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Small Animal Medicine > Cardio - Exam > Flashcards

Cardio - Exam Flashcards

1
Q

What are 3 general pieces of info to gather for a cardio exam?

A

Signalment, presenting complaint, and history

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2
Q

What things are included in the signalment?

A

Species, breed, and age-specific diseases

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3
Q

What things are included in the presenting complaint?

A

Murmur, collapse or exercise intolerance, respiratory signs

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4
Q

What are some things that are included in the history?

A
  • Onset, duration, progression of presenting complaint
  • Changes in weight, appetite, thirst, urination/defecation, vomiting
  • Coughing/sneezing/respiratory effort/gagging (frequency, character)
  • Activity level and any recent changes in activity or endurance, fainting spells, weakness, collapse
  • Travel and vaccine history and any concurrent medical conditions
  • Diet and meds and supplements (drug, dosage, route, response)
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5
Q

What is cachexia?

A

Disproportionate loss in muscle mass that is commonly seen in inflammatory conditions

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6
Q

What are DDx for cachexia?

A

End stage CV disease, neoplasia, renal disease, chronic inflammatory conditions

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7
Q

What are DDx for abdominal distension?

A

Abdominal fluid (R-CHF), organomegaly, weakened abdominal muscles

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8
Q

What is a fluid wave?

A

Vibration of fluid palpated on ballotment of moderate to severe abdominal fluid

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9
Q

What are DDx for a fluid wave?

A

R-CHF (modified transudate), liver dz, PLE/PLN (transudate), neoplasia (mod transudate), trauma, bleeding mass, coagulopathies (hemorrhagic)

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10
Q

What color are normal mucous membranes?

A

pink

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11
Q

What are DDx for pale MM?

A

Poor perfusion​, peripheral vasoconstriction, anemia

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12
Q

What are DDx for blue/gray (cyanotic) MM?

A

R to L shunting, pulmonary parenchymal disease (i.e. pulm edema from L-CHF), airway disease, hypoventilation, shock

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13
Q

What is the appearance of “differential cyanosis” and what does it mean?

A

Pink MM cranially and blue MM caudally - finding in dogs with R to L shunting PDA (reverse PDA)

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14
Q

What is the Dx for brick red or “injected” MM?

A

early phases of shock

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15
Q

What are the DDx for yellow (icteric) MM?

A

hemolysis, hepatobiliary disease

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16
Q

What is a CRT of 0-1 seconds?

A

Early, hyperdynamic phase of shock

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17
Q

What is a CRT of 2 seconds?

A

normal

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18
Q

What is a CRT of 3+ seconds?

A

poor perfusion

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19
Q

What is peripheral pitting edema?

A

Edema (fluid in the tissues) in the ventral extremities or ventral thorax/abdomen

(When you push your thumb into edematous areas it leaves an imprint)

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20
Q

What are DDx for peripheral pitting edema?

A

R-CHF (uncommon); more common in horses and cattle

Non-cardiac = hypoalbuminemia, renal disease (rare)

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21
Q

What is palpation of the precordium?

A

Palpating the heartbeat on the chest wall

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22
Q

Where is the precordium normally felt the strongest?

A

L hemithorax

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23
Q

What does it mean if the precordium is felt strongest on the right?

A

R heart enlargement

(Can also be mass lesions displacing the heart, collapsed lung lobes that displace the heart, or focal accumulations or air or fluid)

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24
Q

What does it mean if the precordium is the same strength on the L as it is on the R?

A

R and L heart enlargement

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25
Q

What does it mean if the precordium has decreased intensity?

A

Weak cardiac contractions, pericardial or pleural effusion

(Can also be due to obesity, thoracic masses, or pneumothorax)

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26
Q

What is a precordial thrill?

A

Palpable fine vibrations of a murmur on the chest wall;

May be palpated in patients with very loud murmurs (grade V or VI)

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27
Q

What are the 2 parts of the end of the stethoscope?

A

Bell and diaphragm

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28
Q

What is the bell for?

A

Best for listening to low frequency sounds (heart sounds and gallops)

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29
Q

What is the diaphragm best used for?

A

Listening to high frequency sounds (murmurs and clicks)

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30
Q

What are transient heart sounds?

A

Short sounds that may be caused by normally auscultated heart sounds (S1, S2), gallops (S3, S4), or abnormal valve movement (mid-systolic clicks).

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31
Q

What are the systolic sounds?

A

S1 and S2, mid-systolic click

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32
Q

What causes S1?

A

Closure of the mitral and tricuspid valves - abrupt deceleration of blood flow resulting in vibrations of the cardiac walls and blood

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33
Q

What does S1 sound like compared to S2?

A

S1 is longer and lower pitched

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34
Q

Where is S1 best heard?

A

Over the mitral valve

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35
Q

What causes S2?

A

Closure of aortic and pulmonic valves

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36
Q

Where is S2 best heard?

A

Over the aortic area

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37
Q

What is a mid-systolic click due to?

A

Prolapse of the mitral or tricuspid valve

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38
Q

Where is a mid-systolic click best heard?

