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SA Cardiology > Clinical examination of the cardiovascular system > Flashcards

Clinical examination of the cardiovascular system Flashcards

1
Q

Breed predisposition of mitral valve disease

A

CKCS

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2
Q

Breed predisposition of cardiomyopathy

A

Dobermans

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3
Q

Breed predisposition of aortic stenosis

A

Boxers

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4
Q

Cause of syncope/lethargy

A

Reduced cerebral perfusion

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5
Q

Cause of weakness/reduced stamina

A

Reduced skeletal muscle perfusion

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6
Q

Cardiac causes of a cough

A

Mitral valve insufficiency with left atrial enlargement and compression of the left main-stem bronchus

Often in the abscence of heart failures

Softer and moister than resp cough

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7
Q

Cardiac dyspnoea/wheeze/orthopnoea

A

Due to pulmonary oedema or pleural effusion

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8
Q

What can cause abdominal distension in patients with cardiac disease?

A

ascites and/or hepatomegaly or splenomegaly

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9
Q

Possible physical exam findings in heart failure

A

Slow capillary refill time

Pale or cyanosed MM, dry/tacky MM

Jugular venous distension

‘Resp’ signs

Thrill on precordial palpation

Hepatomegaly and/or splenomegaly

Abdominal effusion/ascites

Subcut oedema

Pulse deficits

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10
Q

What causes cyanosed MMs?

A

Increased quantity of deoxygenated haemoglobin
Arterial saturation less than70% or pAO2 less than 40mmHg

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11
Q

Abdominal effusion/ascites in cadiac patients

A

Right-sided heart failure produces ascites in dogs

Ascites is less common in cats

The presence of ascitic fluid implies an increase in pressure on the right side of the heart i.e. impairment of pumping of blood into the pulmonary vasculature

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12
Q

What could cause weaker pulses?

A

Decreased pressure in heart failure or hypovolaemia

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13
Q

What could cause increased pulses?

A

Anaemia, PDA, aortic regurgitation

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14
Q

What are pulse deficits?

A

Pulse deficits are present when the pulse rate is less than the heart rate.

This occurs because a cardiac contraction or several contractions take place prematurely not allowing enough time for ventricular filling (preload).

This results in heart beats that do not eject enough blood to generate a palpable pulse.

The presence of pulse deficits should alert you to the occurrence of premature ectopic beats.

These may be either supraventricular or ventricular in origin, only the ECG can distinguish these.

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15
Q

What is a hepato-jugular reflux?

A

This test checks for the presence of jugular distention or jugular pulsations when pressure is placed in the region of the cranial abdomen in a ventral to dorsal direction.

The animal should be standing or in sternal recumbency to perform this test.

A positive test result indicates that there is moderate elevated pressure in the right atrium or right ventricle.

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16
Q

What does a positive heapto-jugular reflux test show?

A

Indicates that there is elevated pressure in the right atrium or right ventricle.

Venous distention indicates a severe elevation in pressure, a positive HJR indicates a moderate elevation in pressure.

Patients with a mild elevation in pressure to the right heart cannot be identified on physical examination.

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17
Q

How to determine strength of the pulse:

A

Pulse pressure = systolic pressure - diastolic pressure

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18
Q

What is the arterial pulse affected by?

A

Left ventricular stroke volume

Ejection velocity

The relative compliance and capacity of the arterial system

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19
Q

When do exuberant (bounding) arterial pulses occur?

A

Patent ductus arteriosus and aortic valve insufficiency

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20
Q

Palpation of the heart

A

Palpate the precordial impulse – left side 4th –5th intercostal space

Feel for a precordial thrill – caused by vibrations created by turbulence within the heart through the chest wall

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21
Q

What can be identified on heart auscultation?

A

heart murmurs

gallop rhythms

dysrhythmias

count heart rate - tachycardia/bradycardia

muffled heart sounds due to pleural or pericardial effusions

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22
Q

Diaphragm of the stethoscope used for?

A

High frequency sounds

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23
Q

Bell of stethoscope used to accentuate:

A

low-frequency sounds - 3rd and 4th heart sounds in dogs

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24
Q

Where is the apex beat heard?

A

Over the mitral valve (left apex)

The stethoscope is moved towards the left heart base (2 rib spaces forward and 1/4 chest height up)

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25
Q

Where are aortic and pulmonary valves heard?

A

Over left heart base

26
Q

Where can the precordial impulse be felt?

A

left side 4th - 5th intercostal space (left apex)

27
Q

What heart sounds are normally heard in cats and dogs?

