Computer test - Cardiac system Flashcards
What are the charasteristics of the pulse pressure ?
- Difference between systolic and diastolic blood pressure
- Determined by HR, stroke volume, and peripheral resistance
What are the indications of an ECG ?
- Irregular heartbeats noted during physical exam
- Bradycardia
- Tachycardia
- …
- Evaluation of cardiac arrhytmias
- Detect enlarged cardiac chambers (echocardiography is better)
- Show cardiac disturbances of electrolytess and systemic diseases
- Aid cardiac diseases diagnosis
- Monitor anaesthesia
- Evaluate effectiveness of cardiac drugs (digitalis glycosides…)
In dogs, right sided heart failure can lead to (F/T) :
- Ascites
- Pulmonary oedema
- Distended jugular
- Dyspnoaea
True : Ascites, pulmonary edema, distended jugular
What is true about pre-cordial thrill (fremitus) ?
Pathological, grade 5 murmur
When is fremitus heard ?
Dry pleurisy, bronchitis, fibrinous pericarditis, stenotic cardial valves, valve insufficiency
Where can the heart be palpated ?
Between the 3rd and 6th ICS, all species on both sides except Ru, Pig (only on the left)
Where is the apical beat located on the dog ?
Over the edge of the sternum, left 3-6 ICS, right 3-5 ICS
Where can the pulse be measured on the cow ?
- A. facialis
- A. transversa faciei
- A. coccygea
- A. auricularis caud
- A. femoralis
- A. digitalis lat and med
- A. facialis
- A. transversa faciei
- A. coccygea
Where can the pulse be measured on the horse ?
- A. facialis
- A. transversa faciei
- A. coccygea
- A. auricularis caud
- A. femoralis
- A. digitalis lat and med
- A. facialis
- A. transversa faciei
- A. digitalis lat and med
(+ median arteries in the axillary region)
Pericardial tamponade in cows signs ?
Pulse changes with respiration
Positive veinous stasis test → no emptying below the compression point
What is grade 5/6 of cardiac murmurs ?
Very loud murmur with precordial thrill
Puncta maxima of the dog on the left side ?
For heart apex : 3-6 ICS
For murmur : 3P-4A-5M
In which species can you feel the heart on the right side ?
- Cat
- Cattle
- Goat
- Dog
- Horse
- Swine
- Rabbit
- Cat
- Dog
- Horse
- Rabbit
In which species can’t you feel the heart on the right side ?
- Cat
- Cattle
- Goat
- Dog
- Horse
- Swine
- Rabbit
- Cattle
- Goat (+ sheep)
- Swine
Apical beat location in the dog and cat ?
Left 3-6 ICS
Right 3-5 ICS
Arterial palpation standpoints ?
Rhythm
Symmetry
Rate
Quality → Size, strenght, duration of pulse wave, fullness of artery
Type of examination commonly carried out together with ECG ?
PhonoCardioGraphy PCG
What is true concerning the systolic heart murmur in horses ?
- Can be physiologic
- Graded 1-3/6
- Can be heard on the left side of the thorax
- Localized and brief
- Intensity may change with exercise
- Due to ventricular filling
- Happens in late systole
- Crescendo
- Can be physiologic
- Graded 1-3/6
- Can be heard on the left side of the thorax
- Localized and brief
- Intensity may change with exercise
What could cause a cardiac beat dislocation ?
Pneumothorax
Hydrothorax
Abscess
Tumour
In dogs, left-sided heart failure can lead to
- Ascites
- Dysponea
- Coughing
- Tachypnoe
- Dysponea
- Coughing
- Tachypnoe
In what kind of conditions would you hear a stronger heartbeat ?
Thin thoracic wall
Exercise
Cardiac hypertrophy
Dislocation
What causes enlarged P-wave ?
Atrial enlargement
Examination of heart ?
Inspection, palpation, percussion, auscultation
Further exams :
HISTORY (+++ important)
X rays
US +/- Doppler
Blood work (ANP, BNP, troponin, endothelin, cTr-l, AST, CK, LDH1, LDH2
ECG, Holter ECG
Blood pressure measurement
Phonocardiography PCG
Non selective angiography
Cardiac catheterization (intracardiac pressure, oxymetry, selective angiography)
Radionucleide imaging
Serology (Lyme, ANA, Dirofilaria, Trypanosoma…)
CT, MRI
Examination of vessels ?
