Examination of the heart and circulatory system Flashcards
What are the major steps in the examination of the heart and circulatory system (9)?
- Temp
- Pulse
- Respiration
- Mucous membranes
- Thoracic palpation
- Auscultation
- Heart percussion
- Abdominal palpation
- Observatino of peripheral blood vessels
What problems/diagnostic info can be determined from temperature?
- Normal/subnormal: heart failure
- Elevated: infection (myocarditis, valvular endocarditis), hyperthyroidism (myocardial hypertrophy in cats)
Pulse evaluation:
Which vessel is usually used?
What can cause tachycardia? Bradycardia?
What are the 4 quality types and causes of each?
- Femoral artery is usually used: rate, rhythm, quality
- Tachycardia
- Heart failure, fear/excitement, exercise, pain, elevated temp
- Bradycardia
- Sleep, excessive parasympathetic tone, diseases of conduction system of the heart
- Quality
- Hyperkinetic (large, strong)–after exercise, anemia
- Hypokinetic (small, weak)–decreased left ventricular stroke volume
- Dilated cardiomyopathy, shock, aortic stenosis, pericardial effusion
- Waterhammer–arterio-veno shunts, severe anemia
- Alternating–arrhythmias
When might respiration be elevated?
Elevated with left and right heart failure
What will left CHF cause during respiration?
End inspiratory crackles (ventral thorax)
Mucous membrane evaluation–name DDx for the following:
Pale
Cyanotic
Brick red
Delayed CRT
- Pale = fear, left herat failure, shock
- Cyanotic = R-L shunts, severe left heart failure
- Brick red = erythrocytosis (red cell leukemia)
- Delayed CRT = decreased L ventricular output or peripheral vasoconstriction (fright, shock)
Name some DDx for the following changes noted during thoracic palpation:
Cranially shifted
Caudally shifted
Strong beat
Weak beat
- Cranial shift = tumors, abscesses or hernias in caudal thorax
- Caudal shift = cranial thoracic tumors (thymus, pre-sternal lymph nodes), or abscesses and cardiac enlargement
- Strong beat = young/thin animals, as well as animals w/ anemia, yrexia, excitement, fear, pain, hyperthyroidism, shunts, enlargement
- Weak beat = shock, heart failure, obesity, emphysema/tumors of the lungs, diaphragmatic hernias and pleural/pericardial effusion
What is found on abdominal palpation that indicates R CHF?
What can sometimes be felt?
Rounded liver edges
Fluid
When observing peripheral blood vessels, what does distension of the jugular veins indicate?
Right CHF
Which 3 characteristics of the pulse are considered in a physical examination?
Rate, rhythm, quality
What information do mucus membranes provide on the cardiovascular system (general)?
Color and CRT can give an indication on the oxygenation and circulation; moisture indicates hydration status
What are the normal heart sounds? Differentiate between them
- S1
- Closure of AV valves
- Best heard over site of apical beat
- Lub sound
- Longer duration, lower pitch, louder than S2
- S2
- Closure of aortic and pulmonary valves
- Shorter duration, softer
- Best heard over aortic and pulmonary valves
Gallop sounds
What are they?
Which beats are heard and what do they represent?
- Result of extra heart sounds
- S3
- Rapid passive ventricular filling
- In dogs/cats only heard with left ventricular enlargement (normal in large animals)
- S4
- Contraction of atria
- Heard in small animals with reduced ventricular compliance–HCM (cats), 2o ventricular hypertorphy (dogs)
What are the 5 types of gallop sounds?
- Protodiastolic gallop = S1, S2, S3
- Presystolic gallop = S4, S1, S2
- Summation = faster heart rates when one cannot distinguish if there is an S3 or S4
- Split S1 = result of left and right AV valves closing at different times
- Split S2 = pulmonary and aortic valves closing at different times (may be result of systemic or pulmonary hypertension)
- Systolic click = early sound of mitral valve degeneration and occurs when cordae tendinae snap tight as the degenerative mitral valve protrudes into the left atrium in mid systole
What are heart murmurs?
What causes them (4)?
- Audible vibrations produced by turbulent blood flow
- Caused by:
- Narrowing of a vessel (pulmonic or aortic stenosis)
- Valvular insufficiencies (endocardiosis, idiopathic dilated cardiomyopathy, valvular endocarditis)
- Increased rate of blood flow (anemia, fever, shunts, hyperthyroidism)
- Decrease in viscosity of the blood (hyperproteinemia)
