

Question 11

Explain reduced heart sounds:

Answer 11

decreased cardiac output,
pericardial or +/- pleural effusion,
obesity

Question 12

What is demarcation?

Answer 12

distinctness of the cardiac sounds

Question 13

what can be heard in cardiomyopathies?

Answer 13

galopp sounds: three

heart sounds can be heard: 1.,2.,3. or 4.,1.,2

Question 14

what can splitting of the 2. heart sound be caused by?

Answer 14

closure of the aortic and pulmonal valves in different time,
due to cor pulmonale causing increased pulmonary arterial pressure.

Question 15

Additional or adventitious sounds of the heart:

Answer 15

murmur

Question 16

The 4 allways of endocardial murmur

Answer 16

location,
intensity,
relation to cardiac cycle,
pitch

Question 17

What is endocardial murmur caused by?

Answer 17

Turbulence

Question 18

Types of extracardial murmur:

Answer 18

pericardial or pleuropericardial/ pleuropleural

Question 19

what are the morphological causes of the endocardial murmurs?

Answer 19

Morphological : valve deformities, septal or vessel malformations

Question 20

what are the functional causes of the endocardial murmurs?

Answer 20

Functional: innocent murmurs, anemia: decreased blood viscosity

Question 21

What type of murmur can be heard when the extracardial murmur is due to inflammation?

Answer 21

-pericardial splashing, (frictional) rubbing, pleuropericardial/ pleuropleural rubbing.

Question 22

What type of tests can be done when the extracardial murmur is due to inflammation?

Answer 22

Valsalva probe or compression test:

Pleuropericardial/ pleuropleural rubbing disappears if breathing stopped.

Pericardial rubbing increases if breathing stopped at the end of inspiration (increased intrathoracic pressure)

Question 23

Classification of endocardial murmur:

Answer 23

• Localization
• Intensity
• Timing
• Frequency (pitch)
• Character (= quality, shape)
• Conduction

Question 24

How do we localize a murmur?

Answer 24

Find points of maximal intensity (punctum maximum, puncta
maxima):
Determination of intercostal spaces in medium and large size animals.
Heart base vs. apex assignement in small size animals

Question 25

Explain timing of a murmur?

Answer 25

Relation to the phase of the cardiac cycle:

systolic/diastolic/systolic and diastolic

Question 26

How do we classify the frequency (pitch)

Answer 26

low, medium, high

Question 27

Examples of pitches:

Answer 27

blowing, whistling, crackling, rough, musical murmurs

Question 28

How do we describe the character of a murmur?

Answer 28

continuous, < crescendo, > decrescendo, <> crescendo-decrescendo