Approach to Diagnosis and Physical Exam Flashcards
What is the typical approach to a cardiac patient?
Signalment, history, clinical exam, definiteion of primary problem, refinement of clinical problem, likely ddx, diagnostics test, and definitive diagnosis
Why might age be relevant to a cardiac workup?
Young animals are more often to have continental disease whereas older are more likely to have acquired disease.
Why might breed be relevant to a cardiac workup?
Breed can influence what differentials might be on the list e.g. larger dogs are more likely to have myocardial disease where as smaller dogs are more likely to have primary valvular disease. Larger horses are more likely to have atrial fibrillation and pony more likely to have septal defects
Why might sex be relevant in a cardiac work up?
PDAs more common in females
DCM more common and occurs earlier in males
What are the typical historical complaints associated with cardiac disease?
Dyspnoea Cough Exercise intolerance Lethargy Ascites Peripheral oedema Syncope Collapse
What are you looking for on clinical exam when confronted with a cardiac case?
1) MMs and colour - pallor can be poor peripheral circulation due to low volume or reduced PCV. Blue implied inadequate oxygenation
2) Ascites
3) Dyspneoa
4) Tachypnoea
5) BCS
6) Pulse rate, rhythm and character
7) Percussion
8) Auscultation
What are the normal heart sounds and what do they correspond to?
S1 - Closure of the AV valves
S2 - Closure of the pulmonic and aortic values
S3 - Passive ventricular filling
S4 - Active atrial contraction
When listening to a heart murmur what things should you consider?
When Timing Intensity Location Radiation Pitch Shape
What does a heart murmur indicate?
Presence of turbulent flow within an area of the heart due to disturbance to the normal laminar flow of blood within the heart and surrounding vessels.
When is a heart murmur likely to occur?
Increased velocity of blood flow
Increased volume of blood flow
A reduction in blood viscosity
Regurgitation of blood
When are the majority of murmurs heard in small animals?
Systolic phase of the cycle (Between S1 and S2)
What is one of the more common causes of a murmur in the ageing horse?
Aortic regurgitation giving rise to a diastolic murmur
What disease are you likely to hear a systolic murmur with?
Mitral and tricuspid insuffiency
Aortic and pulmonic stenosis
PDA
VSD
What disorders are you more likely to hear a diastolic murmur with?
Mitral and tricuspid stenosis
Aortic and pulmonic insufficiency
PDA
No flow through VSD
Describe the grading system of heart murmurs
I. Audible after a long time listening in perfect conditions
II. Clearly audible but quieter than the heart sounds
III. Audible and as loud as the heart sounds
IV. Louder than the heart sounds
V. Louder than the heart sounds and palpable thrille
VI. Audible with stethoscope lifted off the chest
