Cardio - Exam Flashcards
What are 3 general pieces of info to gather for a cardio exam?
Signalment, presenting complaint, and history
What things are included in the signalment?
Species, breed, and age-specific diseases
What things are included in the presenting complaint?
Murmur, collapse or exercise intolerance, respiratory signs
What are some things that are included in the history?
- 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)
What is cachexia?
Disproportionate loss in muscle mass that is commonly seen in inflammatory conditions
What are DDx for cachexia?
End stage CV disease, neoplasia, renal disease, chronic inflammatory conditions
What are DDx for abdominal distension?
Abdominal fluid (R-CHF), organomegaly, weakened abdominal muscles
What is a fluid wave?
Vibration of fluid palpated on ballotment of moderate to severe abdominal fluid
What are DDx for a fluid wave?
R-CHF (modified transudate), liver dz, PLE/PLN (transudate), neoplasia (mod transudate), trauma, bleeding mass, coagulopathies (hemorrhagic)
What color are normal mucous membranes?
pink
What are DDx for pale MM?
Poor perfusion, peripheral vasoconstriction, anemia
What are DDx for blue/gray (cyanotic) MM?
R to L shunting, pulmonary parenchymal disease (i.e. pulm edema from L-CHF), airway disease, hypoventilation, shock
What is the appearance of “differential cyanosis” and what does it mean?
Pink MM cranially and blue MM caudally - finding in dogs with R to L shunting PDA (reverse PDA)
What is the Dx for brick red or “injected” MM?
early phases of shock
What are the DDx for yellow (icteric) MM?
hemolysis, hepatobiliary disease
What is a CRT of 0-1 seconds?
Early, hyperdynamic phase of shock
What is a CRT of 2 seconds?
normal
What is a CRT of 3+ seconds?
poor perfusion
What is peripheral pitting edema?
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)
What are DDx for peripheral pitting edema?
R-CHF (uncommon); more common in horses and cattle
Non-cardiac = hypoalbuminemia, renal disease (rare)
What is palpation of the precordium?
Palpating the heartbeat on the chest wall
Where is the precordium normally felt the strongest?
L hemithorax
What does it mean if the precordium is felt strongest on the right?
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)
What does it mean if the precordium is the same strength on the L as it is on the R?
R and L heart enlargement
What does it mean if the precordium has decreased intensity?
Weak cardiac contractions, pericardial or pleural effusion
(Can also be due to obesity, thoracic masses, or pneumothorax)
What is a precordial thrill?
Palpable fine vibrations of a murmur on the chest wall;
May be palpated in patients with very loud murmurs (grade V or VI)
What are the 2 parts of the end of the stethoscope?
Bell and diaphragm
What is the bell for?
Best for listening to low frequency sounds (heart sounds and gallops)
What is the diaphragm best used for?
Listening to high frequency sounds (murmurs and clicks)
What are transient heart sounds?
Short sounds that may be caused by normally auscultated heart sounds (S1, S2), gallops (S3, S4), or abnormal valve movement (mid-systolic clicks).
What are the systolic sounds?
S1 and S2, mid-systolic click
What causes S1?
Closure of the mitral and tricuspid valves - abrupt deceleration of blood flow resulting in vibrations of the cardiac walls and blood
What does S1 sound like compared to S2?
S1 is longer and lower pitched
Where is S1 best heard?
Over the mitral valve
What causes S2?
Closure of aortic and pulmonic valves
Where is S2 best heard?
Over the aortic area
What is a mid-systolic click due to?
Prolapse of the mitral or tricuspid valve
Where is a mid-systolic click best heard?
Over the mitral or tricuspid valve
What is a split S1?
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
What is a split S2?
Can occur due to asynchronous closure of the pulmonic and aortic valves (pulm hypertension, arrhythmias, bundle branch blocks).
What condition are systolic clicks most commonly heard with and what valve is affected?
