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Cardiovascular Pathophysiology > Cardiovascular Physical Exam > Flashcards

Cardiovascular Physical Exam Flashcards

1
Q

what are some clinical findings consistent with cardiovascular disease?

A

grade III-IV/VI or louder systolic murmur
diastolic murmer
gallop heart sound
precordial or peripheral cutaneous thrill
venous distension
localized absence of arterial pulse
cardiac enlargement on chest radiographs or echocardiogram
markedly elevated NT-proBNP
ECG arrhythmias, left bundle branch block

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2
Q

what are some differentials for pale mucous membranes?

A

anemia
poor perfusion

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3
Q

what are some differentials for injected mucous membranes?

A

vasodilation: activity, excitement, septic shock
breed variation
polycythemia

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4
Q

what are some differentials for central cyanosis?

A

arterial oxygen desaturation:
V/Q mismatch
right to left shunt

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5
Q

what are some differentials for peripheral cyanosis?

A

reduced cardiac output, regional vasoconstriction
regional cyanosis- vascular obstruction

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6
Q

what are some jugular venous waveforms?

A

A wave
X descent
C wave
V wave
Y descent

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7
Q

what are the appearances of the jugular vein?

A

normal jugular vein appearance
distended
pronounced A wave
pronounced V wave

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8
Q

what is normal jugular vein appearance?

A

normal pulsations in lower 1/3 of neck

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9
Q

what is a hepatojugular reflux?

A

cranial abdominal pressure: increased venous return to right atrium

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10
Q

what is a normal response to a hepatojugular reflux?

A

minimal jugular vein elevation, immediate return to normal

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11
Q

where can you palpate cardiac impulse/apex beat?

A

left ventral thorax
normally left more than right

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12
Q

when is cardiac impulse intensity increased?

A

hyperdynamic conditions: mitral regurgitation, left-to-right shunts, anemia, sympathetic stimulation, hyperthyroidism, bradycardia, sepsis

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13
Q

when might cardiac impulse intensity be decreased?

A

systolic dysfunction
shock

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14
Q

what might large displacement of the thoracic wall with cardiac contraction suggest?

A

hypertrophy

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15
Q

what is the sensation that allows us to feel arterial pulses due to?

A

difference between systolic and diastolic pressure

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16
Q

what can cause hyperdynamic arterial pulses?

A

increased stroke volume
diastolic run-off
also called bounding or waterhammer

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17
Q

what are some arterial pulse abnormalities?

A

bounding pulses
weak pulses: pulsus parvus
pulsus alternans: varying pulse quality
bigeminal pulse
pulsus paradoxus

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18
Q

what is a bigeminal pulse?

A

alternating strong/weak pulse from bigeminal arrhythmia

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19
Q

what do cardiac stroke volume and pulse strength depend on?

A

greatly on time for cardiac filling

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20
Q

what can decrease time for cardiac filling?

A

premature beat: atrial or ventricular

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21
Q

how are pulse deficits determined?

A

pulse palpation with simultaneous cardiac auscultation

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22
Q

what is the diaphragm on the chest piece better for compared to the bell?

A

higher frequency sounds: most murmurs

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23
Q

what is the order from cranial to caudal of the valves on the left side of a dog?

A

pulmonic valve region
aortic valve region
mitral valve region

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24
Q

what does the first heart sound coincide with?

A

closure of mitral and tricuspid valves

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25
Q

when does the first heart sound split abnormally?

A

asynchronous ventricles

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26
Q

what does the second heart sound coincide with?

A

closure of semilunar (aortic and pulmonic) valves

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27
Q

can the second heart sound be split normally?

A

yes: asynchronous closure of aortic and pulmonic valves

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28
Q

what is a pathologic split of the second heart sound like?

A

less subtle

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29
Q

what is a pathologic split of the second heart sound caused by?

A

delayed closure of either aortic or pulmonic valve: prolonged ejection of either ventricle

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30
Q

when is the second heart sound intensity accentuated?

A

hypertension: systemic hypertension, pulmonary hypertension

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31
Q

what can prolong right ventricle ejection?

A

pulmonic stenosis or pulmonary hypertension

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32
Q

what does the third heart sound (S3) coincide with?

A

end of rapid ventricular filling in early diastole, right after S2

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33
Q

what is a pathologic S3 heart sound referred to as?

A

S3 gallop

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34
Q

gallops are _____________ sounds

A

diastolic

35
Q

when is an S3 gallop pathologic?

A

small animal patients
may be normal in large animals

36
Q

what does the fourth heart sound (S4) coincide with?

A

atrial contraction, late diastole, just before S1

37
Q

what is a pathologic S4 heart sound referred to as?

A

S4 gallop

38
Q

what is an S4 gallop in small animals suggestive of?

A

myocardial disease
hypertrophied, stiff ventricle
sometimes iatrogenic fluid overload

39
Q

what is a summation gallop?

A

events corresponding to S3 and S4 sounds coincide in timing
rate dependent gallop

40
Q

what is a midsystolic click associated with?

