CLINICAL MANIFESTATIONS OF CARDIAC DISEASE Flashcards
What are signs of Heart Failure
Weakness and Exercise intolerance
Syncope
Cough and orther respiratory signs
Why Cardiac patients have Exercise intolerance
Cardiac disease —-> Decreased CO —–> Decreased Lung and muscle perfusion—-> Decreases O2 delivered to the muscles —–> decreased tendency to do exercise.
What do you mean by Syncope
Transient unconsciousness associated with loss of postural tone (collapse) from insufficient oxygen or glucose delivery to the brain.
What is the major DDx for Syncope
Seizures
How to DDx syncope from seizures
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
What kind of Syncopes are difficult to DDx from Seizures
Convulsive Syncope
How convulsive Sycope originates
Convulsive Syncope
Sometimes profound hypotension or asystole casues hypoxia —> convulsive suncope with seizure-like activity or twitching, generally preceeded by loss of muscle tone.
What is a presyncope
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.
How to perform diagnostics on Syncope
ECG
CBC
Biochem with electrolytes
Neurological exams
what are Cardiovascular causes of Syncope according to pathophysiology
HINT; HR, Ventricular outflow, oxygenated blood and others
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
What are Pulmonary causes of Syncope
Disease causing hypoxia
Pulmonary hypertension
Pulmonary Thromboembolism
What are Metabolic causes of Syncope
Hypoglycemia
Hypoadrenocorticism
Electrolyte imbalance ( K and Ca especially)
What are Hematological causes of Syncope
Anemia
Hemorrhage
What are Neurological causes of Syncope
Cerebovascular accident
Brain tumor ( seizures)
What are other causes of Syncope
Narcolepsy ( loss of sleep control )
Cataplexy ( loss of muscle tone)
Why a cardiac patient gets cough ?
due to congestive heart failure of left side ( moist)
enlargement of artium ( dry and hacking)
what should be on your checklist for cardiovascualr examination
( HINT; PPFARMJ)
Observation of respiratory pattern
Mucous membranes
Jugular vein
Arterial pulse
Pericordium
Evaluation for fluid accumulation
Auscultation
What to look in respiratory pattern
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
What to look for Mucous membranes
CRT
Color
What does CRT tell
Tells about CO
reasons for slow CRT
Dehydration
Decreased CO
High peripheral Sympathetic tone
Vasoconstriction
What is differential cynosis
When Caudal mm are cynotic in comparision to cranial mm
In which Dz process you will see Differential cynosis
PDA
Reasons for icteric mm
Hemolysis
Hepatobiliary Dz
Biliary obstruction
When will you see Cynotic mm
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
What will cause Icteric mm
Hemolysis ( Pre-hepatic)
Hepatobiliary Dz (Hepatic)
Biliary Dz(post hepatic )
What jugular tells us
Systemic venous pressure
Right heart filling pressure
What two things you need to see in jugular vein
Distension
Pulsation
When will you see presistent jugular vein
Right sided CHF
External presure on jugular vein
Thrombus in Jugular or Cr. Venacava
Pericadial effusion
Right inflow obstruction ( atrial mass )
DCM
Up till where the normal send pulse to the jugular vein
uptill 1/3rd of the neck
When you will see jugular pulse beyond 1/3rd of the neck along with distension
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
What is major DDx for Jugular pulse
Carotid pulse can be transmitted via surrounding tissue
What will you differentiate tranmitted carotid pulse from jugular pulse
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
What is a hepatojugualr reflux
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.
What does positive hepatojugular reflux means
The jugular distension that persists while abdominal pressure is applied constitutes a POSITIVE ( abnormal) TEST
From where you will get aterial pulse
From the diffence in systolic and diastolic blood pressure
What is hypokinetic pulse, when you see it
Weak pulse ( leass difference in SP and DP )
When you see Hypokinetic pulse
DCM
Subaortic stenosis
Pulmonic stenosis
Shock
Dehydration
What is Hyperkinetic pulse, when you see it
Strong pulse ( more difference in SP and DP )
When will you see hyperkinetic pulse
Excitement
Hyperthyroidism
Fever
HCM
When will you see BOUNDING PULSE
Patent ductus arteriosus
Fever
Sepsis
Severe aortic regurgitation
What is Pulsus parvus et tardus, when you see it
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
Key point to remember when to palpate Femoral pulse
Always feel fro both femoral pulses and compare them to each other
What does unilateral femoral pulse deficit means
Thrombus is artery
what is pulsus alternans , when you see it ?
