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CARDIOLOGY > CLINICAL MANIFESTATIONS OF CARDIAC DISEASE > Flashcards

CLINICAL MANIFESTATIONS OF CARDIAC DISEASE Flashcards

1
Q

What are signs of Heart Failure

A

Weakness and Exercise intolerance

Syncope

Cough and orther respiratory signs

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2
Q

Why Cardiac patients have Exercise intolerance

A

Cardiac disease —-> Decreased CO —–> Decreased Lung and muscle perfusion—-> Decreases O2 delivered to the muscles —–> decreased tendency to do exercise.

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3
Q

What do you mean by Syncope

A

Transient unconsciousness associated with loss of postural tone (collapse) from insufficient oxygen or glucose delivery to the brain.

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4
Q

What is the major DDx for Syncope

A

Seizures

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5
Q

How to DDx syncope from seizures

A

Syncope is associated with Exertion and Excitement
Tonic/clonic motions absent in Syncope
Defecation is absent in Syncope
Neurological deficits will be absent in syncope
Postictal phase is not present in Syncope

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6
Q

What kind of Syncopes are difficult to DDx from Seizures

A

Convulsive Syncope

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7
Q

How convulsive Sycope originates

A

Convulsive Syncope
Sometimes profound hypotension or asystole casues hypoxia —> convulsive suncope with seizure-like activity or twitching, generally preceeded by loss of muscle tone.

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8
Q

What is a presyncope

A

where reduced brain perfusion or substate delivery is not severe enough to cause unconsiousness, may appear as transient Wobbliness or weakness, especialy in rear limbs.

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9
Q

How to perform diagnostics on Syncope

A

ECG
CBC
Biochem with electrolytes
Neurological exams

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10
Q

what are Cardiovascular causes of Syncope according to pathophysiology

HINT; HR, Ventricular outflow, oxygenated blood and others

A

HR RELATED
Bradyarrhythmias
Tachyarrythmias

HOW WELL OUTFLOW OF BLOOD IS
Congenital ventricular outflow obstruction
Acquired ventricular outflow obstruction

HOW WELL OXYGENATED BLOOD IS SEPRATED FROM DEOXYGENATED ONE
Cyanotic heart disease

MISC.
Impaired forward cardiac output
Impaired cardiac filling
Cardiovascular drugs
Neurocargiogenic reflex

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11
Q

What are Pulmonary causes of Syncope

A

Disease causing hypoxia
Pulmonary hypertension
Pulmonary Thromboembolism

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12
Q

What are Metabolic causes of Syncope

A

Hypoglycemia
Hypoadrenocorticism
Electrolyte imbalance ( K and Ca especially)

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13
Q

What are Hematological causes of Syncope

A

Anemia
Hemorrhage

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14
Q

What are Neurological causes of Syncope

A

Cerebovascular accident
Brain tumor ( seizures)

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15
Q

What are other causes of Syncope

A

Narcolepsy ( loss of sleep control )
Cataplexy ( loss of muscle tone)

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16
Q

Why a cardiac patient gets cough ?

A

due to congestive heart failure of left side ( moist)
enlargement of artium ( dry and hacking)

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17
Q

what should be on your checklist for cardiovascualr examination
( HINT; PPFARMJ)

A

Observation of respiratory pattern
Mucous membranes
Jugular vein
Arterial pulse
Pericordium
Evaluation for fluid accumulation
Auscultation

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18
Q

What to look in respiratory pattern

A

Prolonged Laboured Inspiration ( obstruction in URT)
Prolonged Laboured Expiration ( lower pulmonary infilrative Dz, edema)
Open mouth breathing in cats
Orthopnea ( unable to lie in lateral or dorsal position)
Abdducted elbows

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19
Q

What to look for Mucous membranes

A

CRT
Color

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20
Q

What does CRT tell

A

Tells about CO

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21
Q

reasons for slow CRT

A

Dehydration
Decreased CO
High peripheral Sympathetic tone
Vasoconstriction

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22
Q

What is differential cynosis

A

When Caudal mm are cynotic in comparision to cranial mm

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23
Q

In which Dz process you will see Differential cynosis

A

PDA

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24
Q

Reasons for icteric mm

A

Hemolysis
Hepatobiliary Dz
Biliary obstruction

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25
Q

When will you see Cynotic mm

A

WHEN O@ DOES NOT GET TO LUNGS
Pulmonary Parenchyma Dz
Airway obstruction
Pleural space Dz
Pulmonary Edema
Hypoventilation

WHEN HEART IS HAVING TROUBLE SEPRATING BLOOD
Right to left shunt

Misc.
Shock
Cold exposure
Methemoglobinuria

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26
Q

What will cause Icteric mm

A

Hemolysis ( Pre-hepatic)
Hepatobiliary Dz (Hepatic)
Biliary Dz(post hepatic )