A

mitral valve prolapse
may occur in early in degenerative mitral valve disease

41
Q

what are heart murmurs caused by?

A

turbulent, disturbed blood flow

42
Q

in whom are “innocent” heart murmurs common in?

A

young animals: relative anemia and decreased body fat

43
Q

what are the murmur characteristics?

A

intensity
location
timing

44
Q

a __________ occurs when murmur intensity is great enough to be palpable on the thoracic wall

A

thrill

45
Q

what classifies a grade I murmur?

A

veery soft murmur heard (with difficulty) in one specific location after minutes of listening in a quiet room or stall

46
Q

what classifies a grade III murmur?

A

moderately loud murmur that is readily heard and radiates slightly

47
Q

what may murmurs do with increasing disease severity?

A

increase or decrease

48
Q

when do holosystolic murmurs occur?

A

starts with S1 and continues to end of S2

49
Q

what are the disease associations of systolic ejection murmurs?

A

subaortic or pulmonic stenosis
hypertrophic cardiomyopathy

50
Q

what are some causes of diastolic murmurs?

A

aortic insufficiency
pulmonic insufficiency
mitral stenosis

51
Q

what can cause a continuous murmur?

A

patent ductus arteriosus

52
Q

where do you need to have your stethoscope for a continuous murmur?

A

far cranial left heart base

53
Q

what grades of systolic and diastolic murmurs are associated with cardiovascular disease?

A

grade III-IV/VI systolic
any grade diastolic

54
Q

what can cause injected mucous membranes with vasodilation?

A

activity
excitement
septic shock

55
Q

what are the jugular venous waveforms?

A

A wave
X descent
C wave
V wave
Y descent

56
Q

what is the V wave in the jugular venous waveforms?

A

atrial filling

57
Q

why might a pronounced A wave occur?

A

incompliant right ventricle
cannon A waves: AV dissociation

58
Q

what does caudal displacement of the cardiac impulse suggest?

A

cardiac enlargement
if to right: right-sided enlargement

59
Q

what can large displacement of thee thoracic wall with cardiac contraction suggest?

A

hypertrophy

60
Q

what can cause diastolic run-off?

A

aortic insufficiency
PDA

61
Q

when might pulses be hyperdynamic?

A

increased stroke volume
diastolic run-off

62
Q

what can cause decreased stroke volume and therefore diminished pulses?

A

marked systolic dysfunction
hypovolemia
tachycardia

63
Q

what is pulsus alternans associated with?

A

severe myocardial dysfunction
tachyarrhythmias with variable cardiac filling

64
Q

what is pulsus paradoxus?

A

decreased pulse strength on inspiration resulting from cardiac tamponade (pericardial effusion)

65
Q

what do pulse deficits have the same clinical implication as?

A

premature beats: reason to investigate for cardiac disease

66
Q

what is the bell of the stethoscope best for?

A

low frequency sounds: normal heart sounds, clicks, gallops

67
Q

what valve can be auscultated on the right side?

A

tricuspid valve

68
Q

when is the intensity of S1 (closure of AV valves) increased?

A

hyperdynamic conditions

69
Q

what is physiologic splitting of S2 (closure of pulmonic and aortic valves)?

A

normally right ventricle takes longer to eject than left
accentuated with inspiration and subtle

70
Q

what is an S2 pathologic split caused by?

A

delayed closure of aortic or pulmonic valve: prolonged ejection

71
Q

what can cause an S2 pathologic split?

A

right ventricle prolonged: pulmonic stenosis or pulmonary hypertension
left ventricle prolonged: aortic stenosis or systemic hypertension

72
Q

what can cause a fixed split of S2?

A

atrial septal defect

73
Q

what can accentuate S2 intensity?

A

hypertension: pulmonary more common than systemic

74
Q

what is an S3 gallop (S3 sound) suggestive of in small animals?

A

myocardial disease
sometimes iatrogenic fluid overload

75
Q

what is a summation gallop dependent on?

A

rate

76
Q

what is the equation for reynolds number?

A

radius x velocity x density/blood viscosity

77
Q

what classifies a physiologic heart murmur?

A

normal cardiac structure with hyperdynamic state or small aorta

78
Q

what does murmur intensity relate to?

A

pressure and rate of flow

79
Q

what grades of heart murmurs include a thrill?

A

V or VI/VI

80
Q

what diseases are associated with a holosystolic murmur?

A

mitral or tricuspid regurgitation
VSD

81
Q

what diseases are associated with a systolic ejection murmur?

A

subaortic or pulmonic stenosis
hypertrophic cardiomyopathy

82
Q

what can cause a diastolic murmur?

A

aortic insufficiency
pulmonic insufficiency
mitral stenosis (rarely audible)

83
Q

what commonly causes a continuous murmur?

A

patent ductus arteriosus

84
Q

where do you need to listen for a patent ductus arteriosus?

A

far cranial left heart base

Cardiovascular Pathophysiology (35 decks)

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