A

Over the mitral or tricuspid valve

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39
Q

What is a split S1?

A

Asynchronous closure of the mitral and tricuspid valves due to abnormal conduction (R bundle branch block, VPCs), or can sometimes be normal in very large dogs

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40
Q

What is a split S2?

A

Can occur due to asynchronous closure of the pulmonic and aortic valves (pulm hypertension, arrhythmias, bundle branch blocks).

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41
Q

What condition are systolic clicks most commonly heard with and what valve is affected?

A

Early DMVD (before overt regurgitation); occasionally affects the tricuspid valve

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42
Q

What are the diastolic sounds?

A

S3 and S4

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43
Q

What causes S3?

A

Vibrations in the heart wall associated with rapid ventricular filling; can be normal in LA

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44
Q

What causes S4?

A

Atrial contraction; is also normal in LA

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45
Q

When can an S3 gallop be heard in dogs and cats?

A

When the ventricles are very dilated (i.e. DCM)

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46
Q

When is an S4 gallop heard in dogs and cats?

A

With thickened, stiff, ventricles (i.e. HCM); heard during contraction or dilated atria

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47
Q

What is a murmur?

A

Prolonged, audible vibration of blood in the heart or great vessels that can be associated with turbulent blood flow or abnormal blood flow.

48
Q

What is a grade I/VI murmur?

A

Soft murmur heard in only 1 valve location, only in very quiet room; may be intermittent

49
Q

In how many quadrants can you hear a grade I/VI murmur?

A

1

50
Q

What is a grade II/VI murmur?

A

Soft murmur heard consistently, but only in 1 valve area

51
Q

In how many quadrants can you hear a grade II/VI murmur?

A

2

52
Q

What is a grade III/VI murmur?

A

Moderate murmur heard in multiple valve locations on one side of the chest

53
Q

In how many quadrants can you hear a grade III/VI murmur?

A

3

54
Q

What is a grade IV/VI murmur?

A

Loud murmur heard on both sides of the chest

55
Q

In how many quadrants can you hear a grade IV/VI murmur?

A

4

56
Q

What is a grade V/VI murmur?

A

Loud murmur heard at all valve locations, associated with precordial thrill

57
Q

In how many quadrants can you hear a grade V/VI murmur?

A

4 + thrill

58
Q

What is a grade VI/VI murmur?

A

Loud murmur heard at all valve locations, even when stethoscope held 1 cm from chest wall

59
Q

In how many quadrants can you hear a grade VI/VI murmur?

A

4 + thrill + audible with stethoscope off chest

60
Q

What is the point of maximal intensity (PMI?)

A

Location on the heart where the murmur is the most audible; helps determine what valve the murmur is originating from

61
Q

What is radiation?

A

Describes where else you can hear the murmur other than the PMI

62
Q

What valves are best heard on the L side of the chest?

A

PAM

Pulmonic, Aortic, Mitral

63
Q

What valve is best heard on the R side of the chest?

A

tricuspid

64
Q

What is the base?

A

Upper half of the heart (above costochondral junction)

65
Q

Murmurs that are loudest at the base originate from the _____ or _____ valves.

A

aortic, pulmonic

66
Q

What is the apex?

A

Lower half of the heart (below the costochondral junction)

67
Q

Murmurs loudest at the apex originate from the _____ or _____ valves.

A

mitral, tricuspid

68
Q

When can you hear a systolic murmur?

A

During ventricular systole (between S1 and S2)

69
Q

When can you hear a diastolic murmur?

A

During ventricular diastole (after S2)

70
Q

When can you hear a continuous murmur?

A

Throughout systole and diastole

71
Q

What is a to-and-fro murmur?

A

systolic + diastolic

2 separate murmurs are present

72
Q

What are the 2 quality terms used to describe a murmur?

A

regurgitant and ejection

73
Q

What is a regurgitant murmur?

A

Consistent intensity and sound throughout the murmur

74
Q

What is an ejection murmur?

A

Increases in intensity or sound changes over time

75
Q

What murmur is this?

A

systolic

76
Q

What murmur is this?

A

diastolic

77
Q

What murmur is this?

A

Continuous

78
Q

What murmur is this?

A

To-and-fro / systolic + diastolic

79
Q

If you hear a L apex, systolic, regurgitant murmur, what are the possible echo findings and DDx?

A

Echo = mitral regurgitation

DDx = DMVD, endocarditis, MV dysplasia, DCM

80
Q

If you hear a L base, systolic, ejection murmur, what are the possible echo findings and DDx?

A

Echo = PS, aortic stenosis, no structural abnormalities

DDx = PS, aortic stenosis, physiologic murmur (fever, anemia, increased sympathetic tone)

81
Q

If you hear a L base, diastolic, regurgitant murmur (descrescendo, blowing), what are possible echo findings and DDx?

A

Echo = pulmonic regurg, aortic regurg

DDx = degen valve disease, endocarditis

82
Q

If you hear a craniodorsal to L base, continuous murmur, what are possible echo findings and DDx?

