Cardiology Review and Physical Exam Flashcards
Is the resistance in the pulmonary vessels high or low ?
Low resistance => low pressure (P=CO x R)
What enters the right atrium at the craniodorsal aspect, near the sinus node?
Cranial vena cava
The right atrioventricular valve is AKA?
Tricuspid valve
T/F: The right ventricle is crescent shaped and its valves can only be heard on the left side
False
Crescent shaped-> beginning in right hemithorax (tricuspid valve) and terminate in left hemithorax (pulmonary valve)
Where do the pleural veins empty into in dogs and cats?
Cranial vena cava
-in cats, also empty into the left atrium
Where do the abdominal veins empty into in dogs and cats?
Caudal vena cava
Where does the pericardium drain into in cats and dogs??
Crainial vena cava
The left AV valve is AKA?
Mitral valve
Basilar refers to???
Dorsal 1/3rd of the heart
-atria, auricle, aortic, and pulmonary valves, ascending aorta, main PA
Apical refers to???
Ventral 2/3 of the heart
-includes the ventricles and AV valves
Where do the coronary arteries originate?
Left coronary artery - L aortic sinus
Right coronary artery - R aortic sinus
When does most coronary flow occur?
During diastole
The great coronary vein originates at ____________ and empties into the ________
Apex of left ventricle; coronary sinus
What are the components of the conduction system of the heart?
SA node AV node Bundle of His Bundle branches Purkinje fibers
Is the ventricular myocardium primarily controlled by the SNS or PSNS?
SNS
T/F: the SA and AV nodes have both parasympathetic (vagal) and sympathetic innervation
True
The sympathetic effects of the heart are mediated by what receptors?
B1 adrenergic receptors
The parasympathetic effects of the heart are mediated by what receptors ?
Muscarinic
_________ is the volume of blood ejected out the heart during each cardiac cycle
Stroke volume (EDV-ESV)
Stroke volume is determined by what 3 factors?
Preload
Afterload
Contractility
What is the sequel of increased right atrial pressure?
Increased hydrostatic pressure in vena cava
Increased hydrostatic pressure in systemic veins
Effusion on body cavities -> peritoneal/pleural/pericardial
Interstitial edema in systemic organs
What is the sequel of increased left atrial pressure
Increased hydrostatic pressure in pulmonary viewings —> edema in pulmonary parenchyma
Cats ONLY- increased hydrostatic pressure in pleural veins —> effusion in pleural cavity
If you have decreased ambulation and abdominal distention, what concerns may you have relating to the CV system?
Thromboembolism (cat)
Hypotension ascites
What do you examine on the head with regard to a CV exam
Mucous membranes
- normal, pink, CRT<2sec
- assess for pallor, cyanosis, CRT > 2sec, petechiae, and icterus
Eyes
-evaluate for hyphema, retinal hemorrhage, and retinal detachment (systemic hypertension ))
What nutrient is vital for heart function in cats and when lacking you can see central rental degeneration ?
Taurine deficiency cardiomyopathy
What would you suspect if there is distention of the jugular veins?
Elevated systemic venous pressure
—> right sided heart disease
—> pericardial disease
—> obstruction of the cranial vena cava
T/F: it is normal to see pulsation of the jugular vein above the distal third
False
Normal below distal third
Abnormal above distal third —> tricuspid regurgitation/ventricular cardiomyopathy/pericardial disease/3rd degree AV block
What is the palpable heart beat on the left chest surface ?
Apex beat (AB) -mitral valve
AB may be exaggerated in patients with __________
Cardiomegaly
What should you listen for during cardiac auscultation?
Start at apex beat
Determine heart rate
Identify normal heart sounds/respiratory sounds
Listen for any abnormal sounds
Listen for arrhythmias
Repeat at aortic and then pulmonary valve and then tricuspid on the right
What is the “lub” heart sound?
S1
Ventricular systole
What are the valves doing during S1?
Ventricular systole
- AV valves closing (this generates the “lub” sound)
- Semilunar valves opening
What is the “dub” heart sound?
S2
End of ventricular systole
What are the valves doing during S2?
AV valves are opening
Semilunar valves are closing (this generates the “dub” sound)
S1 and S2 are higher frequency sounds, and are best heard with what part of the stethoscope ?
Diaphragm
What is a murmur?
Sound generated by abnormal movement of blood in the heart chambers or great vessels
T/F: the higher the velocity, the louder the murmur
True
Grade the murmur..
Very faint
Several seconds or longer to hear
Does not radiate
Grade 1
Grade the murmur
Readily heard
Radiates on same side as the point of maximal intensity
Grade 3
Grade the murmur
Loud
Rates to opposite side of PMI
Grade 4
Grade the murmur
Faint
Doesn’t radiate
Grade 2
Grade the murmur
Palpable thrill
Audible with stethoscope lifted off chest
Grade 6
Grade the murmur
Palpable thill
Loud
Radiates to opposite side
Grade 5
It is most common for murmurs to occur when?
During systole
- pansystolic
- holosystolic
What is a gallop?
S3 or S4 sounds
Occurring before or after S1 and S2–> usually indicate a “stiff ventricle”
What occurs during S4? When is it most commonly heard?
Atrial contraction —> active ventricular filling
Hypertrophic cardiomyopathy
What occurs during S3? When is it most commonly heard?
Passive ventricular filling
Dilated cardiomyopathy
S3 and S4 are low frequency sounds, and are best heard with what part of the stethoscope ?
Bell
A ___________ occurs between S1 and S2. Usually due to a prolapse of an AV valve
Systolic click
High frequency -heard best with diaphragm
What are pathologic causes of a split S1?
Bundle branch block
Ventricular ectopic beat
Mitral/tricuspid stenosis
What are pathologic causes of a split S2?
Pulmonary hypertension Bundle branch block Ventricular ectopic beats Left-right intracardiac shunt Pulmonic/aortic/mitral stenosis
What heart sound is often audible in a patient with 3rd degree AV block
S4
What are causes of pauses heard in cardiac auscultation ?
Premature beat
Sinus arrhythmia
2nd degree AV block
Sinus arrest
What are causes of increased intensity of heart sound?
Thin body condition
Hyperdynamic states: fever, anemia, hyperthyroidism
What are causes of decreased intensity of heart sounds?
Obesity
Pericardial or plural effusion
Intrathoracic mass effect
Poor left ventricular contractility
Why do a pulmonary auscultation to assess heart function?
Congestive heart failure —> pulmonary edema/plural effusion/pericardial effusion
Can hear these on auscultation
What sounds may you be able to hear in peracute pulmonary edema ?
Bronchial/bronchovesicular sounds increased
What would you be able to hear in severe pulmonary edema?
Crackles/ wheezes
If you hear muffled lung sounds ventrally what do you suspect?
Pleural effusion
In a cat.. absent femoral pulses Paralysis of both hindlimbs Cyanotic paw pads Firm musculature Painful!
What is this?
Feline distal aortic thromboembolism “saddle thrombus”
What are you primarily looking for in the abdomen when doing a CV exam?
Distention - peritoneal effusion or cranial organomegaly
Fluid wave- peritoneal effusion
Cranial organomegaly - hepatomegaly is the most common
T/F: patients with CHF may have weight/muscle loss
True
-cardiac cachexia
If you have a dyspneic patient, how should you conduct your CV exam?
Observe
R-respiratory
A-ambulation and abdominal distention
M-mentation
Auscultation
Palpate femoral pulse
Tentative diagnosis and initiate therapy
History
Perform diagnostics once respiratory status has improved and is stable
