Cardiac exam & Heart failure/Cardiovascular Conditions Flashcards
What is the normal aortic BP
Systolic 120 Diastolic 80 written 120/80
What maintains aortic BP during diastole
Elastic muscle fibers stretch reflex
What creates the BP during systole
The contraction of the LV
What activates the SNS to maintain BP
baroreceptors
What is the Frank Starling relationship
increase in stretch (preload) = increase in force of contraction of muscle fibers
What is RAAS
Renin-angiotensin-aldosterone system
What is RAAS responsible for
Angiotensin II causes veno/arterioconstiction Aldosterone increases Na retention which leads to H2O retention which increases circulatory volume
What effect does the SNS have on CV system
veno/arterioconstriction +ve inotropy & chronotropy
How does the heart compensate for and increase in preload
hypertrophy
What is heart failure
Cardiac output is insufficient to meet body needs
When does heart failure occur
When heart disease is severe
What are the 2 major problems that are caused by heart disease
Volume overload Pressure overload
How does the heart compensate for a volume overload
eccentric hypertrophy enlargement of the ventricular volume (capacity)
Give an example of a condition that causes volume overload
myxomatous AV valve dz (endocardiosis)
What is the sequelae of eccentric hypertophy
there is a systolic emptying problem which leads to an increased afterload. Not all the blood leaves the ventricles after contraction
If an animal has an aortic/pulmonic (talking about the valves here) stenosis what type of overload would be caused
pressure overload
what type of hypertrophy would you see as a result of pressure overload in the ventricles
concentric hypertrophy
What are the sequelae of concentric hypertrophy
there is a diastolic filling problem which leads to an increased preload. Not enough space for the normal amount of blood that should fill the ventricles
In either case of hypertrophy how does the body try to maintain CO what changes in each type of hypertrophy
CO = SV * HR eccentric hypertrophy the stroke volume increases more concentric hypertrophy the heart rate increases more
What are the cardiac related CS of LCHF why
Left-sided congestive heart failure: hypotension pale mm incr. CRT incr. rate decr. pulses weakness syncope azotemia The left side pumps oxygenated blood to the body via the aorta. in failure (loss of effective pump) no blood is circulation which creates a relative hypovolemia that the body tries to compensate for.
Why is azotemia seen in LCHF
Because there is decr volume of blood flowing to kidneys therefore buildup of waste products
What are the pulmonary related CS of LCHF why
lung edema dyspnea coughing orthopnea tachypnea ex. intolerance cyanosis If there is a backup of blood in the LV there will be backup into the LA which will cause backup into lungs via pulmonary veins leading to fluid accumulation and decr in oxygen exchange
What are the CS of RCHF why
Ascites hepato-splenomegaly pleural effusion distension of veins hypotension If there is a backup of blood in the RV there will be backup into RA which will cause blood to remain in “great veins” beyond even their enormous reserve capability.
what is the hypotension in RCHF related to
The relative loss of circulating blood volume due to sequestration in extravascular compartment in addition to lack of an effective pump
which is more commonly seen in animals R or L CHF
Left
What are the clinical stages of heart failure
I - dz but NO CS II - CS w/normal to strenuous exercise III - CS w/ any activity IV - at rest
What stage of HF has dz but no CS
One
What stage of HF has CS with normal to strenuous exercise
Two
What stage of HF has CS with any activity
Three
What stage of HF has CS at rest
Four
How do you do a CV system exam
TPR MM Thoracic palpation Auscultation
what are the changes you might see in TPR if HF is present Why
decr. T incr. RR decr. P less circ bv will decr. T less oxygen in blood, body will try to get more pulses are difference between systolic & diastolic pressures if the pump is ineffective then less difference will be felt.
why are MM pale
decr circ BV
Why do you palpate the thorax
to locate the apical beat for good auscultation
what are you listening to when you auscultate
you listen for normal or abnormal sounds
http: //multimedia.3m.com/mws/media/346089O/heart-and-lung-sounds-soundfile.wav?fn=Normal%20Split%20S1.wav
http: //multimedia.3m.com/mws/media/346098O/heart-and-lung-sounds-soundfile.wav?fn=Early%20Systolic%20Murmur.wav
what happens if you hear abnormal heart sounds
you send for cardiac ultrasound!