A

S1 and S2

28
Q

What does S1 correlate to?

A

Closure of the AV valves - start of systole

Loudest at the apex of the heart

29
Q

What is the intensity of the first heart sound affected by?

A

It is dependent on the ventricular contractility and therefore is affected by stress and exercise etc.

30
Q

What does S2 correlate to?

A

Closure of the semi-lunar valves

Marks the end of systole and beginning of diastole

Loudest at heart base

31
Q

What could cause the second heart sound to be ‘split’?

A

pulmonary hypertension e.g. secondary to heartworm

32
Q

S3 in small animals

A

Abnormal heart sound

Coincides witht the opening of the mitral valve

Heard in heart diseases that cause dilation of the ventricles (DCM)

Caused by vibrations in a stiffer than normal left ventricular wall

33
Q

S4 in small animals

A

Atrial contraction and flow through the AV valve

Occurs before S1

Most commonly heard in cats with HCM where ventricle is over-distended

Difficult to distinguish with a HR over 180

34
Q

What is a gallop rhythm?

A

The presence of S3 or S4 (or both)

35
Q

Split S1 sound

A

can be heard in some normal large-breed dogs.

36
Q

Split S2 sound

A

Occurs when there is asynchronous closure of the semi-lunar valves e.g. when pulmonary hypertension causes delayed closure of the pulmonic valve.

37
Q

Two mechanisms of heart murmurs

A

Turbulence of blood flow

Vibration of a cardiac structure

38
Q

What is used to characterise a heart murmur?

A

Location, intensity, frequency, timing, quality

39
Q

What causes heart murmus?

A

Insufficient valves
Stenotic valves
Interarterial and interventricular defects (holes in the heart)
Arterial - venous communications e.g. PDA

40
Q

How does blood viscosity affect a heart murmur?

A

If the viscosity of blood is decreased –> murmur;

If the viscosity of blood is increased –> mask a murmur.

41
Q

Innocent murmurs

A

Functional (physiologic) murmurs

Tend to occur in puppies and resolve by 6mo

42
Q

Characteristics of innocent murmurs

A

Soft, low amplitude sounds
Occur in early systole
PMI over the left base
Tend to vary in intensity with a change in HR or body position

43
Q

Aetiology of innocent murmurs

A

Common in young animals
Common in athletes
Occur in pathologic states as fever, anaemia, and hypoproteinaemia

44
Q

Aetiology of functional (physiologic) murmurs

A

common in young animals

common in athletes

occur in pathologic states as fever, anaemia

hypoproteinaemia

45
Q

Examples of systolic murmurs

A

Plateau murmurs e.g. AV valve regurgitation, left to right shunting VSD

Ejection murmurs e.g. aortic stenosis or increased blood flow, pulmonic stenosis,

46
Q

Examples of diastolic murmurs

A

Aortic regurgitation, pulmonic regurgitation, AV stenosis (rarely audible)

47
Q

Examples of continuous murmurs

A

PDA (characteristic machinery murmur), any combination of systolic and diastolic murmur

48
Q

Grade I murmur

A

can only be heard after auscultation in a quiet room, unilateral

49
Q

Grade II murmur

A

can be heard bilaterally, more easily than I

50
Q

Grade III murmur

A

same intensity as the heart sounds

51
Q

Grade IV murmur

A

louder than the heart sounds, no precordial thrill

52
Q

Grade V murmur

A

louder than the heart sounds, but with a thrill

53
Q

Grade VI murmur

A

can be heard with the stethoscope lifted away from the chest wall

54
Q

What is a precordial thrill?

A

A vibration on the chest wall due to fluid turbulence within the heart that also causes a heart murmur on auscultation.

Can be palpated by placing the hands on either side of the thorax overlying the heart.

55
Q

What murmur is systolic, with a PMI at the left base?

A

Pulmonic stenosis
Aortic stenosis
Subaortic stenosis

56
Q

What murmur is systolic, with a PMI at the left apex?

A

Mitral regurgitation

57
Q

What murmur is systolic, with a PMI at the right mid-heart?

A

Tricuspid regurgitation
Subaortic stenosis

58
Q

What murmur is systolic, with a PMI at the right sternal border?

A

Ventricular septal defect

59
Q

What murmur is diastolic, with a PMI at the left base?

A

Pulmonic regurgitation
Aortic regurgitation

60
Q

What murmur is diastolic, with a PMI at the left apex?

A

Mitral stenosis

61
Q

What murmur is diastolic, with a PMI at the right chest wall?

A

Tricuspid stenosis

SA Cardiology (12 decks)

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