Cardiovascular Physical Exam Flashcards
what are some clinical findings consistent with cardiovascular disease?
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
what are some differentials for pale mucous membranes?
anemia
poor perfusion
what are some differentials for injected mucous membranes?
vasodilation: activity, excitement, septic shock
breed variation
polycythemia
what are some differentials for central cyanosis?
arterial oxygen desaturation:
V/Q mismatch
right to left shunt
what are some differentials for peripheral cyanosis?
reduced cardiac output, regional vasoconstriction
regional cyanosis- vascular obstruction
what are some jugular venous waveforms?
A wave
X descent
C wave
V wave
Y descent
what are the appearances of the jugular vein?
normal jugular vein appearance
distended
pronounced A wave
pronounced V wave
what is normal jugular vein appearance?
normal pulsations in lower 1/3 of neck
what is a hepatojugular reflux?
cranial abdominal pressure: increased venous return to right atrium
what is a normal response to a hepatojugular reflux?
minimal jugular vein elevation, immediate return to normal
where can you palpate cardiac impulse/apex beat?
left ventral thorax
normally left more than right
when is cardiac impulse intensity increased?
hyperdynamic conditions: mitral regurgitation, left-to-right shunts, anemia, sympathetic stimulation, hyperthyroidism, bradycardia, sepsis
when might cardiac impulse intensity be decreased?
systolic dysfunction
shock
what might large displacement of the thoracic wall with cardiac contraction suggest?
hypertrophy
what is the sensation that allows us to feel arterial pulses due to?
difference between systolic and diastolic pressure
what can cause hyperdynamic arterial pulses?
increased stroke volume
diastolic run-off
also called bounding or waterhammer
what are some arterial pulse abnormalities?
bounding pulses
weak pulses: pulsus parvus
pulsus alternans: varying pulse quality
bigeminal pulse
pulsus paradoxus
what is a bigeminal pulse?
alternating strong/weak pulse from bigeminal arrhythmia
what do cardiac stroke volume and pulse strength depend on?
greatly on time for cardiac filling
what can decrease time for cardiac filling?
premature beat: atrial or ventricular
how are pulse deficits determined?
pulse palpation with simultaneous cardiac auscultation
what is the diaphragm on the chest piece better for compared to the bell?
higher frequency sounds: most murmurs
what is the order from cranial to caudal of the valves on the left side of a dog?
pulmonic valve region
aortic valve region
mitral valve region
what does the first heart sound coincide with?
closure of mitral and tricuspid valves
when does the first heart sound split abnormally?
asynchronous ventricles
what does the second heart sound coincide with?
closure of semilunar (aortic and pulmonic) valves
can the second heart sound be split normally?
yes: asynchronous closure of aortic and pulmonic valves
what is a pathologic split of the second heart sound like?
less subtle
what is a pathologic split of the second heart sound caused by?
delayed closure of either aortic or pulmonic valve: prolonged ejection of either ventricle
when is the second heart sound intensity accentuated?
hypertension: systemic hypertension, pulmonary hypertension
what can prolong right ventricle ejection?
pulmonic stenosis or pulmonary hypertension
what does the third heart sound (S3) coincide with?
end of rapid ventricular filling in early diastole, right after S2
what is a pathologic S3 heart sound referred to as?
S3 gallop
gallops are _____________ sounds
diastolic
when is an S3 gallop pathologic?
small animal patients
may be normal in large animals
what does the fourth heart sound (S4) coincide with?
atrial contraction, late diastole, just before S1
what is a pathologic S4 heart sound referred to as?
