cardiovascular Flashcards
Order of cardiovascular examination
– History (fatigue, dyspnea, coughing, ascites,
oedema, fainting)
– General condition (impression)
– Detailed examination of the cardiovascular system – Heart
– Blood vessels:
Arterial system
Venous system (Capillary system)
Physical cardiovascular examination:
- Inspection(heart,vessels)
- Palpation(heart,vessels)
- Percussion(heart)
- Auscultation(heart)
– Thoracic radiography – Electrocardiography (ECG) – Echocardiography – Blood pressure measurement – Phonocardiography (PCG) – Nonselective angiocardiography – Cardiac catheterization • intracardiac pressure measurement • oxymetry • selective angiocardiography – Radionuclide imaging – Serology (Lyme, ANA test, Dirofilaria, Trypanosome, etc.) – (CT, MRI) – Blood test (ANP, BNP, troponin, endothelin)
heart palpation
• Location of the heartbeat
influenced by the strength of the beat
dislocation of the cardiac beat can be caused by: tumor, abscess, pneumothorax, diaphragmatic hernia
• Strength(intensity)of the heartbeat
increased: exercise, cardiac hypertrophy, dislocation
decreased: cardiac insufficiency (DCM), pericardial/pleural fluid, thickened chest wall
• Fremitus(palpablethrill):
endocardial, pericardial, extrapericardial
Normal place of heart (apex) beat in horse
left : 3-6 ics
right: 3-4 ics
Normal place of heart (apex) beat in cow, swine , small ru
left : 3-5 ics
Normal place of heart (apex) beat in dog and cat
left : 3-6 ics
right: 3-5 ics
Normal place of heart (apex) beat in rabbit
left : 2-4 ics
right: 2-4 ics
horse cardiac dullness
absolute
left : 3-5 ics
right: 3-4 ics
Ru cardiac dullness
Relative
left: 3-4
Swine cardiac dullness
Relative
left: 2-3
Dog cardiac dullness
Absolute
left : 4-6 ics
right: 4-5 ics
Cat cardiac dullness
Relative
Enlargement of cardiac dullness
cardiac enlargement (dilation, hypertrophy)
cardiac dislocation
pericardial effusion
• False enlargement:
dullness in other neighboring organs
detection: frictional (rubbing) auscultation
Decreasing of cardiac dullness:
lung emphysema
emphysema of the skin
pneumothorax
cardiac dislocation
Normal heart sounds:
4
Audibility is different according to species and heart rate
Changes of heart sounds
FRIDA
Frequency (heart rate)
- Usually the same as the pulse (but there can be a pulse deficit!)
- Different in various species (normal values)
- Changes; tachycardia, bradycardia (physiological or abnormal)
Rhythm
- Normally regular (respiratory arrhythmia)
- Horse: intermission cordis (dropped beat)
- Arrhythmia: pathological forms
Intensity
- Normally strong and even (uniform strength)
- Pounding beat: increasing of the first and/or second sound (slight variation over
different valve areas)
- Reduce heart sounds: decreased cardiac output
- +/- Pericardial, pleural effusion, obesity
Demarcation
- Horse: LUB-LUB-DUP-DUP
- Changes: different species and heart rate
- Duplication of heart sounds
Adventitious sounds
- Endocardial murmurs:
o Morphological or functional origin
o Stable: location, intensity, relation to cardiac cycle
→ Causes: morphological changes (valve deformities, septal or vessel malformations),
functional changes
- Extracardial murmurs:
o Pericardial or pleuropericardial
o Variable location, intensity, more or less related to cardiac or respiratory cycle → Causes: pericardial splashes, rubbing, pleuropericardial rubbing
Valsalva probe: pleuropericardial rubbing (disappears if breathing stops)
Grading of murmurs
I
Very soft murmur, heard only after a few seconds in a quiet room
II
Soft murmur but easily heard directly upon auscultation
III
Moderate intensity murmur with good audibility
IV
Loud murmur, very good audibility but without precordial thrill
V
Very loud murmur with precordial thrill
VI
Loudest murmur, even audible with stethoscope lifte
Examination of the blood vessels: ARTERIES
Methods:
- Digital palpation
- Blood pressure measurement (direct, indirect (sphygmomanometer))
- Blood flow registration (Doppler ultrasound)
Examination of the arterial pulses, parameters
Should be palpated on both sides → symmetric!
Frequency, rhythm and quality (size, strength and duration of the pulse wave and the degree of fullness of the artery)
Normal findings:
- Symmetric
- Rate: physiological
- Rhythm: regular
- Size, duration and strength: even, normal
Pulse quality
Size: Difference between systolic and diastolic blood pressure = Pulse pressure
Determined by: Heart rate, stroke volume, and peripheral resistance
Abnormal findings of pulse quality:
- Irregular pulse (pulsus irregularis) – due to respiratory or true arrhythmia
- Uneven pulse (pulsus inequalis, pulsus alternans) – every other beat
- Small, brief and hard: wiry (pulsus contractus)
- Small, prolonged and weak: thread (pulsus piliformis)
- Skipping and large: bumping (pulsus celer et magnus) → Corrigan-pulse
- Paradox pulse (pulsus paradoxus) – weak in inspiration vs. expiration → caused by
cardiac tamponade - Changing with respiration (pericardial tamponade)
Size: - Large, hyperkinetic (pulsus magnus) - Small, hypokinetic (pulsus parvus) Strength: - Strong/weak → cardiac function - Hard (pulsus durus)/soft (pulsus mollis) → vascular tone Duration: - Sluggish (pulsus tardus) - Skipping (pulsus celer) Size and duration: - Full (pulsus plenus) - Empty (pulsus vacuus)
Examination of the blood vessels – VEINS
Methods:
Inspection and palpation,
measurement of central venous pressure
Veins available for examinations:
- Jugular vein (v. jugularis)
- Saphenous vein (v. saphena)
- Episcleral veins, veins of other mucous membranes
- Subcutaneous abdominal vein (“milk vein”) in cattle
