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SAM > Exam of the cardiovascular system > Flashcards

Exam of the cardiovascular system Flashcards

1
Q

Detailed exam of the cardiovasc system: order

A

Heart
Blood vessles: arterial, venous, capillary
Blood: mucous membranes, anemia, polycythaemia, dehydration

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2
Q

Physical exam:

A

Inspection (heart and vessels)
Palpation (heart and vessels)
Percussion (heart)
Auscultation (heart)

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3
Q

Inspection of the heart

A

Abnormalities of the thorax e.g injury or malformation
Heart beat- the apex beat in cat and dog
-it’s location and possible dislocation
-intensity/strength and if it is increased or decreased

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4
Q

Palpation of the heart

A

To detect pain
Location of the heart beat- diclocation can be caused by e.g tumour, abscess or pneumothorax
Strength/intensity of heart beat
-increased: exercise, cardiac hypertrophy
-decreased: heart disease, fluid, thickened chest wall
To detect fremitus which can be endo, peri or extra pericardial (the endo is caused by turbulent flow of blood)

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5
Q

Percussion of the heart

A 
Primary goal in smalls is to detect:
- fluid accumulation
-space occupying lesions 
-PTX
To locate the area of cardiac dullness- absolute or relative
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6
Q

Causes of alterations in the area of cardiac dullness

A

Enlargement of cardiac dullness is when dullness is detected in the lower part of the chest
Dilation, hypertrophy
Pericardial effusion
Cardiac dislocation
False enlargement: other organs or space occupying lesions e.g tumour, abscess, hernia
Fluid accumulation- causes a horizontal line of dullness and the Diernhofer triangle disappears

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7
Q

Auscultation of the heart

A

Maximum audibility of the valves
1-4 normal heart sounds
Alterations of the heart sounds: FRIDA
frequency, rhythm, intensity, demarcation, additional

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8
Q

FRIDA: Frequency

A

Coincides with pulse
Starts in aorta coincides with closing of the valves
Pulse deficit is always patho!
Exam: simultaneous ausc and palpation of pulse
Normal values are different depending on species
Changes: tachy or bradycard

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9
Q

FRIDA: rhythm

A

Normally regular

Arrhythmia is patho and is usually accompanied by pulse deficit

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10
Q

FRIDA: intensity

A

Normally uniformly strong and even
Pounding: increasing over first and second sounds
Reduced heart sounds means decreased CO- can be caused by pericardial/pleural effusion or obesity

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11
Q

FRIDA: demarcation

A

Distinctness of the cardiac sounds
Smalls- the 1 and 2 sounds are the most pronounced
Patho: gallop sounds (cardiomyopathy) where 3 can be heard: either 1,2,3 or 4,1,2
Splitting of heart sounds e.g in the 2nd heart sound closure of the aortic and pulmonary valves at different times- can be caused by cor pulmonale

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12
Q

FRIDA: additional sounds

A

MURMURS!!!

Endocardial or extracardiac

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13
Q

Endocardial murmurs

A

Caused by turbulence

  1. Location: points of maximal intensity
  2. Relation to phase of cardiac cycle: systolic or diastolic
  3. Frequency/pitch
  4. Character/quality/shape: continuous, crescendo, decrescendo
  5. Conduction

Morphological: valve, septal, vessel
Functional: innocent murmurs, anaemia causing decreased blood viscosity

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14
Q

Extracardiac murmurs

A

Pericardial or pleuro-pericardial or pleuro-pleural
VARIABLE! location and intensity can be heard during different phases of the cardiac cycle
Extremely rare in smalls

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15
Q

Further/ additional exams

A

Radiography
Echocardiography
US

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16
Q

What can thoracic radiography diagnose

A

Cardiac enlargement
Pulm edema
Extracardiac diseases

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17
Q

How US pictures are formed

A

Sound waves encounter tissues of different densities, sound wave is reflected back to probe and is detected as an echo
When the sound waves penetrate fluid, no echos will be reflected from it and the area appears black in the image

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18
Q

Acoustic impendance

A

Constant value for material in question

Calculated based on density and the acoustic speed of US within the material

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19
Q

Technique of US

A

Transducer can be linear or sector with the necessary frequency
Linear: in a row- supf organs e.g tendons
Sector: cone shaped, smaller contact surface- deeper organs

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20
Q

For echocardiography

A

SECTOR transducers only- needs to fit btw ribs

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21
Q

Diagnostic possibilities of US and echocardiography

A

Exam of the cardiac chambers
Valvular disorders
Contrast echocardiography- shunts, septal defects
Doppler echocardiography- blood flow disorders

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22
Q

Technique for echocardiography

A

Lateral recumbency

Exam from the right hemithorax

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23
Q

Views for echocardiography

A

Right parasternal transducer view

  • long-axis plane gives 4 chamber view
  • short-axis plane changes the angle 90 degress and gives a cross-sectional view of the heart

Quantitative
-gives the left atrial to aortic ratio which is very important to assess left heart failure and severity

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24
Q

What can be diagnosed specifically with echocardiography

A

Dilated cardiomyopathy– dogs
Hypertrophic cardiomyopathy– cats
Pericardial fluid and mass

25
Q

ECG, what is it?

A

Measures amplitude and time of potential differences of electrical current generated through depolarization and repolarization of cardiac structures

26
Q

Principles of the ECG

A

Intracardial- invasive and obsolete
Epicardial
Measurement on surface of body
Voltage measured with height of wave- the positivity or negativity of wave is determined by the positioning of the electrodes and the main direction of the electric axis in the heart

27
Q

Einthoven ECG- triangle measurement

A

Electodes on 3 limbs: negative to right arm, positive to left hind

28
Q

Interpretation of the waves

A

P-wave: SA depolarization
Q-wave: potential is travelling in the pukinje fibers- small negative wave
R-wave: ventricular depol
S-wave: repolarization of base of heart- small negative wave
T-wave: end of ventricular repolarization

29
Q

Goldberg vs Einthoven ECG

A

Goldberg: measurement btw one point and the average of the other 2
30 degree angles therefore more precise

Einthoven- P waves are not always visible!!

