Cardiac Physical Exam Flashcards
Valves during systole and diastole
Semilunar (aortic and pulm): open @ systole, closed @ diastole
AV (mitral and tricuspid): closed @ systole, open @ diastole
Pressures in the aorta
100-140/ 60-90
systole @ the top, diastole @ bottom
Pressures in the right atrium and ventricle
RA: 2-8
RV: 15-30/ 2-8
Pressures of the pulmonary artery
15-30/ 4-12
Pressures in the left atrium and ventricle
LA: 2-10
LV: 100-140/ 3-12
What drives BP?
Pressure gradient differences
Physical Exam
Most important dx tool:
Observation, retention of fluid, jug venous evaluation, eval of mm, systemic arterial pulse, thoracic auscultation (cardiac and pulm)
Which breeds are predisposed to dilated cardiomyopathy?
Great dane
Doberman
Portugese water dog
Which breeds are predisposed to chronic degenerative valve disease?
Cavalier King charles spaniel, Daschund
Which breeds are predisposed to tricuspid valve dysplasia?
Labs
Which breeds are predisposed to arrhythomogenic right ventricular cardiomyopathy?
Boxer
Which breeds are predisposed to patent ducts arteriosis?
Poodle
Which breeds are predisposed to subvalvular aortic stenosis?
Newfoundland
Which breeds are predisposed to pulmonic stenosis?
Beagle
Common CS of cardiac disease in dogs and cats
Coughing, dyspnea/ tachypnea, syncope (fainting), cyanosis, lethargy, exercise intolerance**, abdominal distention fluid
Respiratory rate
Best initial indicator of left side CHF in dogs
Orthopnea
Abnormal physical posture that maximizes intake of oxygen
Animals in sitting or standing position with elbows abducted and neck extended
Coughing
Common sign of LCHF in dogs
Heartworm disease, pulmonary hypertension, heart base tumor, collapsing trachea, bronchial compression, pneumonia
Most common reasons dogs cough from cardiac disease
Severe left atrial dilation causing compression of the left caudal mainstem bronchus (hacking cough ending with terminal retch)
Pulmonary edema (LCHF)- softer cough
Moderate signs of cardiac heart disease in horses
Tachycardia, tachypnea, dyspnea following exercise, abnormal arterial pulses, jugular distension/ pulses, dependent edema (pitting)
Where is dependent edema found in horses?
Vetral midline, pectorals, prepuce or distal limbs
Mild signs of cardiac disease in horses
No CS
Reduced performance
Abdominal distension (with fluid)
Ascites- severe causes push on diaphragm and impeded breathing
Right sided CHF (↑ pressure on the vena cava then to jug)
_______________ is uncommon in dogs and cats and almost always due to RCHF
Peripheral edema
Cardiac cachexia
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
Signs of severe cardiac disease in horses
Coll extremities, WL, reduced capillary refill time, cough, dyspnea @ rest, pulmonary edema (ruptured chordae tendinae) and collapse
Pale mm
↓ perfusion from low cardiac output and vasoconstriction
Cyanotic (blue)
Desaturated Hb
Dx: respiratory disease, pulm. edema, pleural effusion, R-to-L cardiac shunt, pulm. hypertension
Trachea and thyroid glands (PE)
Thyroid slip in cats (abnormal)
Paroxysms of coughing (abnormal)- tracheal collapse, bronchitis, LCHF
Jugular veins (PE)
Evaluate when standing
Distended or pulsation greater than 1/3 up the neck= elevated right atrial pressure
Estimation of right ventricular filling pressures
Dog and cat: distension not exceeding point of shoulder
Horse: should not exceed 1/3 distance of neck when head in normal position
Cannon a-wave
Abnormal jugular pulsation
Large and common with 3 AV block
Severely elevated RV pressures
CV-wave
Abnormal jugular pulsation
Moderate to severe tricuspid regurgitation
T/F: in the horse the carotid pulse can be referred through the jugular vein
TRUE
Testing for jugular distension in the horse
Occlude vein proximally, empty toward heart
Refill: abnormal
Jugular vein should be ___________ for distension or pulsation
Elevated
Jugular pulse and distension in a cow
Standing cow, head parallel to the ground
Pulsation shouldn’t be observed beyond the lower 1/3 of the jugular groove
Muffled/ dull lung sounds (thorax)
Fluid in pleural space