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27
Q

What jugular tells us

A

Systemic venous pressure
Right heart filling pressure

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28
Q

What two things you need to see in jugular vein

A

Distension
Pulsation

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29
Q

When will you see presistent jugular vein

A

Right sided CHF
External presure on jugular vein
Thrombus in Jugular or Cr. Venacava
Pericadial effusion
Right inflow obstruction ( atrial mass )
DCM

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30
Q

Up till where the normal send pulse to the jugular vein

A

uptill 1/3rd of the neck

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31
Q

When you will see jugular pulse beyond 1/3rd of the neck along with distension

A

Tricuspide insufficiency ( right side)

Pulmonic senosis (right side )

Heartworm Dz ( it effects rigth side)

Pulmonary hypertension ( pushes blood back)

VPC ( pushing blood beyond need)

3rd degree AV block ( ventricles are over flowing)

Constrictive pericarditis ( heart can’t pump )
Hypervolemia

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32
Q

What is major DDx for Jugular pulse

A

Carotid pulse can be transmitted via surrounding tissue

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33
Q

What will you differentiate tranmitted carotid pulse from jugular pulse

A

The jugualr vein is occluded lighly below the area of visible pulse , if pulse disappears, it is a TRUE JUGULAR PULSE . If it continues then pulse is tranmitted from the carotid artery

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34
Q

What is a hepatojugualr reflux

A

pressure is applied to teh abdomen while animal stands quietly, this increases the venous return, which leads to the transient to no change jugualr distension.

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35
Q

What does positive hepatojugular reflux means

A

The jugular distension that persists while abdominal pressure is applied constitutes a POSITIVE ( abnormal) TEST

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36
Q

From where you will get aterial pulse

A

From the diffence in systolic and diastolic blood pressure

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37
Q

What is hypokinetic pulse, when you see it

A

Weak pulse ( leass difference in SP and DP )

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38
Q

When you see Hypokinetic pulse

A

DCM
Subaortic stenosis
Pulmonic stenosis
Shock
Dehydration

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39
Q

What is Hyperkinetic pulse, when you see it

A

Strong pulse ( more difference in SP and DP )

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40
Q

When will you see hyperkinetic pulse

A

Excitement
Hyperthyroidism
Fever
HCM

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41
Q

When will you see BOUNDING PULSE

A

Patent ductus arteriosus
Fever
Sepsis
Severe aortic regurgitation

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42
Q

What is Pulsus parvus et tardus, when you see it

A

Pulsus parvus et tardus, also known as a “slow-rising” or “anacrotic” pulse, is a sign of a weak and late pulse. The pulse is weak (parvus) and late (tardus) relative to the heart’s contraction.

in Sub aortic stenosis

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43
Q

Key point to remember when to palpate Femoral pulse

A

Always feel fro both femoral pulses and compare them to each other

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44
Q

What does unilateral femoral pulse deficit means

A

Thrombus is artery

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45
Q

what is pulsus alternans , when you see it ?

A

Alternate patternn of weak and strong pulses

During severe myocardial failure

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46
Q

What is pulsus paradoxus? when you see it

A

Weakl pulse with inspiration

Patients with Cardiac temponade–> decreases systolic pressure on inspiration

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47
Q

What is Precordium

A

palpated by placing the palms and fingers of each hand on corresponding side of the animal’s chest wall over the heart

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47
Q
A
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47
Q
A
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48
Q

Where you will feel strongest impulse , what is it’s loction

A

Over area of LEFT APEX during systole
Location = 5th IC space at CC junction on left side )

49
Q

When this impulse moves to abnormal place

A

Cardiomegaly
Space occupying mass in chest

50
Q

When this impulse will be weak

A

Obesity
Pericardial effusion
Weak cardiac contraction
Pneumothorax
Pleural effusion
Intrathoracic mass

51
Q

What it you feel the impulse on right side

A

MEans

Right Ventricualr hypertrophy
Heart is shifted to right side by something
Lung atelectasis
Chest defromity

52
Q

What is PRECORDIAL THRILL

A

very loud murmurs causes palpable vibrations on chest wall

feels like buzzing sensation

53
Q

Where you will feel it

A

On area of maximum intensity

54
Q

Where does the fluid accumulates due CHF

A

in body cavities

55
Q

Where does the fluids accumulate with right sided CHF

A

In Abdomen
Subcutaneous edema

56
Q

What are other signs of right sided CHF

A

Hepatomegaly
Spleenomegaly
Jugular pulse and distension

57
Q

What are parts of Chest auscultation

A

Heart sounds
Heart rate
Heart rhytm
Pulmonary sounds

58
Q

What are two types of cardiac sounds

A

Transient Sounds
( thopse of short duration)
Heart murmurs
( longer soudns occurng during normally the silent part of the cardiac cycle )