Inspection, palpation
What can you evaluate during inspection of the cardiac area ?
Abnormalities of the thorax Heart beat (ictus cordis) : apex beat (dog+cat), location, intensity
What can you evaluate during palpation of the cardiac area ?
Intensity/location of the heart beat
Pain
Fremitus (endo/peri/extraperi -cardial)
Normal place of the heart apex in horse ?
Left 3-6 ICS
Right 3-4
Normal place of the heart apex in cattle ?
Under the shoulder line
Left 3-5 ICS
Normal place of the heart apex in sheep/goat/swine ?
Left 3-5 ICS
Normal place of the heart apex in dog & cat ?
Over the edge of the sternum
Left 3-6 ICS
Right 3-5 ICS
Normal place of the heart apex in rabbit ?
Over the edge of the sternum
Left 2-4 ICS
Right 2-4 ICS
What can you evaluate during percussion of the cardiac area ?
Pain
Cardiac dullness, Diernhofer triangle
Area of cardiac dullness and type of cardiac dullness in horse ?
Left 3-5 ICS
Right (ventral third) 3-4 ICS
ABSOLUTE
Area of cardiac dullness and type of cardiac dullness in cattle & small ruminants ?
Left 3-4 ICS
Relative
Area of cardiac dullness and type of cardiac dullness in swine ?
Left 2-3 ICS
Relative
Area of cardiac dullness and type of cardiac dullness in dog ?
Left 4-6 ICS
Right (ventral third) 4-5 ICS
ABSOLUTE
Area of cardiac dullness and type of cardiac dullness in cat ?
Left not easily detected
Relative
How is absolute dullness of the cardiac area ?
Dull
Due to direct contact between heart and thorax
How is relative dullness in cardiac area ?
+/- dull
Due to thin lung tissue between heart and thorax
Enlargement of cardiac dullness area possible causes ?
Cardiac enlargement
Cardiac dislocation
Pericardial effusion
False enlargement of cardiac dullness area possible causes ?
Dullness in neighbouring organs
Frictional (rubbing) auscultation
Decreasing of cardiac dullness area possible causes ?
Lung emphysema
Emphysema of the skin
Pneumothorax
Cardiac dislocation
How many normal heart sounds ?
4
What is the cause for the first heart sound ?
Beginning of systole, caused by the initial movement of the ventricle, the abrupt arrest of blood flow as AV valves tense, and the early part of ejection
What is the cause for the 2nd heart sound ?
End of systole, caused by the change in direction of blood flow, closing the semilunar valves
What is the cause for the 3rd heart sound ?
Termination of rapid ventricular filling, commonly heard at or caudal and dorsal to the apex beat
What is the cause for the 4th heart sound ?
Atrial contraction and sudden arrest of the distended ventricle
In which species can the 4 heart sounds be audible ?
Horse
In horses, when heart rate is <35 / min, how many heart sounds can be heard ? Which ones ?
4
4-1 2-3 4-1 2-3
In horses, when heart rate is [35-80] / min, how many heart sounds can be heard ? Which ones ?
2
4+1) (2+3) (4+1) (2+3
In horses, when heart rate is >80 / min, how many heart sounds can be heard ? Which ones ?
3 1 2 (3+4) 1 2 (3+4)
What are the possible changes of heart sounds (5 keywords) ?
FRIDA Frequency Rhythm Intensity Demarcation Adventitious sounds
Physiological changes in heart rhythm in horses ?
Intermissio cordis (dropped heart beat) 2nd degree AV block
What is respiratory arrhythmia ?
Slower heart rare during expiration (vagus effect, cranial nerve X)
Changes in frequency (examples) ?
Tachycardia, bradycardia
What heart sounds can be heard in the case of a cardiomyopathy ?
4 - 1 - 2
2 types of adventitious sounds ?
Endocardial & extracardial murmurs
Causes for endocardial murmurs ?
Morphological changes (valve deformities, septal/vessel malformations..) Functional changes (innocent murmurs, anemia..)
Causes for extracardial murmurs ?
Pericardial or pleuropericardial murmurs → pericardial splashes, rubbing, pleuropericardial rubbing (tested with Valsalva probe)
What is the Valsalva probe ?