Alternate patternn of weak and strong pulses
During severe myocardial failure
What is pulsus paradoxus? when you see it
Weakl pulse with inspiration
Patients with Cardiac temponade–> decreases systolic pressure on inspiration
What is Precordium
palpated by placing the palms and fingers of each hand on corresponding side of the animal’s chest wall over the heart
Where you will feel strongest impulse , what is it’s loction
Over area of LEFT APEX during systole
Location = 5th IC space at CC junction on left side )
When this impulse moves to abnormal place
Cardiomegaly
Space occupying mass in chest
When this impulse will be weak
Obesity
Pericardial effusion
Weak cardiac contraction
Pneumothorax
Pleural effusion
Intrathoracic mass
What it you feel the impulse on right side
MEans
Right Ventricualr hypertrophy
Heart is shifted to right side by something
Lung atelectasis
Chest defromity
What is PRECORDIAL THRILL
very loud murmurs causes palpable vibrations on chest wall
feels like buzzing sensation
Where you will feel it
On area of maximum intensity
Where does the fluid accumulates due CHF
in body cavities
Where does the fluids accumulate with right sided CHF
In Abdomen
Subcutaneous edema
What are other signs of right sided CHF
Hepatomegaly
Spleenomegaly
Jugular pulse and distension
What are parts of Chest auscultation
Heart sounds
Heart rate
Heart rhytm
Pulmonary sounds
What are two types of cardiac sounds
Transient Sounds
( thopse of short duration)
Heart murmurs
( longer soudns occurng during normally the silent part of the cardiac cycle )
How you describe the Heart sounds quality
Frequency ( pitch)
Amplitude ( intensity / loudness)
Duration
Quality (timbre )
PMI ( Point of maximal intensity)
What are ideal conditions to heart sounds
Queit room
Standing animal
Stop panting ( holding the mouth shut )
Decrease Respiratory sounds ( placing fingers on one or both nostrils)
Stop purring in cat
How to stop purring in cats during cardiac auscultaion
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
How heart sounds are there
S1
S2
S3
S4
What is the origin of S1
Closure of AV valve at onset of Systole
What is the origin of S2
Closure of Pulmonic and Aortic valve followifn ejection
What is the origin of S3 ( ventricular gallop)
End of the rapid ventricualr filling
What is the origin of S4 ( pesystolic gallop/ atrial gallop )
flow of blood into the ventricles during atrial contraction
What kind of the sounds does the diaphragm of the stethoscope allows you to listen?
High frequency sounds
S1 and S2
https://www.vetvisions.com/wp-content/uploads/2020/04/Poodle-heart-rate.mp3
What kind of the sounds does the bell of the stethoscope allows you to listen?
Low frequency sounds
S3 and S4
When using dtethoscope what to take care ?
Firm pressure using diaphragm
Light pressure using bell
What to hear on Left side of the chest ?
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 )
What to hear on Right side of the chest
Tricuspide valve ( 3rd and 5th IC sapce near CC junction)
In Dogs and cats which heartsounds are audible normally
S1 and S2
How to differentiate Systole and Diastole
Systole ( between S1 and S2)
Diastole ( between S2 and S1)
When will Precordial impulse occurs
After S1( systole)
When will Arterial pulse originates
Betwen S1 and S2
Reasons for loud S1
Thin Chest wall
High sympathetic tone
Tachycardia
Systemic arterial hypertension
Short PR interval
Reasons for muffled S1 sound
Obesity
Pericardial effusions
Diaphragmatic hernia
DCM
Hypovolemia
Poor ventricular filling
Pleural effusions
Reasons for Split and sloppy S1
may be normal in large dogs
VPC
Intraventricular conduction delays
Reason for loud S2 sound
Pulmonary hypertension
Normal Physiologic S2 split, how it works
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
When will pahtological Split S2 occurs
Delayed ventricular activation
Prolonged rigth ventricular ejection secondary to -
-ventricular premature beat
-Right bundle branch block
-ventricular or Atrial septal defect
-pulmonary hypertension
What is a gallop sound
S3 and S4 heartsounds are the gallop sounds ( during diastole)
What is Summation glallop
Overlaping of S3 and S4 sound
Reasosn for S3 gallop in dogs
DCM
Advanced valvular disease
CHF
Where can you hear S3 gallop best at ?
