CLINICAL - Clinical Presentation of Cardiorespiratory Patients Flashcards
What are the two normal heart sounds in small animals?
S1
S2
What are S1 heart sounds?
S1 is the ‘lub’ sound caused by the closure of the atrioventricular (AV) valves
What are the S2 heart sounds?
S2 is the ‘dub’ sound caused by the closure of the aortic and pulmonic valves
What is a heart murmur?
A heart murmur is an abnormal heart sound due to turbulent blood flow
What are the five categories you should use to describe a heart murmur?
Timing
Intensity
Location
Quality
Pitch
What is the timing of a heart murmur?
The timing of a heart murmur refers to when during the cardiac cycle the murmur is heard
What is a systolic murmur?
A systolic murmur occurs between the S1 and S2 heart sounds
Pay attention to the sound of the systolic murmur
What is a diastolic murmur?
A diastolic murmur occurs between the S2 and S1 heart sounds
What is a continuous/machine/holo murmur?
A continuous/machine/holo murmur is continuous throughout the cardiac cycle
Machine murmur sound: https://www.msdmanuals.com/professional/multimedia/audio/patent_ductus_arteriosus_murmurs
What is the intensity of a heart murmur?
The intensity of a heart murmur is how loud the murmur is
This is classified based on a scale from I to VI
What is a grade I heart murmur?
Very soft murmur heard only in a quiet room after a period of concentrated listening
What is a grade II heart murmur?
Murmur audible as soon as the stethoscope is appropriately placed over the point of maximal intensity (PMI)
What is a grade III heart murmur?
Murmur as loud as the normal heart sounds. Heard easily from a distance from the point of maximal intensity (PMI), but not generally on the contralateral side of the chest
What is a grade IV heart murmur?
Murmur louder than the normal heart sounds. Sound radiates widely beyond the point of maximal intensity (PMI) and can be heard on the contralateral side of the chest
What is a grade V heart murmur?
Very loud murmur associated with a palpable precordial thrill
What is a grade VI heart murmur?
Very loud murmur with a precordial thrill that can be detected even without the stethoscope
What can make it challenging to properly assess the intensity of a heart murmur?
Obsese patients can make it challenging to accurately assess the intensity of a heart murmur as the extra layers of fat can obscure the murmur intensity
What is the location of a heart murmur?
The location of a heart murmur refers to where you can hear the loudest point of the heart murmur
Where should you auscultate to hear the pulmonic valve?
Left sided base of the heart
Where should you auscultate to hear the aortic valve?
Left sided base of the heart
Where should you auscultate to hear the mitral valve?
Left sided apex of the heart
Where should you auscultate to hear the tricuspid valve?
Right apical side of the heart
What is the quality of a heart murmur?
The quality of a heart murmur refers to the ‘shape’ of a heart murmur
What kind of murmur is indicated by this murmur quality?
Plateau murmur
What kind of murmur is indicated by this murmur quality?
Crescendo-decrescendo murmur
What kind of murmur is indicated by this murmur quality?
Decrescendo murmur
What is the pitch of a heart murmur?
The pitch of a heart murmur describes the auscultators perception of the frequency of the murmur
What is an arrhythmia?
An arrhythmia is a variation from the normal cardiac rhythm
Which diagnostic test should you do to confirm diagnosis if you have auscultated an arrhythmia?
ECG
What is sinus rhythm?
Sinus rhythm is a regular rhythm characterised by a montonous S1 and S2 cadence
What is a sinus arrhythmia?
Sinus arrhythmia is a regulalrly irregular rhythm associated with a variation in intensity of vagal tone when an animal breathes
In which species is sinus arrhythmia generally normal?
Dogs
Why would you be more concerned if you heard sinus arrhythmia in a cat?
Cats are often stressed when at the vets and thus will have high sympathetic tone so it would generally be abnormal to hear sinus arrhythmia as they will have low vagal tone when at the vets
What is atrial fibrillation?