A

Echo = PDA

DDx = PDA

83
Q

If you hear a R apex, systolic, regurgitant murmur, what are possible echo findings and DDx?

A

Echo = tricuspid regurg

DDx = DTVD, endocarditis, TV dysplasia, DCM

84
Q

If you hear a R-sided, systolic, ejection murmur at the costochondral junction, what are possible echo findings and DDx?

Why is this best heard at the CC junction?

A

Echo = VSD

DDx = VSD

VSDs are usually located high up on the IVS close to the valves

85
Q

How are the jugular veins properly assessed?

A

Standing position with the head upright

86
Q

What is expected in the jugular vein of a horse but not in SA?

A

Horse = pulsation in lower 1/3 of neck only

SA = no pulsation

87
Q

What are DDx for abnormal jugular pulsation?

A

Elevated R heart pressures, pericardial disease, inflow obstruction, arrhythmias

88
Q

What is jugular distension?

A

The vein remains full of blood as if someone was holding off for a blood draw

89
Q

What are DDx for jugular distention?

A

Same as jugular pulsation but to a more extreme degree

90
Q

What is a hepato-jugular reflux?

A

A positive one is abnormal;

Jugular pulsation seen after pressing on the liver; an increased amount of blood is returned to the R heart and if it is diseased it cannot accomodate the increased venous return –> jugular pulse

91
Q

What are DDx for a hepato-jugular reflux?

A

Same as for jugular pulsation and distention

92
Q

What is A?

A

Normokinetic pulse pressure

93
Q

What is B?

A

Hypokinetic (narrow pulse pressure)

94
Q

What is C?

A

Hyperkinetic (wide pulse pressure)

95
Q

Pulse pressure is the difference between _____ and _____ pressures.

A

systolic, diastolic

96
Q

What can cause a hypokinetic pressure?

A

Subaortic stenosis, hypovolemia, some arrhythmias

97
Q

What can cause a hyperkinetic pressure?

A

PDA, severe aortic insufficiency, bradycardia, decreased vascular resistance (anemia), high sympathetic tone

98
Q

What is a synchronous pulse?

A

When the auscultated heartbeat and palpated pulse are almost simultaneous. This is a normal finding.

99
Q

What are asynchronous, delayed pulses?

A

Pulse is present, but is palpated well after the heartbeat.

Most common in patients with subaortic stenosis or HOCM

100
Q

What are asynchronous, pulse deficits?

A

Heartbeat without an palpated pulse.

Found in patients with arrhythmias (supraventricular or ventricular premature beats)

101
Q

What are symmetrical pulses?

What can it mean if they are asymmetrical?

A

R and L femoral arteries should have the same strength;

Asymmetrical = poor perfusion to one of the limbs due to a blood clot (arterial thromboembolism)

102
Q

What are clinical signs of patients with pulmonary edema?

A

Tachypnea at rest, short/shallow respiratory pattern with inspiratory effort, signs of severe dyspnea

103
Q

What are the signs of severe dyspnea?

A

Orthopneic, elbow abducted, wide eyed, neck outstretched, open mouthed breathing in cats

104
Q

What are clinical signs of pleural effusion?

A

Tachypnea at rest, inspiratory and expiratory effort, abdominal component to breathing

105
Q

What does stertor sound like?

A

Snoring on inspiration, localized to pharynx

106
Q

What does stridor sound like?

A

High pitched inspiratory sound, localized to larynx or cervical trachea

107
Q

What are DDx for stertor? Stridor?

A

Stertor = brachycephalic syndrome, pharyngeal disease

Stridor = laryngeal paralysis or masses, cervical tracheal collapse/masses/obstruction

108
Q

What respiratory sounds are associated with pleural effusion (R-CHF)?

A

Reduced or absent breath sounds ventrally

109
Q

What respiratory sounds are associated with pulmonary edema (L-CHF)?

A

Soft crackles at the end of inspiration and beginning of expiration

110
Q

Where can loud crackles be heard?

A

Throughout inspiration, lower airways

111
Q

What are DDx for loud crackles?

A

Canine bronchitis, COPD

112
Q

What are wheezes and where are they heard?

A

High pitched, expiratory, common in asthmatic patients

113
Q

If you hear noise on inspiratory effort without a stethoscope that is localized to the upper airway, what are the DDx?

A

Stenotic nares, rhinitis/masses, laryngeal disease, pharyngeal disease

114
Q

If you hear noise on inspiratory effort with a stethoscope that is localized to the lower airway, what are the DDx?

A

Tracheal or large airway disease, intraluminal or extraluminal masses

115
Q

If you hear end-inspiratory and expiratory effort and noise with a stethoscope that is localized to the lungs, what are the DDx?

A

Pulmonary edema, infiltrative disease, pneumonia

116
Q

If you hear inspiratory and expiratory effort that is localized to the pleural space, what are the DDx?

A

Pleural effusion, pericardial effusion, pneumothrax, intrathoracic mass

117
Q

If you hear tachypnea without overt effort that is systemic, what are the DDx?

A

Anemia, acidosis, pain, methemoglobinemia, neurologic

Small Animal Medicine (100 decks)

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