What are normal heart sounds
Lub-Dub
What are some types of abnormal heart sounds
gallops
clicks
murmurs
what are gallops sounds
S3 & S4
which are normal in LA but abn in SA
what are clicks
when the valves are slow to close due to chordae tendinae being stretched so you hear it as a separate sound
Lub-click-Dub
What causes murmurs
murmurs are the sounds of turbulent blood flow due to narrowing of a vessel, valvular insufficiency, incr. blood flow or decr. blood viscosity
What are things you’d use to describe a murmur
where is occurs in cardiac cycle: systolic or diastolic
where it is loudest: apex or base
intensity on a scale of 1 to 6 with 6 being most severe grade of murmur
what use are radiographs with HF
Really good at seeing lung status in CHF
Size & shape of pulmonary vessels
evidence of pleural edema
somewhat good at determining whether heart is enlarged esp for DCM and where
What is the best modality to evaluate HF
Echocardiogram!
Where does blood flowing into left atrium (LA) come from?
the lungs
specifically the pulmonary veins
Blood flows into atria during _________ which is the _______ phase of cardiac cycle?
diastole, resting
Blood flows from LA to left ventricle (LV) through the ______ or ____ ________________ _____ during which phase?
mitral (human term), left atrioventricular valve
diastolye
What is the mechanical means to cause the blood flow into the heart during diastole?
negative pressure created during inspiration
At end of passive filling phase the atria contract which results in?
last little bit of blood squeezed into LV to ↑ volume to allow for ↑ contraction due to Frank-Starling relationship
Why doesn’t blood flow backwards into LA when LV contracts?
Due to closure of LAV valve
Why doesn’t LAV valve prolapse back into atrium during ventricular contraction?
Chordae tendinae holding it in place.
what is another name for myxomatous AV valve dz?
endocardiosis
what type of overload does endocardiosis lead to?
what part of cardiac cycle problem? afterload or preload?
what type of hypertrophy?
volume overload
systolic emptying problem (↑ afterload)
eccentric hypertrophy
what type of overload does aortic/pulmonic stenosis lead to?
what part of cardiac cycle problem? afterload or preload?
what type of hypertrophy?
pressure overload
diastolic filling problem (↑ preload)
concentric hypertrophy
CS of LCHF
Front side vs back side
Front side = signs as a direct result of heart failure
hypotension
syncope
ex intolerance
mm: pale, cyanotic
CRT ↑
↑ HR
↓ pulses
weakness
azotemia
Back side = signs due to consequences of direct CS of heart failure
lung edema
dyspnea
coughing
orthophnea
tachypnea
ex intolerance
cyanosis
CS of RCHF
Front side vs back side much less common than LCHF
Front side:
Syncope
weakness
ex. intolerance
azotemia
Back side:
ascites
hepato-plenomegaly
pleural effusion
distension of veins
hypotension
Which spp coughs more with CHF dogs or cats?
dogs
Clinical stages of heart failure
1: dz but no CS 2: CS w/ normal or strenuous exercise 3: CS w/ any activity 4: CS at rest
What changes in TPR may be seen w/ pt w/ CHF
T: may be ↓ d/t ↓perfusion R: RR may be ↑ d/t hypoxia P: rate ↑, rhythym reg or irreg, quality ±↓
what are MM supposed to be?
pink, moist
ddx of pale MM
anemia shock heart failure
ddx of cyanotic mm
heart failure R→L shunts
ddx of bright red mm
sepsis R→L shunts erythrocytosis
ddx of yellow mm
liver problem pernicious anemia
what is felt on thoracic palpation
apical beat -mitral valve if displaced caudally from right behind elbow think ddx of what can displace heart caudally
what is normally heard on thoracic auscultation?
What do the sounds represent?
normal heart sounds -LubDub Lub=closure of AV valves, start of systole Dub=closure of aortic/pulmonic valves, start of diastole
What are the abnormal sounds that can be heard on auscultation
gallops = S3 +S4 sounds (normal in LA abn in SA) -S3= filling of ventricles (lubdubdub) -S4= contraction of atria (dublubdub) clicks= mitral valve dz (lubclickdub) murmurs= turbulance of blood flow, ↑ blood flow (hyperthyroidism), ↓viscosity (anemia)
How to describe murmurs
functional (physiological) vs pathological
timing in cardiac cycle -systolic vs diastolic pansystolic vs holosystolic -lubwooshdub = holosystolic -wooshwooshwoosh = pansystolic continuous aka washing machine Location & radiation of murmur -base vs apex Intensity of murmur -grade 1-6
what dz has characteristic washing machine murmur PDA
grades of murmur intensity
Grade 1: very soft, over sm area Grade 2: Grade 3: Grade 6: very loud, off the chest wall, over the entire thorax, palpable thrill