Atrial fibrillation is a rapid, irregularly irregular rhythm with a variable intensity of heart sounds
What is pulse pressure?
Pulse pressure is the difference between systolic and diastolic pressure
What is indicated by a high pulse pressure?
A high pulse pressure indicates there is a wide difference between the systolic and diastolic pressure
What is indicated by a low pulse pressure?
A low pulse pressure indicates there is a small difference between the systolic and diastolic pressure
What is an anacrotic pulse?
An anacrotic pulse is a weak and delayed pulse
What is pulsus alternans?
Pulsus alternans is an alternation between a strong and weak pulse
What is pulsus paradoxus?
Pulsus paradoxus is where there is a weak pulse during inhalation and a strong pulse during exhalation
(T/F) Jugular distension and pulsation is normal in small animals
FALSE. Jugular distension and pulsation is abnormal in small animals
What is a hepatojugular reflux test?
The hepatojugular reflex test is a non-invasive test used to help diagnose right-sided heart dysfunction
How do you carry out the hepatojugular reflux test?
Press firmly on the right upper quadrant of the abdomen (i.e. over the liver). This should increase the venous return to the right side of the heart via the caudal vena cava. If there is right sided heart failure and fluid overload, this will result in a backflow of blood into the cranial vena cava in response to the further increase in venous return, resulting in jugular distension and pulsations
What is evaluated by capillary refill time (CRT)?
Capillary refill time (CRT) evaluates peripheral perfusion
What is cyanosis?
Cyanosis is the bluish discolouration of the body tissues
What is central cyanosis?
Central cyanosis is a generalised bluish discoloration of the body and the visible mucous membranes
What is peripheral cyanosis?
Peripheral cyanosis is bluish discoloration of the extremities
What is differential cyanosis?
Differential cyanosis is the bluish discolouration of the caudal body
How do you stabilise a dyspnoeic patient?
Oxygen supplementation
Sedation
Analgesia if indicated (i.e. just experienced trauma)
What history questions can be useful to ask when investigating a dyspnoeic patient?
Is the dyspnoea acute or chronic?
Have you noticed any other clinical signs?
Vaccination/worming?
Any recent travel?
Any concurrent disease?
What should you assess during a clinical exam of a dyspnoeic animal?
- General clinical examination
- Assess breathing pattern
- Thoracic auscultation to detect lung sounds, heart sounds, arrhythmias, heart rate etc.
- Assess mucous membranes
- Assess pulse quality
Minimising stress is crucial when assessing dyspnoeic patients
What produces normal respiratory sounds during auscultation?
Normal respiratory sounds are created by the turbulent movement of air in the tracheobronchial tree. These sounds are then transmitted to the chest wall and can be auscultated
What are the normal respiratory sounds?
Inspiratory sounds
Expiratory sounds
Normal respiratory sounds: https://www.msdmanuals.com/professional/multimedia/audio/normal_breath_sounds
How does respiratory disease affect respiratory sounds?
Respiratory disease alters the transmission of the sounds from the tracheobronchial tree to the chest wall, resulting in increased or decreased lung sounds
Which differentials can be indicated by inspiratory dyspnoea?
Nasopharyngeal obstruction (mass, stenosis, foreign body etc.)
Tracheal obstruction (mass, stenosis, foreign body etc)
Laryngeal paralysis
Neoplasia
Which differentials can be indicated by expiratory dyspnoea?
Dynamic airway collapse
Feline asthma
Pulmonary parenchymal disease
Which differentials can be indicated by mixed inspiratory and expiratory dyspnoea?
Pleural effusion
Pneumothorax
Pulmonary thromboembolism
What are adventitious lung sounds?
Adventitious lung sounds are abnormal lung sounds that are superimposed onto normal or increased or decreased respiratory sounds
What are the three classifications of adventitious lung sounds?