S4 gallop
what is an S4 gallop in small animals suggestive of?
myocardial disease
hypertrophied, stiff ventricle
sometimes iatrogenic fluid overload
what is a summation gallop?
events corresponding to S3 and S4 sounds coincide in timing
rate dependent gallop
what is a midsystolic click associated with?
mitral valve prolapse
may occur in early in degenerative mitral valve disease
what are heart murmurs caused by?
turbulent, disturbed blood flow
in whom are “innocent” heart murmurs common in?
young animals: relative anemia and decreased body fat
what are the murmur characteristics?
intensity
location
timing
a __________ occurs when murmur intensity is great enough to be palpable on the thoracic wall
thrill
what classifies a grade I murmur?
veery soft murmur heard (with difficulty) in one specific location after minutes of listening in a quiet room or stall
what classifies a grade III murmur?
moderately loud murmur that is readily heard and radiates slightly
what may murmurs do with increasing disease severity?
increase or decrease
when do holosystolic murmurs occur?
starts with S1 and continues to end of S2
what are the disease associations of systolic ejection murmurs?
subaortic or pulmonic stenosis
hypertrophic cardiomyopathy
what are some causes of diastolic murmurs?
aortic insufficiency
pulmonic insufficiency
mitral stenosis
what can cause a continuous murmur?
patent ductus arteriosus
where do you need to have your stethoscope for a continuous murmur?
far cranial left heart base
what grades of systolic and diastolic murmurs are associated with cardiovascular disease?
grade III-IV/VI systolic
any grade diastolic
what can cause injected mucous membranes with vasodilation?
activity
excitement
septic shock
what are the jugular venous waveforms?
A wave
X descent
C wave
V wave
Y descent
what is the V wave in the jugular venous waveforms?
atrial filling
why might a pronounced A wave occur?
incompliant right ventricle
cannon A waves: AV dissociation
what does caudal displacement of the cardiac impulse suggest?
cardiac enlargement
if to right: right-sided enlargement
what can large displacement of thee thoracic wall with cardiac contraction suggest?
hypertrophy
what can cause diastolic run-off?
aortic insufficiency
PDA
when might pulses be hyperdynamic?
increased stroke volume
diastolic run-off
what can cause decreased stroke volume and therefore diminished pulses?
marked systolic dysfunction
hypovolemia
tachycardia
what is pulsus alternans associated with?
severe myocardial dysfunction
tachyarrhythmias with variable cardiac filling
what is pulsus paradoxus?
decreased pulse strength on inspiration resulting from cardiac tamponade (pericardial effusion)
what do pulse deficits have the same clinical implication as?
premature beats: reason to investigate for cardiac disease
what is the bell of the stethoscope best for?
low frequency sounds: normal heart sounds, clicks, gallops
what valve can be auscultated on the right side?
tricuspid valve
when is the intensity of S1 (closure of AV valves) increased?
hyperdynamic conditions
what is physiologic splitting of S2 (closure of pulmonic and aortic valves)?
normally right ventricle takes longer to eject than left
accentuated with inspiration and subtle
what is an S2 pathologic split caused by?
delayed closure of aortic or pulmonic valve: prolonged ejection
what can cause an S2 pathologic split?
right ventricle prolonged: pulmonic stenosis or pulmonary hypertension
left ventricle prolonged: aortic stenosis or systemic hypertension
what can cause a fixed split of S2?
atrial septal defect
what can accentuate S2 intensity?
hypertension: pulmonary more common than systemic
what is an S3 gallop (S3 sound) suggestive of in small animals?
myocardial disease
sometimes iatrogenic fluid overload
what is a summation gallop dependent on?
rate
what is the equation for reynolds number?
radius x velocity x density/blood viscosity
what classifies a physiologic heart murmur?
normal cardiac structure with hyperdynamic state or small aorta
what does murmur intensity relate to?
pressure and rate of flow
what grades of heart murmurs include a thrill?
V or VI/VI
what diseases are associated with a holosystolic murmur?
mitral or tricuspid regurgitation
VSD
what diseases are associated with a systolic ejection murmur?
subaortic or pulmonic stenosis
hypertrophic cardiomyopathy
what can cause a diastolic murmur?
aortic insufficiency
pulmonic insufficiency
mitral stenosis (rarely audible)
what commonly causes a continuous murmur?
patent ductus arteriosus
where do you need to listen for a patent ductus arteriosus?
far cranial left heart base