At apex of the heart
What are other transient sounds
Systolic clicks
What are systolic clicks
Mid-to late systolic sounds that are usually heard best over the mitral valve area
When will you hear systolic clicks
associated with Degenrative valvular Dz
Early systolic high pitch ejection sound at left base , which Dz process
Valvualr pulmonic stenosis
other Dz with dilation of great vessels
What is Pericardial knock
Distolic sound is caused by sudden checking of ventricular filling by restrective pericardial Dz
Timing is simialr to S3
What is a Cardiac murmur
continous heart sounds
How to describe a cardaic murmur
With in cardaic cycle
Systolic/ Diastolic
PMI on precordium
Radiation over chest wall
Pitch
Quality
What are types of systolic murmur
Early systolic ( Protosystolic)
Middle of systole ( mesosystolic)
Late systole ( telesystolic)
throughout systole ( holosystolic)
What are types of diasystolic murmurs
Early diastoel ( protodiastolic)
Throughout diastole ( holodiastolic)
What will you call the murmurs at end of diastole
Pre-Systolic
yes its pre syctolic
What is continuous murmur
begins in systole and extends throughout diastole
How will you grade the murmurs
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 )
How will you describe PMI
Right or Left hemithorax
Apex or Base
Intercostal space
Location of valves
How will you describe the murmurs accordign to phonocardiography
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)
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
must esstablish Murmurs are there
Must tell: Diastolic or systolic
PMI
Grade
What are Functional murmurs, when do they disapear
Decresendo, Phyiologic , innocent puppy murmurs over left heart base.
They disappear at age of 6months
What are the causes of Functional murmurs
Anemia
Fever
high sympahetic tone
Hyperthyroidism
Marked bradycardia
Peripherla arteriovenous fistula
Hypoproteinemia
Athletic hearts
Which disease process has Holosytolic murmurs on left side
justify
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
Where will you hear HS murmurs associated with MVR
Left apex
radiates dorsally
Which Dz process will cause Systolic ejection murmurs
justify
Subaortic stenosis
Pulmonic Stenosis
Both are Ventricular outflow obstruction Dzs , so blood has to be ejected during systole via them to cause murmur.
where will you hear SAS mumurs
Loud Left hear base
radiates via aortic arch
then right base too
also radiated to carotid arteries
then at calvarium
JUST FOLLOW THE ANATOMY
Which breed can have grade II murmurs as normal
Boxer and other large breeds
Where will you hear PS murmurs
at left heart base
What is DDx for PS murmurs
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.
which Dz process is ahving Holosystolic murmurs on right side
Tricuspide valve regurgitation
Cat with systolic murmurs , what do you think
it can be normal, doesnot indicate cardiomyopathy forsure.
what is prevelence of Diastolic murmurs in cats and dogs
Uncomon
DDx for diastolic murmurs
Degenrative aortic valve Dz
IN which disease process you will hear Decrescendo Diastolic murmurs
Pulmonic valve insufficiency
Where will you hear Pulmonic valve insufficiency murmurs
Left heart base
In which Dz process you will hear Continous MAchinery murmurs
PDA
Where you will hear murmrus linked to PDA
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)
DDX of Continous MURMURS
Concurrent SAS and AV insufficency
Concurrent VSD and AV insufficency
What kind of murmurs you will here in Concurrent SAS and AV insufficency
Sytolic ejection + S2 sound +Diastolic decrescendo mumurs
S2 sound will not be clear in Continous murmurs
What kind of murmurs you will here in Concurrent VSD and AV insufficency
Holosystolic +S2 + Diastolic decrescendo murmurs
S2 sound will not be clear in Continous murmurs
Short cut
|T|P|A|M| [VALVES]
|R|S|S|R| [SYSTOLIC]
|S|R|R|S| [DIASTOLIC]
S= stenosis
R= Regurgitaion