59
Q

How you describe the Heart sounds quality

A

Frequency ( pitch)
Amplitude ( intensity / loudness)
Duration
Quality (timbre )
PMI ( Point of maximal intensity)

60
Q

What are ideal conditions to heart sounds

A

Queit room
Standing animal
Stop panting ( holding the mouth shut )
Decrease Respiratory sounds ( placing fingers on one or both nostrils)
Stop purring in cat

61
Q

How to stop purring in cats during cardiac auscultaion

A

place fingers on one or both nostrils
gently pressing the cricothyroid ligament
Waving an alcohol cotton ball near the cat’s nose
or turning water faucet enar the animal

62
Q

How heart sounds are there

A

S1
S2
S3
S4

63
Q

What is the origin of S1

A

Closure of AV valve at onset of Systole

64
Q

What is the origin of S2

A

Closure of Pulmonic and Aortic valve followifn ejection

65
Q

What is the origin of S3 ( ventricular gallop)

A

End of the rapid ventricualr filling

66
Q

What is the origin of S4 ( pesystolic gallop/ atrial gallop )

A

flow of blood into the ventricles during atrial contraction

67
Q

What kind of the sounds does the diaphragm of the stethoscope allows you to listen?

A

High frequency sounds
S1 and S2

https://www.vetvisions.com/wp-content/uploads/2020/04/Poodle-heart-rate.mp3

68
Q

What kind of the sounds does the bell of the stethoscope allows you to listen?

A

Low frequency sounds
S3 and S4

69
Q

When using dtethoscope what to take care ?

A

Firm pressure using diaphragm
Light pressure using bell

70
Q

What to hear on Left side of the chest ?

A

Pulmonic valve ( 2nd and 4th IC space just above sternum )

Aortic valve ( 4th IC space just above CC junction)

Mitral valve ( 5th IC space at CC juntion )

71
Q

What to hear on Right side of the chest

A

Tricuspide valve ( 3rd and 5th IC sapce near CC junction)

72
Q

In Dogs and cats which heartsounds are audible normally

A

S1 and S2

73
Q

How to differentiate Systole and Diastole

A

Systole ( between S1 and S2)
Diastole ( between S2 and S1)

74
Q

When will Precordial impulse occurs

A

After S1( systole)

75
Q

When will Arterial pulse originates

A

Betwen S1 and S2

76
Q

Reasons for loud S1

A

Thin Chest wall
High sympathetic tone
Tachycardia
Systemic arterial hypertension
Short PR interval

77
Q

Reasons for muffled S1 sound

A

Obesity
Pericardial effusions
Diaphragmatic hernia
DCM
Hypovolemia
Poor ventricular filling
Pleural effusions

78
Q

Reasons for Split and sloppy S1

A

may be normal in large dogs
VPC
Intraventricular conduction delays

79
Q

Reason for loud S2 sound

A

Pulmonary hypertension

80
Q

Normal Physiologic S2 split, how it works

A

in some dogs with variation in stroke volume during respiratory cycle

During inspiration, the venous return to the Right ventricle increases –> delayed closure of thed Pulmonic valve
and
During inspiration, the left ventricle filling is reduced –> acceltrated Aortic valve closure

this time gap in PV and AV closure causes Split S2

81
Q

When will pahtological Split S2 occurs

A

Delayed ventricular activation
Prolonged rigth ventricular ejection secondary to -
-ventricular premature beat
-Right bundle branch block
-ventricular or Atrial septal defect
-pulmonary hypertension

82
Q

What is a gallop sound

A

S3 and S4 heartsounds are the gallop sounds ( during diastole)

83
Q

What is Summation glallop

A

Overlaping of S3 and S4 sound

84
Q

Reasosn for S3 gallop in dogs

A

DCM
Advanced valvular disease
CHF

85
Q

Where can you hear S3 gallop best at ?

A

At apex of the heart

86
Q

What are other transient sounds

A

Systolic clicks

87
Q

What are systolic clicks

A

Mid-to late systolic sounds that are usually heard best over the mitral valve area

88
Q

When will you hear systolic clicks

A

associated with Degenrative valvular Dz

89
Q

Early systolic high pitch ejection sound at left base , which Dz process

A

Valvualr pulmonic stenosis
other Dz with dilation of great vessels

90
Q

What is Pericardial knock

A

Distolic sound is caused by sudden checking of ventricular filling by restrective pericardial Dz

Timing is simialr to S3

91
Q

What is a Cardiac murmur

A

continous heart sounds

92
Q

How to describe a cardaic murmur

A

With in cardaic cycle
Systolic/ Diastolic

PMI on precordium

Radiation over chest wall

Pitch

Quality

93
Q

What are types of systolic murmur

A

Early systolic ( Protosystolic)
Middle of systole ( mesosystolic)
Late systole ( telesystolic)
throughout systole ( holosystolic)

