Approach To Diagnosis And PE Flashcards
How can age affect CV disease?
Congenital diseases in young
Some acquired diseases in aged animals
How is gender linked to CV disease?
Give examples
Some cardiac diseases have sec predilection
- PDA in bitches
- Males have earlier onset with MVD and DCM
What breeds are susceptible to MVD?
Small breed dogs particularly CKCS
Why don’t all patients with heart disease go on to develop heart failure?
If its a slow progressive disease they might die of something else first
What common historical complaints are associated with heart failure?
Dyspnoea Cough Exercise intolerance Lethargy Ascites Oedema Syncope Collapse Weight Loss
In which animals is exercise tolerance easier to detect?
Performance animals e.g. race horses
What can signs of cardiac disease be confused with?
Respiratory problems
Neurological
Musculoskeletal
Metabolic
What are the key elements of a CV physical examination?
Observation
Palpation
Percussion (not often done)
Auscultation
What should you observe?
Demeanour Respiratory effort and rate Mucous membranes BCS Venous congestion Ascites
What is a benefit of assessing genital mucous membranes?
Look for differential cyanosis
- cyanosis of the back half of the animal, not the front
What does cyanosis indicate about the circulation?
Adequate delivery of Hb, by Hb not oxygenated
How do the colours of the oral mms and conjunctiva usually compare?
Oral often paler than conjunctiva
What can capillary refill time be used to assess?
What is the most reliable site?
Tissue perfusion
Normally less than three seconds
Oral gum/tooth junction
Why might an animal with individual ribs and vertebral spinous processes showing have a prominent abdomen ?
ASCITES due to accumulation of fluid in systemic venous circulation
What vessels can be used to indirectly assess right atrial pressure?
Jugular vein
What are the principle problems of major blood vessels in horses?
Thrombosis and thrombophlebitis
What clinical signs are associated with thrombophlebitis?
Distension Focal swelling Latency Heat Pain
Why are venous problems common in horses in a veterinary setting?
Catheterisation of veins can result in formation of blood clots which occlude the vein (thrombosis) or cause inflammation (thrombophlebitis)
What is cranial caval syndrome?
Something occluding the cranial vena cava causes all veins rostral to the CVC to become distended resulting in oedema of the head, neck and forelimbs
Abroad, what parasite may be associated with RCHF?
Dirofilaria
What should you do before you auscultate?
Palpate the thorax
What should you palpate?
precordium and abdomen
What should you palpate in the precordium?
Apex beat Location Intensity Rate and rhythm Presence of thrill
What is meant by the term ‘thrill’ ?
What causes it?
Vibration through the thoracic wall
Vibration of the heart and associated structures due to the very turbulent blood flow through the circulation
Why would you palpate the abdomen when doing a CV physical exam?
To check for ascites and concurrent disease
What is respiratory sinus arrhythmia?
What animal is it normally seen in?
Speeding and slowing of the heart associated with breathing.
Dogs = normal
What is pulse deficit?
When an audible contraction is not associated with a palpable pulse
What is the difference between a regularly irregular or irregularly irregular pulse?
Regular - e.g. sinus arrhythmia in dogs
Irregular - not normally observed in a species
What artery is found under the tail of cattle?
Coccygeal artery
What are the four main pulse points in a horse?
External maxillary / facial a
Transverse facial a
Median a
Digital a
What is the ideal position to auscultate a dog?
Why?
Ideally standing to ensure the heart is in the normal position in the thorax
What is the left apex?
The area where we hear the mitral valve
How can you identify which sounds are from the mitral valve?
When you palpate the heart, the left apex is what you’ll feel.
These sounds are most likely due to the mitral valve
What causes S1?
How loud is it compared to S2?
Where is it most audible?
Closure of the AV valves
Usually loudest
Most audible on the left
What can you hear on the right side of the heart?
Tricuspid
As the aorta is in the centre, you might also hear these sounds too
What causes S2?
Where is it most audible
Closure of the outflow valves
Most audible cranially
When would you expect to hear S3 and S4?
Larger animals, e.g horses
If in dogs and cats = GALLOP SOUND
What valves are murmurs heard in the left heart base associated with?
Pulmonic and aortic valve
What valves are murmurs heard in the left heart apex associated with?
Mitral valve
What valves are murmurs heard on the right associated with?
What else could be identified?
Tricuspid
VSD loudest on right
Where are murmurs most audible in cats?
Sternum
What is the point of maximal intensity?
Loudest point of murmur
Typically heard over the valve associated with the generation of that murmur
When might you hear murmurs in other areas of the thorax ?
Very loud murmurs may radiate so that they are audible elsewhere on the thorax
E.g. loud mitral murmurs can be heard dorsal or on the right side. (PMA should still be over the mitral valve)
What can cause heart murmurs in cats?
Can be valvular
Can be caused by dynamic obstruction of left or right outflow tract
Instead of localising a particular valve, how should auscultation of murmur in cats be approached?
Why?
Does it have a murmur?
Is it loudest on left or right?
How audible is it?
Cats have small hearts
How can you describe a murmur?
Timing/Duration
Location
Intensity (at PMA) / Audibility
(Also, radiation, pitch, shape)
What is the most common type of murmur in small animals?
Systolic
What are the AV valves doing during systole?
CLOSED
What kind of murmur is associated with PDA ?
Why?
Continuous murmur - present in systole and diastole
Aortic pressure is greater than that in the pulmonary artery in both.
What could cause a systolic murmur?
Mitral/ tricuspid insufficiency
Aortic and pulmonic stenosis
Ventricular septal defect (LV pressure > RV)
What could cause a diastolic murmur
Mitral/tricuspid stenosis
A+P insufficiency
PDA
What is the main diastolic murmur in horses?
Aortic insufficiency
Describe a Grade I murmur
Barely audible in ideal conditions (i.e. animal not wriggling, owner not talking)
Describe a Grade II murmur
Clearly audible at PMI, does not radiate (not as loud as S1 or S2)
Describe a Grade III murmur
Clearly audible, as loud as S1 and S2
May radiate
Describe a Grade IV murmur
Louder than S1 and S2
Usually can only hear murmur
Describe a Grade V murmur
Precordial thrill palpable
Describe a Grade VI murmur
Audible with stethoscope off thorax
Where do aortic murmurs tend to radiate?
Up the carotid arteries
Where do mitral murmurs tend to radiate?
Dorsally
What is meant by the term ‘pitch’ in reference to murmurs ?
Subjective description of the frequency of the audible sound associated with a murmur
What is meant by the term ‘shape’ in reference to murmurs?
Description of the appearance on phonocardiogram
Crescendo-decrescendo - diamond shaped
Pansystolic - plateau
How might you interpret grade I/II / 6 systolic murmurs in a horse?
Why?
Non-pathological flow murmur
Become more common as they get fitter
Large ejection into aorta or slight dilation due to physiological hypertrophy
What are S3 and S4 a result of?
S3 - End of ventricular relaxation/passive filling
S4 - Atrial contraction
What is a gallop sound?
Additional heart sound that is NOT a murmur
Audible in diastole
S3 or S4 audible
What might a gallop sound indicate?
Poor diastolic relaxation of the ventricle
What do crackles indicate?
PULMONARY OEDEMA
Indicate alveoli and small airways snapping open at the end of inspiration
Can also occur with respiratory disease e.g. PNEUMONIA, PULMONARY FIBROSIS
