Cardiovascular Physical Examination Flashcards
what is the 1st step of the CV exam
general eval!!
- attitude, mentation
- ambulation
- body condition
- resting resp rate and character
- cough
- abdominal distension
what are the components of a cardiovascular exam
- mucous membranes
- jugular veins
- cardiac auscultation
- respiratory auscultation
- arterial pulses
- abnormal fluid accumulation
describe mucous membrane eval (5)
- estimate adequacy of peripheral perfusion and tissue oxygenation
- most often oral: gums and tongue
- CRT:
-normal: <2 sec
-prolonged: decreased cardiac output - color:
-normal = pink
-pallor: not getting appropriate blood flow; anemia, peripheral vasoconstriction, reduced tissue perfusion, or combo (ex. shock, dehydration, heart failure, cardiac tamponade, PTE)
-hyperemic, injected: breed variation! but generally, high PCV or peripheral vasodilation due to activity, excitement, or septic shock
-cyanosis: bluish discoloration; increase in deoxygenated hemoglobin (>5 g/dL hemoglobin, <80% oxygen saturation); central vs. peripheral vs. differential
-icteric: due to hemolysis, hepatobiliary disease, or bile duct obstruction
-petechiation: platelet disorder
- not just the mouth!!
-conjunctiva in cows and horses
-buttholes
-birds: combs/waddles
-reptiles: get what you get and you don’t pitch a fit
whata re the 3 types of cyanosis?
- central:
-systemic arterial hypoxemia; entire body head to toe is hypoxemia
-due to ventilation/perfusion (V/Q mismatch; one of the 2 is off or both)
-ex. shunts (tetralogy of fallot) - peripheral:
-locally desaturated hemoglobin or
-increased oxygen extraction
-ex. arterial thromboembolism - differential:
-characterized by: normal (pink) MM cranially and cyanotic membranes caudally
-ex. R to L PDA
describe jugular vein eval
- normal: pulsation up to 1/3 of the neck
- increase in jugular venous distension/pulse indicates
-lesion on the right side of the heart
-or increased RA pressure - distended (>1/3 up the neck):
-increased venous pressure: volume overload, R CHF, CrVC obstruction - pulsation:
-variations in volume due to arrhythmia: atrial fibrillation, atrioventricular block
-increased pressure in RIGHT heart: tricuspid regurgitation, pulmonary valve stenosis
“jugular veins are the window to the right heart”
describe where to ascultate in dogs
valve areas:
-mitral: at and dorsal to left apical impulse
-aortic: craniodorsal to MV, second sound is loudest
-pulmonary: one ICS cranial to aortic valve
other locations: over great vessels: left craniodorsal thorax
PAM
345
right side:
valve areas:
-tricuspid on right, just cranial to MV
other locations: right sternal edge, thoracic inlet
describe where to auscultate in cats/ferrets/ birds
auscultate along each side of sternum/keel apically and cranially
describe where to auscultate in reptiles
we don’t! scales get in the way and blood moves too slow
-just use a doppler to listen to rate
describe obtaining rate and rhythm
- count number of beats over 15 sec, multiple by 4 = BPM
- is HR appropriate for patient? activity level? sympathetic drive?
-too fast: tachycardia
-too slow: bradycardia - rhythm: regular or irregular?
describe heart sounds
- S1/Lub
-closure of the atrioventricular (mitral, tricuspid) valves
-lower pitch
-normal in all animals - S2/Dub
-closure of the semilunar (aortic, pulmonary)
-higher pitch
-normal in all animals - S3
-rapid ventricular filling due to poorly compliant ventricle
-early diastole
-pathologic in SA (gallop)
- +/- normal in LA - S4
-atrial contraction (kick)
-abnormal ventricular relaxation
-late diastole
-pathologic in SA (gallop)
- +/- normal in LA
describe a cardiac murmur
- definition: prolonged audible variations heard during a normally quiet period of cardiac cycle
- general causes:
-high velocity/turbulent flow
-ejection of stroke volume
-decreased blood viscosity (anemia)
-narrow region to large area - physiologic versus pathologic
-not always a sign of disease!
describe murmur description
- intensity/how loud
-grade I-VI
-SUBJECTIVE - location/where is it the loudest
- timing/within cardiac cycle
describe the grades of murmurs
I: low-intensity murmur, heard only in a quiet environment after careful auscultation over a localized cardiac area
II: low-intensity murmur, heard immediately when auscultating over point of maximal intensity, quieter than S1/S2
III: moderate intensity murmur, as loud as S1/S2, easily localized
IV: high-intensity murmur, radiates to several areas of the heart, no precordial thrill
V: high-intensity murmur with palpable precordial thrill (can feel with hands like a barrel of bees)
VI: high intensity murmur with a palpable precordial thrill, can be heard even without stethoscope
describe murmur location
where is it the loudest?
- base/most cranial aspect of heart:
-left: aortic valve, pulmonary valve - apex/most caudal aspect:
-left: mitral valve
-right: tricuspid valve
describe murmur timing
- systolic: 95% of the time
-mitral regurgitation: MOST COMMON
-tricuspid regurgitation
-subaortic/aortic stenosis
-pulmonary valve stenosis
-ventricular septal defect - diastolic:
-aortic insufficiency
-pulmonary insufficiency
-mitral stenosis - continuous:
-PDA - to-and-fro:
-aortic valve stenosis AND aortic insufficiency
-pulmonary valve stenosis AND pulmonary insufficiency