Pleuropericardial-pleuropleural rubbing (disappears if breathing stops). Pericardial rubbing is increased if breathing stops at the end of inspiration (increased intrathoracic pressure)
Normal (functional) heart murmurs in horses ?
→ Caused by vibrations (ejection of blood from the heart during early systole → blood flow in aorta and pulmonary artery)
Left side of thorax, Grade 1-3, PMI over aortic or pulmonary valves, early-to-midsystolic, crescendo-decrescendo or decrescendo, localized and brief, intensity may change with exercise
→ OR Rapid filling of the ventricles during early diastole (ventricular filling). Common in young horses and thoroughbreds. Left side of thorax, Grade 1-3, PMI over mitral area, early diastolic (S2-3), or late diastolic (S4-S1). Quality is often musical/squeaking
PMI in horses ?
Pulmonary : left 3rd ICS below point of shoulder
Aortic : left 4th ICS below point of shoulder
Mitral : left 5th ICS halfway between shoulder and sternum
Triscuspid : right 4th ICS
Number of murmurs grades ?
6
Description of murmurs grades ?
I - Very soft murmur, heard only after a few seconds in a quiet room
II - Soft murmur but easily heard directly upon auscultation
III - Moderate intensity murmur with good audibility
IV - Loud murmur, very good audibility but without precordial thrill
V - Very loud murmur with precordial thrill
VI - Loudest murmur, even audible with stethoscope lifted from the chest wall
Classification of endocardial murmurs standpoints ?
Localization Grade/Intensity Timing (related to the cardiac cycle) Frequency/Pitch Character (quality, shape : crescendo, decrescendo, continuous, plateau, diamond-shaped) Conduction (y/n) Duration Effect of changing heart rate
Possible endocardial murmurs “frequency/pitch”
Low, medium, high,
Blwing, whisthling, crackling, rough, musical
Examination of the arteries ?
Digital palpation
BP measurement (direct/indirect via sphygmomanometer)
Blood flow registration (Doppler US)
Where can the pulse be measured on the swine ?
- A. facialis
- A. transversa faciei
- A. coccygea
- A. auricularis caud
- A. femoralis
- A. facialis
- A. femoralis
Where can the pulse be measured on dogs and cats ?
- A. facialis
- A. transversa faciei
- A. coccygea
- A. auricularis caud
- A. femoralis
- A. femoralis
How to qualify these pulse qualities : Uneven pulse Irregular pulse Small, brief & hard pulse Small, prolonged and weak pulse Skipping &large pulse Paradox pulse
Uneven pulse = pulsus irregularis (respiratory or true arrhythmia)
Irregular pulse = p.inequalis / alternans (arrhythmia, cardiomyopathy)
Small, brief & hard pulse = p. contractus
Small, prolonged and weak pulse = p. piliformis
Skipping & large pulse = p. celer et magnus (Corrigan-pulse)
Paradox pulse = p. paradoxus = weak during inspiration, strong in expiration, due to cardiac tamponade
How to qualify these pulse sizes ?
- Large & hyperkinetic
- Small & hypokinetic
- Large & hyperkinetic = pulsus magnus
- Small & hypokinetic = p. parvus
How to qualify these pulse durations ?
- Sluggish
- Skipping
- Sluggish = pulsus tardus
- Skipping = p.celer
How to qualify these pulse sizes & durations ?
- Full
- Empty
- Full = pulsus plenus
- Empty = p. vacuus
Examination of the veins ?
Inspection palpation
Measurement of central venous pressure
Veins available for examination ?
Jugular
Sapehnous
Episcleral, Mm veins
Subcutaneous abdominal vein (milk vein) in cattle
What parameters can be evaluated in veins ?
Degree of fullness (jugular vein is normally empty)
Movement within the veins (normal = undulation; negative/atrial venous pulse, positive/ventricular pulse; hepato-jugular reflux)
Define :
Negative/atrial venous pulse
Positive or ventricular pulse
Hepato-jugular reflux
→ Negative/atrial venous pulse : increased right atrial pressure during diastole, can be normal or caused by tricuspid stenosis
→ Positive or ventricular pulse : increased right ventricular pressure and improper valve closure during systole. Always pathological (right sided heart failure)
→ Hepato-jugular reflux: increased CVP causes distended jugular vein seen by pushing liver of small animals
Pathological vein pulse description ?
Systolic, pronounced (over the ventral 1/3rd of the neck), persistant after compression test, congested jugular vein
