Hx and PE Flashcards
What are the cardiac signalments to look out for?
Species
Age
Breed/type
sex
Small breed dogs/CKCs are prone to what?
Mitral valve disease
* more likely in males and with age
Large breed dogs/Dobermans/irish wolfhounds are prone to what?
Dilated cardiomyopathy
What do cats often develop?
myocardial disease
hypertrophic cardiomyopathy is the most prevalent
What is the difference between heart dz and heart failure?
Heart dz: animal with detectable abnormality of heart
heart failure: animals with clinical signs of forward/backward failure
What are the most common hx complaints for heart dz?
dyspnoea
cough
exercise intolerance
lethargy
ascites
oedema
syncope
collapse
weight loss
What are the ddx for dz presenting like cardiac dz?
respiratory
neuro
musculoskeletal
metabolic
What are the 4 steps of a cardia PE?
observation
palpation
percussion
auscultation
What are the main things to observe in cardiac PE?
demeanour
respiratory effort and rate
mucous membranes
BCS
venous congestion (jugular pulses/distention)
ascites
What does the mucous membrane colour indicate?
moist/salmon pink: normal
pale: poor peripheral circulation or reduced haemoglobin in circulation
blue: inadequate oxygenation
What does the capillary refill time indicate?
estimates tissue perfusion
<3s = normal
What do we need to palpate in a cardiac PE?
apex beat
location
intensity
rate and rhythm
presence of thrill
abdomen (ascites, concurrent dz)
What is important to ask when palpating the pulse?
are pulse rate and heart rate the same
is the pulse regular, if irregular is that regular or irregular
describe the quality of the pulse
What is percussion for?
fluid lines
areas of dullness
in abdomen: detection of fluid thrill
Describe the position of the heart’s valves
Left side of body
pulmonic valve (R heart)
aortic valve
mitral valve
R side of body
tricuspid valve
What can we auscultate on the left side?
apex of heart: caudal, mitral valve more audible S1 loudest
base of heart: cranial, pulmonic and aortic valve more audible S2 loudest
What can we auscultate on the right side?
tricuspid valve
possibly aortic valve
ventricular septal defects
When is systole/diastole during the heart beats?
S1 to S2: systole
S2 to S1: diastole
When hearing a murmur near the left heart base we suspect?
pulmonic/aortic valve
When hearing a murmur near the left heart apex we suspect?
mitral valve
When hearing a murmur on the right side we suspect?
tricuspid valve
VSD loudest on right
What is important to remember about murmur in. cats?
can be dynamic
most audible at the sternum
not all murmurs are pathological
What are the characteristics to properly describe a murmur?
timing/duration
location
intensity/audibility
radiation
pitch
shape
What is a systolic murmur?
between S1 and S2: lub-woo-dup
What is a diastolic murmur?
After S2: lub-dup-woo
What is a continuous murmur?
Through S1 and S2, can muffle the heart sounds: woosh-woosh
What is a crescendo-drecrescendo murmur?
between S1 and S2 with loudest moment in the middle
What are the causes of systolic murmurs on the left side?
Apex: mitral insufficiency
Base: Aortic stenosis, Pulmonary stenosis
What are the causes of systolic murmurs on the right side?
Sternal border: VSD
Cranial: Tricuspid stenosis, Aortic stenosis
What are the causes of diastolic murmurs on the left side?
Apex: mitral stenosis
Base: Aortic insufficiency, pulmonic insufficiency
What are the causes of diastolic murmurs on the right side?
Cranial: aortic insufficiency, tricuspid stenosis
What are the 6 grades of murmurs?
Grade 1: barely audible
Grade 2: clearly audible at PMI, does not radiate
Grade 3: clearly audible, as loud as S1 and S2, may radiate
Grade 4: Louder than S1 and S2
Grade 5: precordial thrill palpable
Grade 6: Audible with stethoscope off thorax
What is radiation of murmur?
describes the fact that the murmur continues to be more clearly audible in a particular direction as you go away from the point of maximal intensity
Where can aortic murmurs radiate?
up the carotid arteries
Where can mitral murmurs radiate?
dorsally
What is murmur pitch?
subjective description of the frequency of the audible sound associated with a murmur
What is murmur shape?
description of appearance on phonocardiogram
ex: diamond shaped = crescendo-decrescendo, plateau = pan/holosystolicW
What is a gallop sound?
Additional heart sound, not a murmur, audible in diastole in small animals
du-lub-dup
What does a gallop sound in SA indicate?
S3 or S4 audible may indicate poor diastolic relaxation of the ventricle
What are lung crackles associated with?
pulmonary oedema
indicate that alveoli and small airways are snapping open at the end of inspiration
can also occur with respiratory dz
What are wheezes/stertor associated with?
respiratory dz more likely cause of clinical signs
