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.systems based core clinical specialties > Cardiac Physical Exam > Flashcards

Cardiac Physical Exam Flashcards

1
Q

Valves during systole and diastole

A

Semilunar (aortic and pulm): open @ systole, closed @ diastole
AV (mitral and tricuspid): closed @ systole, open @ diastole

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2
Q

Pressures in the aorta

A

100-140/ 60-90
systole @ the top, diastole @ bottom

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3
Q

Pressures in the right atrium and ventricle

A

RA: 2-8
RV: 15-30/ 2-8

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4
Q

Pressures of the pulmonary artery

A

15-30/ 4-12

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5
Q

Pressures in the left atrium and ventricle

A

LA: 2-10
LV: 100-140/ 3-12

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6
Q

What drives BP?

A

Pressure gradient differences

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7
Q

Physical Exam

A

Most important dx tool:
Observation, retention of fluid, jug venous evaluation, eval of mm, systemic arterial pulse, thoracic auscultation (cardiac and pulm)

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8
Q

Which breeds are predisposed to dilated cardiomyopathy?

A

Great dane
Doberman
Portugese water dog

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9
Q

Which breeds are predisposed to chronic degenerative valve disease?

A

Cavalier King charles spaniel, Daschund

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10
Q

Which breeds are predisposed to tricuspid valve dysplasia?

A

Labs

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11
Q

Which breeds are predisposed to arrhythomogenic right ventricular cardiomyopathy?

A

Boxer

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12
Q

Which breeds are predisposed to patent ducts arteriosis?

A

Poodle

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13
Q

Which breeds are predisposed to subvalvular aortic stenosis?

A

Newfoundland

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14
Q

Which breeds are predisposed to pulmonic stenosis?

A

Beagle

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15
Q

Common CS of cardiac disease in dogs and cats

A

Coughing, dyspnea/ tachypnea, syncope (fainting), cyanosis, lethargy, exercise intolerance**, abdominal distention fluid

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16
Q

Respiratory rate

A

Best initial indicator of left side CHF in dogs

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17
Q

Orthopnea

A

Abnormal physical posture that maximizes intake of oxygen
Animals in sitting or standing position with elbows abducted and neck extended

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18
Q

Coughing

A

Common sign of LCHF in dogs
Heartworm disease, pulmonary hypertension, heart base tumor, collapsing trachea, bronchial compression, pneumonia

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19
Q

Most common reasons dogs cough from cardiac disease

A

Severe left atrial dilation causing compression of the left caudal mainstem bronchus (hacking cough ending with terminal retch)
Pulmonary edema (LCHF)- softer cough

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20
Q

Moderate signs of cardiac heart disease in horses

A

Tachycardia, tachypnea, dyspnea following exercise, abnormal arterial pulses, jugular distension/ pulses, dependent edema (pitting)

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21
Q

Where is dependent edema found in horses?

A

Vetral midline, pectorals, prepuce or distal limbs

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22
Q

Mild signs of cardiac disease in horses

A

No CS
Reduced performance

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23
Q

Abdominal distension (with fluid)

A

Ascites- severe causes push on diaphragm and impeded breathing
Right sided CHF (↑ pressure on the vena cava then to jug)

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24
Q

_______________ is uncommon in dogs and cats and almost always due to RCHF

A

Peripheral edema

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25
Q

Cardiac cachexia

A

Severe WL with adequate food intake
Uncommon complication of end stage cardiac disease
Elevation of resting metabolic rate and circulatory concentration of inflamm cytokines and impairment to intestinal absorption

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26
Q

Signs of severe cardiac disease in horses

A

Coll extremities, WL, reduced capillary refill time, cough, dyspnea @ rest, pulmonary edema (ruptured chordae tendinae) and collapse

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27
Q

Pale mm

A

↓ perfusion from low cardiac output and vasoconstriction

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28
Q

Cyanotic (blue)

A

Desaturated Hb
Dx: respiratory disease, pulm. edema, pleural effusion, R-to-L cardiac shunt, pulm. hypertension

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29
Q

Trachea and thyroid glands (PE)

A

Thyroid slip in cats (abnormal)
Paroxysms of coughing (abnormal)- tracheal collapse, bronchitis, LCHF

30
Q

Jugular veins (PE)

A

Evaluate when standing
Distended or pulsation greater than 1/3 up the neck= elevated right atrial pressure

31
Q

Estimation of right ventricular filling pressures

A

Dog and cat: distension not exceeding point of shoulder
Horse: should not exceed 1/3 distance of neck when head in normal position

32
Q

Cannon a-wave

A

Abnormal jugular pulsation
Large and common with 3 AV block
Severely elevated RV pressures

33
Q

CV-wave

A

Abnormal jugular pulsation
Moderate to severe tricuspid regurgitation

34
Q

T/F: in the horse the carotid pulse can be referred through the jugular vein

A

TRUE

35
Q

Testing for jugular distension in the horse

A

Occlude vein proximally, empty toward heart
Refill: abnormal

36
Q

Jugular vein should be ___________ for distension or pulsation

A

Elevated

37
Q

Jugular pulse and distension in a cow

A

Standing cow, head parallel to the ground
Pulsation shouldn’t be observed beyond the lower 1/3 of the jugular groove

38
Q

Muffled/ dull lung sounds (thorax)

A

Fluid in pleural space
Fluid line auscultated: normal lung above fluid line and dull below fluid line

