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Cardiovascular > Diagnosing Heart Disease > Flashcards

Diagnosing Heart Disease Flashcards

1
Q

How are CV cases worked up?

A 
Same as any other case
- distance exam 
- history
- PE 
- define 1* problem
- refine
- DDx
- diagnostic tests 
> signalment very relevant
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2
Q

What type of disease are young animals predisposed to?

A

Congential abnormalities

- though cats can acquire abnormalities quite young

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3
Q

How does common disease differ between small and large dogs?

A
  • large dogs usually myocardial disease esp. dilated cardiomyopathy
  • small dogs usually valvular disease
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4
Q

What type of cardiac problem are horses predisposed to?

A

Atrial fibrillation and 2* AV block

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5
Q

What type of cardiac disease do cats mainly present with?

A

Myocardial disease (1*)

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6
Q

What cardiac defect are ponies predisposed to?

A

Septal defects

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7
Q

How may sex impact cardiac diseases?

A
  • PDA in bitches

- Dilated cardiomyopathy and mitral valve disease more common in males (or earlier onset)

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8
Q

Which dogs are most afffected by mitral valve disease?

A

Cavalier King Charles PSaniels

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9
Q

Which dogs are typically affected by dilated cardiomyopathy?

A
  • DOberman, irish wolfhound, great dane
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10
Q

What historical complaints are associated with heart FAILURE?

A
  • dyspnoea
  • cough
  • excercise intolerance (poor performance)
  • lethargy
  • ascites
  • oedema
  • syncope
  • collapse
  • weight loss
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11
Q

Define heart DISEASE v heart FAILURE

A
  • Disease = any detectable abnormality eg. hearing a murmur, may be no clinical signs until detected on routine exams
  • Failure = clinical signs associated with inadequate cardiac output or congestive heart failure
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12
Q

What other systems should be included in DDx?

A
  • Resp
  • Neuro
  • Musculoskeletal (much more common cause of poor performance in horses)
  • Metabolic
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13
Q

What 4 methods of physcial examination should be utilised to diagnose cardic disease?

A
  • Observation
  • Palpation
  • Percussion
  • Auscultation
    > in that order!
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14
Q

What sings are you looking for on observation of a potential cardiac case?

A
  • demeanour
  • resp effort and rate
  • mucous membranes
  • body condition
  • venous congestion
  • ascites
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15
Q

Which mm are commonly paler normally?

A

Oral often paer than conjunctiva

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16
Q

Where abouts in the oral cavity is CRT best estimated?

A

Gum/tooth junction

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17
Q

What are the 2 main problems that occour wrt blood vessels in horses?

A
  • thrombosis and thrombophlebitis

> manifest as distension, focal swelling, patency, heat and pain

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18
Q

Which 2 areas should be palpated on a cardio exam? WHat are you palpating for?

A 
> precordium 
- apex beat ( where heart hits thoracic wall) 
- location 
- intensity
- rate and rhythm 
- thrill 
> Abdomen
- ascites
- concurrent disease
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19
Q

What are you feeling for when taking the pulse?

A
  • pulse rate and hrart rate same? (pulse deficit if audible contraction not associated with a pulse)
  • pulse regular? (regularly irregular or irregularly irregular?)
  • quality of the pulse (subjective - strong, weak, thready, bounding etc.)
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20
Q

What can mucous membrane colour tell? egs.

A
  • Pallor: poor peripheral perfusion with vasoconstriction or reduced hemoglobin in the blood (anaemia) differentiate on PCV and quality of arterial pulse
  • Cyanosis: presence of adequate haemoglobin but inadequate oxygenation (due to pulmonary oedema/effusion OR R>L shunt)
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21
Q

What signs indicate venous congestion?

A
  • jugular pulses or jugular distension (indicates ^ right atrium pressure)
  • veins on ventral abdo obvious
22
Q

What does ascites indicate?

A

RHS heart failure in dogs

23
Q

WHat may percussion help detect?