30
Q

Artefacts of an ECG

A

Movement- sometimes not all leads are affected
Electrical- 50Hz interference from the ‘normal’ electricity in power outlets
Electrode reversal- wrong placement

31
Q

Indications for ECG?

A

The main ones:
Arrhythmia, tachycardia, bradycardia
Monitoring anaesthesia

Others:
Effect of cardiac or cardiotoxic drugs
Cardiac effects of electrolyte distrubances
Enlargement of cardiac chambers

32
Q

First steps in ECG analysis?

A

Check the quality i.e if there are artefacts
Check if there is electrode reversal
Are the P-waves visible?- if not increase speed or use chest leads or modified limb leads

Recognise and name the waves
Determine the heart rate- count the QRS complexes
Measure distance btw 2 beats i.e the RR distance

33
Q

Morphology of ECG waves

A 
Segment= distance without the wave
Interval= includes the wave  
P-wave: atrial depolaeization 
QRS: ventricular depol
Size of the R and P wave: magnitude of depolarization, measured from the baseline 
PQ: beginning of depol in sinus node to reaching the ventricle
QT: time for ventric depol
ST segment: almost flat
34
Q

Examination of the blood vessels: arterial system

A

Digital palpation, pulse pressure- PULSE
Blood pressure measurement- direct or indirect- sphygmomanometry
Blood flow registration- Doppler US
Pulse wave velocity

35
Q

Pulse quality

A

Depends on size

Difference btw systolic and diastolic BP is pulse pressure

36
Q

What is systemic arterial BP

A

CO x total peripheral resistance

37
Q

Factors determining CO and TPR

A 
Heart rate
Ejection volume
-circulating blood
-heart contraction
-integrity of cardiac structures

Total peripheral resistance

  • vessel diameter: small vessels
  • elasticity of the vessels: large
  • blood viscosity: PCV
38
Q

Parameters to measure when taking the pulse

A

Frequency
Rhythm
Quality-
…size, compressibility(strength) and duration of the pulse waves

39
Q

Abnormal findings of the pulse quality

A

Irregular
Uneven
Size: when large is hyperkinetic, small is hypokinetic
Compressibility: hard has to do with cardiac function, soft has to do with vascular tone

40
Q

Examination of the venous system

A

Inspection
Palpation
Measurement of central venous P

Examine the jugular vein

41
Q

Venous system: parameters

A

Degree of fullness- venous stasis compression test

Movement within veins

42
Q

Physio movements within the vein

A

Resp, diastolic, false (carotis pulse)
Max at ventral 1/3 of neck
Disappears with compression test

43
Q

Patho vein pulse

A

Systolic
Pronounced over the ventral 1/3 of neck
Persists after compression test

44
Q

Congested jugular vein

A

ALWAYS patho!!

45
Q

Blood pressure measurement: central venous pressure

A 
Direct: catherization-
Indirect: 
-examination of peripheral veins 
-hepatojugular reflux test
-dogs: collapse of v. saphena during lifting of hindlimb  in lateral recumbent position
46
Q

Exam of the capillary system

A

Exam of the mucus membranes
Colour
CRT
Fullness of caps

Livid- empty
Light red- increased fullness of arterioles
Violet- congestion

47
Q

Systemic arterial pressure

A

Need to understand that blood pressure is not equal to pulse pressure, blood pressure cannot be examined by palpation

48
Q

How to calculate systolic-diastolic values

A

Pulse pressure= systolic pressure minus diastolic pressure

49
Q

How to calculate mean arterial pressure (MAP)

A

Diastolic pressure+pulse pressure

divided by 3

50
Q

Blood pressure depends on…

A 
Anatomical place- the arterial tree
Body position
Heart rate 
Blood pressure itself 
SAP more affected than DAP or MAP
51
Q

Indications for measuring blood pressure

A

To reveal secondary hypertension in case of known predisposing diseases
Search for cause of target organ damage
To monitor the effect of BP lowering drugs
In shock- to avoid hypotension
Monitor anaesthesia- to avoid hypotension

52
Q

Causes of hypertension

A 
Situational, stress induced 
Measurement error 
Kidney diseases 
Adrenal gland e.g Cushing's 
Hyperthyroidism
53
Q

Conseqeunces of hypertension- target organ damage

A

Eye- cornea and retinopathy, maybe permanent blindness
Brain
Heart
Kidney- proteinuria

Most often no clinical signs

54
Q

Methods of measuring blood pressure

A

Direct/invasive: arterial cannulation! but this is painful and sedation is required
Indirect/non-invasive: Doppler, oscillometry

55
Q

General technique for measuring the blood pressure

A

Calm environment, acclimatization
Take mean of 3-5 measurements
If very high- has to be repeated at least 30 mins later
Cuff-size is 30-40% limb or tail circumference
-if too big the measurement is higher!

56
Q

Doppler method

A

Better in cats vs dogs

57
Q

Oscillometry

A

Determination of the mean arterial pressure (MAP)

Use the a. caud. med on the tail but if the tail is not possible use the FL a. brachialis

58
Q

Additional tests

A 
Blood tests: ANP, BNP, troponin, endothelin
Phonocardiography (PCG)
Non-selective angiocardiography 
Cardiac catherization
Radionuclide imaging 
Serology for e.g Lyme

SAM (16 decks)

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