Crackles
Wheezes
Ronchi
Describe fine lung crackles
Fine lung crackles are short duration, high pitch sounds usually heart at the beginning or end of a breath
Listen to sounds on lecture
Describe coarse lung crackles
Coarse lung crackles are longer duration, lower pitch sounds compared to fine lung crackles
Listen to sounds on lecture
What is indicated by coarse lung crackles?
Coarse lung crackles indicate the presence of fluid in the large airways
Listen to sounds on lecture
Describe wheezes
Wheezes are long duration, relatively high frequency, musical noises compared to crackles
Listen to sounds on lecture
What causes wheezes?
Wheezes are caused by narrowing of the airways
Describe rhonchi
Rhonchi are long duration, deeper frequency noises compared to wheezes
Listen to sounds on lecture
What causes rhonchi?
Rhonchi are caused by vibrations of the airways and secretions into the airways
Which lung sounds can indicate pulmonary oedema?
Increased lung sounds with end-inspiratory fine crackles, with or without wheezing
Which lung sounds can indicate pleural effusion?
Decreased lung sounds
Which lung sounds can indicate pneumothorax?
Decreased lung sounds
Which lung sounds can indicate bronchitis?
Normal to increased lung sounds
Which lung sounds can indicate pneumonia?
Increased lung sounds with coarse crackles, with or without wheezes or ronchi
Which six history questions can be useful to ask to investigate an animal presenting with a cough?
Is the cough acute or chronic?
How does the cough sound?
Is the cough productive (expelling stuff) or nonproductive?
How often are they coughing?
Have they been around any other animals?
Have there been any other clinical signs?
List seven respiratory causes of coughing
Obstruction
Tracheobronchomalacia (tracheal collapse)
Inflammation
Infection
Neoplasia
Non-cardiogenic pulmonary oedema
Contusions
What is the signalement for tracheobronchomalacia?
Older, small breed dogs
What are the clinical signs of tracheobronchomalacia?
Progressive cough seen mainly during periods of excitement
Dyspnoea
What can you use to diagnose tracheal collapse?
Bronchoscopy
What can you do to manage tracheobronchomalacia?
Adminsiter codeine (antitussive) and recommend using a harness over a collar and lead
List two cardiovascular causes of coughing
Severe left sided congestive heart failure (cardiogenic pulmonary oedema)
Left atrial enlargment causing compression of the airways
(T/F) A persistent cough can indicate cardiac disease in cats
FALSE. Cats never cough due to cardiac disease, however other species do
What is haemoptysis?
Haemoptysis is coughing up blood
What is eupnoea?
Eupnoea is normal, unlaboured breathing
What is hyperpnoea?
Hyperpnoea is an increased volume of air taken in when breathing
What is tachypnoea?
Tachypneoa is an increased respiratory rate
What is orthopneoa?
Orthopneoa is severe respiratory difficulty with an inability to lay down
What is paradoxical breathing?
Paradoxical breathing is a breathing pattern in which the chest moves in during inhalation and the chest moves out during exhalation
How would you stabilise a patient in respiratory distress?
Oxygen supplementation
Sedatives to reduce stress that could worsen dyspnoea
What are the four generalised causes of dyspnoea?
Alveolar hypoventilation
Ventilation perfusion mismatch
Impaired pulmonary diffusion
Metabolic, systemic, toxic causes
What are the three sub-causes of alveolar hypoventilation?
Impaired respiratory mechanics
Obstruction of the airways
Restriction of pulmonary expansion
What can cause impaired pulmonary diffusion?
Alveolar and interstitial disease processes which disrupt gas exchange between the alveoli and capillaries
What is the signalement for idiopathic pulmonary fibrosis?
Middle to old age dogs
Which dog breed is predisposed to idiopathic pulmonary fibrosis?
West Highland Terrier
What are the five clinical signs of idiopathic pulmonary fibrosis?
Dyspnoea
Tachypnoea
Exercise intolerance
Cough
Marked crackles on auscultation
How can you manage idiopathic pulmonary fibrosis?
Inhaled and systemic corticosteroids