Early DMVD (before overt regurgitation); occasionally affects the tricuspid valve
What are the diastolic sounds?
S3 and S4
What causes S3?
Vibrations in the heart wall associated with rapid ventricular filling; can be normal in LA
What causes S4?
Atrial contraction; is also normal in LA
When can an S3 gallop be heard in dogs and cats?
When the ventricles are very dilated (i.e. DCM)
When is an S4 gallop heard in dogs and cats?
With thickened, stiff, ventricles (i.e. HCM); heard during contraction or dilated atria
What is a murmur?
Prolonged, audible vibration of blood in the heart or great vessels that can be associated with turbulent blood flow or abnormal blood flow.
What is a grade I/VI murmur?
Soft murmur heard in only 1 valve location, only in very quiet room; may be intermittent
In how many quadrants can you hear a grade I/VI murmur?
1
What is a grade II/VI murmur?
Soft murmur heard consistently, but only in 1 valve area
In how many quadrants can you hear a grade II/VI murmur?
2
What is a grade III/VI murmur?
Moderate murmur heard in multiple valve locations on one side of the chest
In how many quadrants can you hear a grade III/VI murmur?
3
What is a grade IV/VI murmur?
Loud murmur heard on both sides of the chest
In how many quadrants can you hear a grade IV/VI murmur?
4
What is a grade V/VI murmur?
Loud murmur heard at all valve locations, associated with precordial thrill
In how many quadrants can you hear a grade V/VI murmur?
4 + thrill
What is a grade VI/VI murmur?
Loud murmur heard at all valve locations, even when stethoscope held 1 cm from chest wall
In how many quadrants can you hear a grade VI/VI murmur?
4 + thrill + audible with stethoscope off chest
What is the point of maximal intensity (PMI?)
Location on the heart where the murmur is the most audible; helps determine what valve the murmur is originating from
What is radiation?
Describes where else you can hear the murmur other than the PMI
What valves are best heard on the L side of the chest?
PAM
Pulmonic, Aortic, Mitral
What valve is best heard on the R side of the chest?
tricuspid
What is the base?
Upper half of the heart (above costochondral junction)
Murmurs that are loudest at the base originate from the _____ or _____ valves.
aortic, pulmonic
What is the apex?
Lower half of the heart (below the costochondral junction)
Murmurs loudest at the apex originate from the _____ or _____ valves.
mitral, tricuspid
When can you hear a systolic murmur?
During ventricular systole (between S1 and S2)
When can you hear a diastolic murmur?
During ventricular diastole (after S2)
When can you hear a continuous murmur?
Throughout systole and diastole
What is a to-and-fro murmur?
systolic + diastolic
2 separate murmurs are present
What are the 2 quality terms used to describe a murmur?
regurgitant and ejection
What is a regurgitant murmur?
Consistent intensity and sound throughout the murmur
What is an ejection murmur?
Increases in intensity or sound changes over time
What murmur is this?
systolic
What murmur is this?
diastolic
What murmur is this?
Continuous
What murmur is this?
To-and-fro / systolic + diastolic
If you hear a L apex, systolic, regurgitant murmur, what are the possible echo findings and DDx?
Echo = mitral regurgitation
DDx = DMVD, endocarditis, MV dysplasia, DCM
If you hear a L base, systolic, ejection murmur, what are the possible echo findings and DDx?
Echo = PS, aortic stenosis, no structural abnormalities
DDx = PS, aortic stenosis, physiologic murmur (fever, anemia, increased sympathetic tone)
If you hear a L base, diastolic, regurgitant murmur (descrescendo, blowing), what are possible echo findings and DDx?
Echo = pulmonic regurg, aortic regurg
DDx = degen valve disease, endocarditis
If you hear a craniodorsal to L base, continuous murmur, what are possible echo findings and DDx?
Echo = PDA
DDx = PDA
If you hear a R apex, systolic, regurgitant murmur, what are possible echo findings and DDx?
