Examination of the Cardio- Respiratory System in dogs and cats Flashcards
What diseases are more likely in certain breeds?
- Myxomatous degenerative valvular disease (= Mitral valve disease) in CKCS or small breed dogs
- Tracheal collapse in Yorkshire terriers
- Dilated cardiomyopathy (DCM) in Dobermanns & giant breeds of dogs
What general history would you take?
- Vaccination & worming status
- Travel outside the UK
- Indoor vs outdoor
- Environment (urban vs rural)
- Other pets or animals in the environment (foxes, slugs etc.)
- Diet / appetite / thirst / V+ / D+ / PUPD
- Access to toxins
- Any change in weight / condition etc.
What history would you take in regard to coughing?
when does the dog cough mainly?
Is the cough “dry” or productive
(retch/ swallow)?
What history would you take in regard to laboured breathing?
When first noticed? episodic / continuous / getting worse?
Orthopnoea (posture to optimise breathing)
Any change in Bark / Miaow?
Nasal discharge?
What history would you take in regard to exercise?
How much normally? changes?
Reluctant to exercise?
Slowing down?
What history would you take in regard to collapsing?
When?
Describe. Loss of consciousness?
Colour of tongue / gums?
Flaccid / rigid? Any muscle movement?
If dyspnoea what should you try defining?
- Inspiratory / Expiratory or Both
- Obstructive versus Restrictive
- Upper vs Lower Airway
With hands on observation what should you check?
- Check Cardiac Output signs and whether adequate peripheral perfusion
- Pulse quality
- Colour of mucus membranes
- Capillary refill (CRT) (normal <2 seconds)
- Warmth of extremities
Forward heart failure is more likely in dilated cardiomyopathy what are the clinical signs?
Lethargy, exercise intolerance
Weak femoral pulses, unable to detect distal pulses (metatarsel)
Pale MM, slow CRT
Cold extremities
Possibly hypothermia
“Cardiogenic shock”
Weak precordial impulse on palpation
Heart sounds “quiet” or “distant” on auscultation
What are the signs of left sided CHF (Backwards HF)?
*Pulmonary oedema
* Tachypnoea, both inspiratory and
expiratory, restrictive breathing pattern
* Cough in dogs due to left atrial enlargement
* +/- soft inspiratory crackles on auscultation
What are the signs of right sided CHF (Backwards HF)?
- Ascites (positive fluid wave on
ballotment) - Distended jugular veins
- Positive hepatojugular reflux
- +/- pleural effusion
- Rarely sub-cutaneous oedema
in SA
How do you check the hepatojugular reflex?
Gentle pressure on the caudal abdomen causes increased distention / pulsation of the jugular veins: sign of increased right sided filling pressure
What is normal HR in dogs + cats?
Dog = 80-140
Cats = 120-200
If HR abnormal what should you do?
Check femoral pulse at same time to detect pulse deficits
What else should you listen out for with the heart?
*Murmurs
*Gallop Sounds
With murmurs what details should you examine?
*Location - Left vs Right; Apex vs Base
*Timing - Systolic / Diastolic / Continuous
*Grade - 1-6
What is a grade 1 murmur?
1/6 = very quiet murmur, only detected in optimal conditions
What is a grade 2 murmur?
2/6 = less loud than the heart sounds
What is a grade 3 murmur?
3/6 = as loud as the heart sounds
What is a grade 4 murmur?
4/6 = louder than the heart sounds
What is a grade 5 murmur?
5/6 = loud heart murmur with a precordial thrill
What is a grade 6 murmur?
6/6 = very loud murmur with a precordial thrill, which can be still detected after lifting the stethoscope off the chest wall
Where is the point of maximal intensity of heart murmurs?
*Left Apex - Mitral valve
*Left Base - Pulmonic valve + Aortic valve
*Left Cranio-Dorsal - Patent ductus arteriosus (PDA)
*Right side of chest:
-Tricuspid valve (apex)
-VSD (cranio-sternal)
What is an innocent murmur what animals are likely to have them?
- Young puppies (and kittens)
- Usually < grade 3/6
- Diminish with growth
- Disappear by 16 – 20 weeks old
- Due to change in foetal to adult haemoglobin
- Can be difficult to distinguish from congenital heart disease
How would you listen out for abnormal S3 + S4 sounds?
- Listen for them with the BELL of the stethoscope; very little pressure on the chest wall, over the left apex.
With auscultation of the lung field what should you check + where could you get referred sound from?
*Referred sounds = URT
*Check Larynx + Trachea
What do crackles and wheezes imply?
*Crackles = Inspiratory - small airway opening
*Wheezes = Expiratory - narrowed airways
What should be done during thoracic percussion?
- Percuss both sides of the chest
- Identify any asymmetry / areas of increased or decreased percussion resonance
Why would you check thoracic compressibility?
- More useful in cats than dogs
- Useful to detect cranial mediastinal masses
- Also less compressible with significant pleural effusion
What is the ABCD classification?
Classification of severity of heart disease/failure
What is in risk group A?
*At risk (all animals)
*no structural abnormality of the heart
What is in risk group B?
*Structural abnormality, no clinical signs.
- B1 – no remodelling or only very mild dilatation of LA or LV (or both)
- B2 – remodelling evident (e.g. significant LA & LV dilatation)
What is in risk group C?
*Structural abnormality with past (treated) or present signs of heart failure. Acute or chronic.
- Moderate: Home treatment of CHF, possibly after hospitalisation treatment.
- Severe: Need for hospitalisation to treat CHF
What is in risk group D?
*Persistent or end-stage heart failure signs, refractory to standard therapy. Can be acute decompensation of chronic CHF.