Fluid line auscultated: normal lung above fluid line and dull below fluid line
Crackles
Short, crepitations made by the opening of small airways collapsed by fluid
Pulmonary edema, bronchitis
__________ and _________ may occur secondary to RCHF
Hepatomegaly and splenomegaly
Systemic Arterial pulse
Assessment of left ventricular function
Dog/ cat: femoral or digital artery
Horse and cow: facial or digital artery
Pulse pressure difference: systolic minus diastolic
Femoral arterial pulses
Unilateral: peripheral disease (aortic thromboembolism-blood clot)
Pulse deficits: Heartbeat auscultated with no assoc pressure (arrhythmia)
Rhythm: reg, irreg or eratic
Equine arterial pulse
Palpated @ facial, transverse facial, coccygeal, dorsal metatarsal or digital artery
Bovine pulse eval
Middle coccygeal artery
Femoral arterial pulses infleucned by
Pulse pressure: diff between systolic and diastolic (larger= strong pulse)
Rate of pressure rise from diastolic to peak systolic pressure
Hyperkinetic femoral arterial pulses
Stronger than normal
Pulse peaks early in systole →fever, hyperthyroidism sepsis
Large pulse pressure → aortic insufficiency, patent ductus arteriosus
Hypokinetic femoral arterial pulses
Weaker than normal
Low systolic press with normal diastolic pressure → heart failure and dehydration
Pulse peaks in in late systole → aortic stenosis
Caudal (PE)
Evaluate posterior mm
Vulva or penis
Cardiac sounds
Vibrations from blood or other cardiac structures
S1, S2: normal
S3, S4, clicks, snaps and murmurs - abnormal
S1 heart sounds (lub)
AV valve closure
Marks the beginning of systole
Loud, long and lower than S2
Loudest @ left apex, high frequency
S2 heart sounds (dup)
Semilunar valve
End of systole
Higher pitched than S1 lub
Loudest @ left base
S3 heart sounds
Occurs during rapid ventricular filling
Early diastole
Audible with fibrotic, non-complaint, severely dilated ventricle
S4 heart sounds
Occurs during atrial contraction
Late diastole
Audible when atria force blood into a full, non-complaint, thick walled ventricle
Stethoscope
Diaphragm: high frequency sounds (S1 and S2)
Bell: low frequency sounds (S3 and S4)
Cardiac auscultation
Palpate the precodridum (locate the apical beat @ the 5th ICS, L, mitral valve)
When is the apical beat in an abnormal locations
Thoracic mass
Cardiomegaly
Feel a thrill
Vibrations felt over the heart
Turbulent blood flow (water flowing through a hose)
Loud murmur
Areas of cardiac auscultation for a dog
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
Areas of cardiac auscultation for a cat
Auscultate ventrally @ the left and right parasternum
Using light pressure (too much= murmur)
Left valve location for a horse
Pulmonic: 3rd ICS below point of shoulder
Aortic: 4th ICS @ point of shoulder
Mitral: 5th ICS @ level of olecranon process
Right valve location for a horse
Tricuspid: 3rd and 4th ICS @ or slightly above olecranon process
Bovine auscultation
Ventral position on the thorax between 3rd and 6th ribs
Placed cranial in the axilla
heart sounds louder on the left
Valve location for a bovine auscultation
Pulmonic: 3rd ICS L
Aortic: 4th ICS L
Mitral: 5th ICS L
Tricuspid: 3rd ICS R
Abnormal heart sounds in a horse
Gallop sounds: S3 or S4 (low frequency)
Split heart sounds
Split S1, Av valves don’t close synchronously (rare)
Split S2: Semilunar valves don’t close synchronously (most common, pulm. hypertension)
Murmurs
Murmur only an abnormal PE finding
NOT a dx
Caused by turbulent blood flow (speed and vicosity of blood)
3 descriptors required if a mumur is auscultated
- Intensity*
- Timing
- Location*
Systolic murmurs
Holosystolic and panseytolic
Crescendo-decrescendo
Heat murmurs
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
Point of maximum intensity (PMI)
Dog: left apex and left base
Cat: left and right parasternal
Innocent murmur
Occurs with no pathology
Common in young animals (puppy murmur)
Disappear by 16 weeks
Physiologic murmur
Not due to structural heart disease
Secondary to ↑ cardiac output or reduced blood viscosity (anemia, pregnancy, fever, hyperthyroidism)