A
  • thorax (lack of resonance if there is consolidation of underlying lung. May detect a fluid line)
  • Fluid thrill in abdomen
24
Q

How should a dog be postiioned for cardiac auscultation?

A

standing

25
Q

Which heart sounds should be audible in the dog and cat? Large animals?

A
  • S1, S2 in small animals

- S1 - 3/4 in large animals

26
Q

What causes S1 sound? Where is it besst heard?

A

CLosure of the AV valves at onset of systole

  • usually loudest sound
  • heard best on left caudally at apex of heart
27
Q

What causes S2? Where will this be heard loudest?

A

Closure of the pulmonic and aortic valves at end of systole

- louest at left heart base (cranially)

28
Q

WHen does systole and diastole occour in relation to the heart sounds?

A

S1 SYSTOLE S2 DIASTOLE S1

29
Q

What causes S3 and S4?

A

> s3
- passive ventricular filling
s4
- active ventricular filling as the atria contract

30
Q

Are s3 and s4 ever normal in small animals?

A

NO

  • 3rd sound indicates poor relaxation and filling of the ventricle
  • Gallop rhythm (Du-Lub-Dup)
31
Q

How can valvular sounds be listened to in the horse?

A

Pull leg forward to gain access to heart

32
Q

What does a murmur indicate?

A

Turbulent flow in the heart (should always be laminar excpet for cats - innocent murmurs)

  • ^ velocity of blood flow
  • ^ volume blood flow
  • v blood viscosity
  • regurgitation across an insufficient valve
33
Q

Which side is VSD loudest?

A

Right

Ventricular Septal Defect

34
Q

When are majority of murmurs heard?

A
  • systole
35
Q

What is the commonest cause of murmur in aging horses? When iin the cardiac cycle is this heard?

A

Aortic regurgitation

- heard in diastole

36
Q

WHat characteristics are used to describe murmurs?

A
  • timing and duration
  • intensity
  • location (point of maximal intensity)
37
Q

Which is the most common cause of continous murmurs?

A

PDA (Patent ductus arteriosus)

38
Q

What is the most important distinction wrt timing of a murmur?

A

systolic v diastolic

- systolic between S1 and S2

39
Q

How can systole be differentiated from diastole is the heart rate is fast?

A

Palpate femoral pulse - will come up soon after systole

40
Q

Where is the heart base? What will be heard here?

A
  • cranial (listen under triceps muscle mass)

- outflow tracts

41
Q

Where is the heart apex? What will be heard here?

A
  • on the left, caudally

- mitral valve will be most audible

42
Q

What can be heard most clearly on the right?

A
  • tricuspid
43
Q

Which diseases may not be heard at a valve possition? Where will they be heard?

A
  • PDA: dorsal to the lef heart base

- VSD: Diagonally from left heart apex to right sternal border

44
Q

How are murmurs graded?

A

> Intensity
1/6: audible after long period listening, perfect conditions
2/6: clearly audible soon as stethoscope placed over area of max intensity
3/6: clearly audible, loud as heart sounds
4/6: louder than heart sounds, no thrill, radiates widely
5/6: thrill palpable at point of maximum intensity
6/6: audible with stethoscope away from chest

45
Q

What is the gallop rhythm?

A

Hearing S3 or S4 in dogs (abnormal)

46
Q

Which way do aortic stenosis murmurs radiate? Mitral?

A
  • aortic up carotid arteries (can be audible over the head)

- mitral radiate dorsally within thorax

47
Q

What does the pitch of a murmur indicate?

A
  • high pitch: ejection murmur

- low pitch: regurgitant flow

48
Q

What type of murmur exhibits a decrescendo? What other descriptions are used for shape?

A

aortic regurgitation in horses

- an be crescendo, crescendo-decrescendo, decrescendo

49
Q

What can intensity of heart sounds tell you?

A
  • muffled with pleural or pericardial effusion

- more audible with gross cardiomegaly

50
Q

What disease may be confused for heart disease?

A

Respiratory disease with concurrent incidental heart murmur - listen for wheezes and crackles

Cardiovascular (11 decks)

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