94
Q

What are types of diasystolic murmurs

A

Early diastoel ( protodiastolic)
Throughout diastole ( holodiastolic)

95
Q

What will you call the murmurs at end of diastole

A

Pre-Systolic

yes its pre syctolic

96
Q

What is continuous murmur

A

begins in systole and extends throughout diastole

97
Q

How will you grade the murmurs

A

Grade I ( very quiet and can be hearded in quiet surrounding after careful listening )

Grade II ( soft murmurs , but easily heard)

Grade III ( Moderate intensity murmurs )

Grade IV( Loud murmurs , but no Precordial thrill)

Grade V( Loud murmur with palpable precodial thrill)

Grade VI( Very loud + Precordial thrill+ can be heard with stethoscope lifeted from the chest wall )

98
Q

How will you describe PMI

A

Right or Left hemithorax
Apex or Base
Intercostal space
Location of valves

99
Q

How will you describe the murmurs accordign to phonocardiography

A

Holosystolic ( pleatu shaped ) uniform intensity ( S1 to S2)

Crescendo-Decrescendo ( diamond shaped , ejection ) (S1 to S2)

Systolic decresccendo ( gradual dec in in tensity , satrt at S1 and end before S2)

Diastolic murmus ( gradual dec in intensity , start at S2 and ends before S1)

100
Q

So far you know whata various parameters to talk about murmurs , now you cant do all of it with stethoscope unless you are a super huaman
what are the must to tell with cardiac ausculatation alone

A

must esstablish Murmurs are there

Must tell: Diastolic or systolic

PMI

Grade

101
Q

What are Functional murmurs, when do they disapear

A

Decresendo, Phyiologic , innocent puppy murmurs over left heart base.

They disappear at age of 6months

102
Q

What are the causes of Functional murmurs

A

Anemia
Fever
high sympahetic tone
Hyperthyroidism
Marked bradycardia
Peripherla arteriovenous fistula
Hypoproteinemia
Athletic hearts

103
Q

Which disease process has Holosytolic murmurs on left side

justify

A

Mirtal valve Insufficiency

If blood had to regurgitate via MV and cause mumurs, it has to be during whole systolic phase

early stages have WHOOPLIKE quality

104
Q

Where will you hear HS murmurs associated with MVR

A

Left apex
radiates dorsally

105
Q

Which Dz process will cause Systolic ejection murmurs

justify

A

Subaortic stenosis
Pulmonic Stenosis

Both are Ventricular outflow obstruction Dzs , so blood has to be ejected during systole via them to cause murmur.

106
Q

where will you hear SAS mumurs

A

Loud Left hear base
radiates via aortic arch
then right base too
also radiated to carotid arteries
then at calvarium

JUST FOLLOW THE ANATOMY

107
Q

Which breed can have grade II murmurs as normal

A

Boxer and other large breeds

108
Q

Where will you hear PS murmurs

A

at left heart base

109
Q

What is DDx for PS murmurs

A

VSD or ASD with Left to right shuting —> can lead to function PS in normal PV

EXPECTION= small VSD to be heard on right side , indicating direction of shunt.

110
Q

which Dz process is ahving Holosystolic murmurs on right side

A

Tricuspide valve regurgitation

111
Q

Cat with systolic murmurs , what do you think

A

it can be normal, doesnot indicate cardiomyopathy forsure.

112
Q

what is prevelence of Diastolic murmurs in cats and dogs

A

Uncomon

113
Q

DDx for diastolic murmurs

A

Degenrative aortic valve Dz

114
Q

IN which disease process you will hear Decrescendo Diastolic murmurs

A

Pulmonic valve insufficiency

115
Q

Where will you hear Pulmonic valve insufficiency murmurs

A

Left heart base

116
Q

In which Dz process you will hear Continous MAchinery murmurs

A

PDA

117
Q

Where you will hear murmrus linked to PDA

A

Loudest at left base of PV area

radiates cranio-vanterally to the right

Systolic component loud ( all oover chest )
Diastolic component low ( on left heart base only)

118
Q

DDX of Continous MURMURS

A

Concurrent SAS and AV insufficency
Concurrent VSD and AV insufficency

119
Q

What kind of murmurs you will here in Concurrent SAS and AV insufficency

A

Sytolic ejection + S2 sound +Diastolic decrescendo mumurs

S2 sound will not be clear in Continous murmurs

120
Q

What kind of murmurs you will here in Concurrent VSD and AV insufficency

A

Holosystolic +S2 + Diastolic decrescendo murmurs

S2 sound will not be clear in Continous murmurs

121
Q

Short cut

A

|T|P|A|M| [VALVES]
|R|S|S|R| [SYSTOLIC]
|S|R|R|S| [DIASTOLIC]

S= stenosis
R= Regurgitaion

CARDIOLOGY (2 decks)

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