39
Q

Crackles

A

Short, crepitations made by the opening of small airways collapsed by fluid
Pulmonary edema, bronchitis

40
Q

__________ and _________ may occur secondary to RCHF

A

Hepatomegaly and splenomegaly

41
Q

Systemic Arterial pulse

A

Assessment of left ventricular function
Dog/ cat: femoral or digital artery
Horse and cow: facial or digital artery
Pulse pressure difference: systolic minus diastolic

42
Q

Femoral arterial pulses

A

Unilateral: peripheral disease (aortic thromboembolism-blood clot)
Pulse deficits: Heartbeat auscultated with no assoc pressure (arrhythmia)
Rhythm: reg, irreg or eratic

43
Q

Equine arterial pulse

A

Palpated @ facial, transverse facial, coccygeal, dorsal metatarsal or digital artery

44
Q

Bovine pulse eval

A

Middle coccygeal artery

45
Q

Femoral arterial pulses infleucned by

A

Pulse pressure: diff between systolic and diastolic (larger= strong pulse)
Rate of pressure rise from diastolic to peak systolic pressure

46
Q

Hyperkinetic femoral arterial pulses

A

Stronger than normal
Pulse peaks early in systole →fever, hyperthyroidism sepsis
Large pulse pressure → aortic insufficiency, patent ductus arteriosus

47
Q

Hypokinetic femoral arterial pulses

A

Weaker than normal
Low systolic press with normal diastolic pressure → heart failure and dehydration
Pulse peaks in in late systole → aortic stenosis

48
Q

Caudal (PE)

A

Evaluate posterior mm
Vulva or penis

49
Q

Cardiac sounds

A

Vibrations from blood or other cardiac structures
S1, S2: normal
S3, S4, clicks, snaps and murmurs - abnormal

50
Q

S1 heart sounds (lub)

A

AV valve closure
Marks the beginning of systole
Loud, long and lower than S2
Loudest @ left apex, high frequency

51
Q

S2 heart sounds (dup)

A

Semilunar valve
End of systole
Higher pitched than S1 lub
Loudest @ left base

52
Q

S3 heart sounds

A

Occurs during rapid ventricular filling
Early diastole
Audible with fibrotic, non-complaint, severely dilated ventricle

53
Q

S4 heart sounds

A

Occurs during atrial contraction
Late diastole
Audible when atria force blood into a full, non-complaint, thick walled ventricle

54
Q

Stethoscope

A

Diaphragm: high frequency sounds (S1 and S2)
Bell: low frequency sounds (S3 and S4)

55
Q

Cardiac auscultation

A

Palpate the precodridum (locate the apical beat @ the 5th ICS, L, mitral valve)

56
Q

When is the apical beat in an abnormal locations

A

Thoracic mass
Cardiomegaly

57
Q

Feel a thrill

A

Vibrations felt over the heart
Turbulent blood flow (water flowing through a hose)
Loud murmur

58
Q

Areas of cardiac auscultation for a dog

A

Mitral area: L 5 ICS @ CCJ
Aortic area: L 4 ICS @ CCJ
Pulmonic area: L 2-4 ICS @ left sternal border
Tricuspid area: R 3-5 ICS near CCJ

59
Q

Areas of cardiac auscultation for a cat

A

Auscultate ventrally @ the left and right parasternum
Using light pressure (too much= murmur)

60
Q

Left valve location for a horse

A

Pulmonic: 3rd ICS below point of shoulder
Aortic: 4th ICS @ point of shoulder
Mitral: 5th ICS @ level of olecranon process

61
Q

Right valve location for a horse

A

Tricuspid: 3rd and 4th ICS @ or slightly above olecranon process

62
Q

Bovine auscultation

A

Ventral position on the thorax between 3rd and 6th ribs
Placed cranial in the axilla
heart sounds louder on the left

63
Q

Valve location for a bovine auscultation

A

Pulmonic: 3rd ICS L
Aortic: 4th ICS L
Mitral: 5th ICS L
Tricuspid: 3rd ICS R

64
Q

Abnormal heart sounds in a horse

A

Gallop sounds: S3 or S4 (low frequency)

65
Q

Split heart sounds

A

Split S1, Av valves don’t close synchronously (rare)
Split S2: Semilunar valves don’t close synchronously (most common, pulm. hypertension)

66
Q

Murmurs

A

Murmur only an abnormal PE finding
NOT a dx
Caused by turbulent blood flow (speed and vicosity of blood)

67
Q

3 descriptors required if a mumur is auscultated

A
  1. Intensity*
  2. Timing
  3. Location*
68
Q

Systolic murmurs

A

Holosystolic and panseytolic
Crescendo-decrescendo

68
Q

Heat murmurs

A

1: soft heart sounds
2: softer than normal heart sounds
3: same as heart sounds
4: Louder than heart sounds
5: Very loud, thrill
6: Very loud, thrill, hear without stethoscope

69
Q

Point of maximum intensity (PMI)

A

Dog: left apex and left base
Cat: left and right parasternal

70
Q

Innocent murmur

A

Occurs with no pathology
Common in young animals (puppy murmur)
Disappear by 16 weeks

71
Q

Physiologic murmur

A

Not due to structural heart disease
Secondary to ↑ cardiac output or reduced blood viscosity (anemia, pregnancy, fever, hyperthyroidism)

.systems based core clinical specialties (27 decks)

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