Cardiac Auscultation & Murmurs Flashcards
what side of the stethoscope is used to hear LOW pitched sounds
bell
s3, s4, gallop sounds
what side of the stethoscope is used to hear HIGH pitched sounds
diaphragm
murmurs, lung sounds
what position is best for cardiac auscultation
above and behind the patient while patient is standing
where is the precordium
left apex
PMI - point of maximal intensity - area where the heart beat is the loudest/strongest
where should you listen on a dog
left apical
left basilar
right apical
where should you listen on a cat
left caudal parasternal
right caudal parasternal
left cranial
listen more caudally and sternally than in dogs
what valves are involved in left apical murmurs
mitral
what valves are involved in left basilar murmurs
pulmonic
aortic
what valves are involved in right apical murmurs
tricuspid
what is the S1 heart sound
NORMAL - av valves closing
mitral and tricuspid CLOSE
what is the S2 heart sound
normal - SL valves closing
aortic and pulmonary CLOSE
what is the S3 heart sound
abnormal in SA
passive filling during early diastole
what is the S4 heart sound
abnormal in SA
active filling “atrial kick” in late diastole
diagnostic value of heart murmurs in dogs vs cats
dogs - almost ALL heart disease dogs have a murmur
cats - cats with heart disease may or may not have a murmur
- murmurs VERY common but often physiologic; not a good indicator of heart disease
physiologic murmur
murmurs caused by: bradycardia, anemia, fever, increased sympathetic tone, vasodilation, hyperthyroid, age
young kittens/puppies - > 4-6 months
typically grade II-III
systolic murmurs
murmur occurs between S1 and S2 sounds
“sh sh sh sh sh”
may or may not hear the lub dub sounds
systole: AV valves should be closed, SL valves should be open
diastolic murmurs
murmur occurs between S2 and S1 sounds
“dub shhh dub shhh”
lower pitched grumbling sounds
diastole: AV valves should be open, SL valves should be closed
ddx for left apical systolic murmurs
mitral regurgitation
1. MMVD
2. DCM
3. endocarditis
4. mitral valve dysplasia
ddx for left apical diastolic murmurs
mitral stenosis
ddx for left basilar systolic murmurs
aortic stenosis
pulmonic stenosis
aortic septal defect (ASD)
ddx for left basilar diastolic murmur
SL valve endocarditis
SL valve regurgitation
ddx for right apical systolic murmurs
tricuspid regurgitation
ventricular septal defect (VSD)
ddx for right apical diastolic murmurs
tricuspid stenosis
ddx for continuous murmurs
PDA (patent ductus arteriosus)
grade I murmur
soft
one sided
NOT readily apparent
grade II murmur
soft
one sided
readily apparent
grade III murmur
moderate intensity
one sided
+/- radiates from apex to base
grade IV murmur
very loud
both sides of chest
radiates apex to base
NO palpable thrill
grade V murmur
very loud
both sides of chest
radiates apex to base
HAS palpable thrill
grade VI murmur
murmur is audible without a stethoscope
gallop sounds
low pitched, diastolic extra heart sounds (S3, S4)
better indicator of heart disease in cats than murmurs
S3 gallop sound
early diastole - indicates increased left ventricular end-diastolic pressure
“lub dub thud”
ddx: DCM, heart failure
S4 gallop sound
late diastole - indicates diastolic dysfunction
“bub lub dub”
ddx: concentric ventricular hypertrophy, old age