Echo = tricuspid regurg
DDx = DTVD, endocarditis, TV dysplasia, DCM
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?
Echo = VSD
DDx = VSD
VSDs are usually located high up on the IVS close to the valves
How are the jugular veins properly assessed?
Standing position with the head upright
What is expected in the jugular vein of a horse but not in SA?
Horse = pulsation in lower 1/3 of neck only
SA = no pulsation
What are DDx for abnormal jugular pulsation?
Elevated R heart pressures, pericardial disease, inflow obstruction, arrhythmias
What is jugular distension?
The vein remains full of blood as if someone was holding off for a blood draw
What are DDx for jugular distention?
Same as jugular pulsation but to a more extreme degree
What is a hepato-jugular reflux?
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
What are DDx for a hepato-jugular reflux?
Same as for jugular pulsation and distention
What is A?
Normokinetic pulse pressure
What is B?
Hypokinetic (narrow pulse pressure)
What is C?
Hyperkinetic (wide pulse pressure)
Pulse pressure is the difference between _____ and _____ pressures.
systolic, diastolic
What can cause a hypokinetic pressure?
Subaortic stenosis, hypovolemia, some arrhythmias
What can cause a hyperkinetic pressure?
PDA, severe aortic insufficiency, bradycardia, decreased vascular resistance (anemia), high sympathetic tone
What is a synchronous pulse?
When the auscultated heartbeat and palpated pulse are almost simultaneous. This is a normal finding.
What are asynchronous, delayed pulses?
Pulse is present, but is palpated well after the heartbeat.
Most common in patients with subaortic stenosis or HOCM
What are asynchronous, pulse deficits?
Heartbeat without an palpated pulse.
Found in patients with arrhythmias (supraventricular or ventricular premature beats)
What are symmetrical pulses?
What can it mean if they are asymmetrical?
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)
What are clinical signs of patients with pulmonary edema?
Tachypnea at rest, short/shallow respiratory pattern with inspiratory effort, signs of severe dyspnea
What are the signs of severe dyspnea?
Orthopneic, elbow abducted, wide eyed, neck outstretched, open mouthed breathing in cats
What are clinical signs of pleural effusion?
Tachypnea at rest, inspiratory and expiratory effort, abdominal component to breathing
What does stertor sound like?
Snoring on inspiration, localized to pharynx
What does stridor sound like?
High pitched inspiratory sound, localized to larynx or cervical trachea
What are DDx for stertor? Stridor?
Stertor = brachycephalic syndrome, pharyngeal disease
Stridor = laryngeal paralysis or masses, cervical tracheal collapse/masses/obstruction
What respiratory sounds are associated with pleural effusion (R-CHF)?
Reduced or absent breath sounds ventrally
What respiratory sounds are associated with pulmonary edema (L-CHF)?
Soft crackles at the end of inspiration and beginning of expiration
Where can loud crackles be heard?
Throughout inspiration, lower airways
What are DDx for loud crackles?
Canine bronchitis, COPD
What are wheezes and where are they heard?
High pitched, expiratory, common in asthmatic patients
If you hear noise on inspiratory effort without a stethoscope that is localized to the upper airway, what are the DDx?
Stenotic nares, rhinitis/masses, laryngeal disease, pharyngeal disease
If you hear noise on inspiratory effort with a stethoscope that is localized to the lower airway, what are the DDx?
Tracheal or large airway disease, intraluminal or extraluminal masses
If you hear end-inspiratory and expiratory effort and noise with a stethoscope that is localized to the lungs, what are the DDx?
Pulmonary edema, infiltrative disease, pneumonia
If you hear inspiratory and expiratory effort that is localized to the pleural space, what are the DDx?
Pleural effusion, pericardial effusion, pneumothrax, intrathoracic mass
If you hear tachypnea without overt effort that is systemic, what are the DDx?
Anemia, acidosis, pain, methemoglobinemia, neurologic
