Cardiorespiratory Disease Flashcards
PQRST wave
QRS - ventricular depolarisation
T - ventricular repolarisation
normal - regular rhythm, P for every QRS
sinus arrhythmia
irregular pace but in time with breathing
HR up when breathing in - stimulates vagus nerve - common and normal
1st degree A-V block
P with no QRS
2nd degree A-V block
QRS with no P
pause between beats with S4 sound in pause
3rd degree A-V block
regular rhythm but QRS slower than P so gets out of sync
normal atrial contraction sound with slower ventricular bear
Atrial fibrillation
high rate, squiggly line, no regular pattern
rapid irregular beat - bongo sounds
common cause of poor performance in horses
heart failure
when the heart can no longer meet the metabolic needs of the body
common breed heart problems
corgi - patent ductus arteriosus
kcc - mitral valve disease
male cats - HCM
female cats - PDA
heart disease signs
non-specific
exercise intolerance
weakness
syncope/presyncope
cyanosis
coughing
paresis
neurological signs - blindness
shifting lameness (endocarditis)
heart failure - tachypnoea, weight loss, swollen abdomen, peripheral oedema
heart disease exam
BCS
RR and effort
ascites
distended jugular - right sided heart disease
pulsating jugular
peripheral oedema
exam - mm
pale - shock, vasoconstriction
slow CRT - poor CO
cyanosis - right-to-left shunt
- 3 types - body wide, differential (head membranes normal, caudal pale), peripheral (only affecting certain regions)
exam - jugular
pulsating - eg arrhythmia
tricuspid regurgitation - back flow of blood up vena cava
collapsed right atrium - pericardial effusion
distension - elevated systemic venous pressure
exam - auscultation
both sides at apex and base
heart murmur
gallop rhythm
arrhythmia
HR
all lung fields
compare dorsal and ventral
muffled sounds
crackles
exam - palpation
apex - should not be prominent on right
thrill
compression - decreased compressibility in cats with heart disease
Abdominal examination
palpation - ascites, splenomegaly, hepatomegaly, pain
hepatojugular reflex - blood flow up jugular when squeeze under ribs - high right side filling pressure
exam - arterial pulse
femoral - does it match HR
pulsus alternas - alternating weak and strong - myocardial failure
pulsus paradoxus - decreased pulse quality on inspiration - pericardial effusion
Gallop rhythm
extra sounds - S3 and/or S4
S3 - early diastolic filling - systolic dysfunction
S4 - atrial contration - forced atrial ejection of blood
Heart murmur
systole - between lub and dub
dyastole - between dub and lub
continuous - both/all the time
turbulent flow over an obstruction
heart murmur - grading
1 - barely audible
2 - audible but quieter than heart sounds
3 - clearly audible and loud as heart sounds
4 - louder than heart sounds
5 - thrill present
6 - audible with stethoscope lifted off chest
apical systolic murmurs
left side - mitral regurgitation - DCM or myxomatous mitral valve disease
right side - tricuspid regurgitation - tricuspid vlave dysplasia, pulmonary hypertension, degeneration of valve
musical/whooping sound
basilar systolic murmurs
under axilla
harsh sound
innocent/functional murmurs
innocent - in puppies/kittens - resolves on its own
functional - as side effect of another disease process
diastolic murmurs
aortic regurgitation - heart base, quiet
pulmonic regurgitation - uncommon, left base of heart
mitral stenosis - rare, left apex
continuous - PDA
heart murmur investigation
BP
bloods - CBC, Biochem, electrolytes, NT-proBNP, cardiac troponin 1
Acquired heart disease
mitral valve disease (dogs) - thickened mitral valve, dilated left atrium and ventricle, bowing of interarticular and intraventricular septums
DCM (cats)
pericardial effusion (dogs)
HCM (cats) - LV hypertrophy, slightly dilated LA, mitral regurgitation
Hypertrophic obstructive cardiomyopathy (Cats)
restrictive cardiomyopathy (cats)
Normal heart sounds
S1 - atrial filling - closure of mitral and tricuspid - start of systole - QRS
S2 - ventricular emptying - aortic valves close - start of diastole - T
S3 - blood from atria to ventricles - P (inaudible)
S4 - slowing of blood with atrial contraction - T (inaudible)
systole and diastole
systole = ventricular contraction (blood out)
diastole = ventricular relaxation (blood in)
gallop rhythm
3 sounds
abnormal in dogs and cats
indications for endoscopy
cough
difficulty breathing after exercise
snotty or bleeding nose
abnormal breathing sounds
poor performance
endoscope controls
up/down lock - has an F on it
left/right direction lock - smaller
water/air suction for clearing lens - blue
suction valve - red
tracheal aspirate
tracheal and tracheobronchial changes
pros - quick, easy, less invasive and well tolerated, bacteriology, visual assessment
cons - lack of specificity for lower airway inflammation, normal cell counts vary between horses
bronchoalveolar lavage (BAL)
assessment of lower airway inflammation
pros - cytology, cheap and equipment easily available
cons - can’t use for bacteriology, more invasive (sedation), more technically challenging, causes transient inflammation
eupnoea
normal respiration
tachypnoea
increased rate
apnoea
no respiration
dyspnoea
sensation of difficult or laboured breathing - use increased respiratory effort instead
hypo/hyperventilation
alterations to ventilation at alveolar level
changes to respiratory pattern
variations in tidal volume
engaging of extra-thoracic muscles
increased abdominal effort
forced
nasal flaring
posture
open mouth breathing
neck stretching and abduction of elbow
upper tract obstruction
increased inspiratory effort
inspiratory stridor and stertor
lower tract obstruction
increased expiratory effort
early collapse during expiration
stridor
wheezing/whistle sound
stertor
lower pitched gurgling noise
nasal discharge
serous - allergic rhinitis, acute inflammation, viral infection
mucoid - chronic disease
purulent - bacterial infection
haemorrhagic - traume, clotting disorder, vascular disase
mucopurulent - secondary infection
mixed - inflammation + mucosal haemorrhage + secondary infection
LRT - unilateral
URT - bilateral
Coughing
URT - harsh dry cough, often productive - trachieitis or tracheobronchitis (eg kennal cough)
LRT - soft, chesty cough - lower airway inflammation or pneumonia, can be cardiogenic
Lung auscultation
wheezing - air passing through narrowed airways
crackles - air passing through fluid
dull/absent - no air movement
pleural rubs - friction between pleural surfaces
