Lecture 1b: Clinical Evaluation of CV System & PE Flashcards
diaphragm side of stethoscope listens to:*
high frequency sounds
bell side of stethoscope listens to:*
low frequency sounds
differential cyanosis
the bluish coloration of the lower but not the upper extremity and the head. This is seen in patients with a patent ductus arteriosus (web)
normal jugular veins on PE should:*
not extend past thoracic inlet, should bounce back after being depressed
Hepatojugular reflex*
gentle pressure applied to cranial abd to increase venous return. If jugular pulsations seen, means there is a right-sided heart disease (such as diastolic dysfunction or volume overload)
When you are feeling a pulse, you are feeling the difference between:
systole and diastole
Thrill*
vibration caused by a murmur. The jet of a murmur “hits your hand”
PMI*
point of maximal intensity. Usually located over the LV apex. Web: the point on the chest wall at which the maximal cardiac impulse is seen and/or palpated
murmur is what kind of blood flow?*
turbulent
Regions of cardiac auscultation*
- left apex
- left base
- left, cranial
- R apex
- R base
- Sternum
left apex murmur assoc. with:*
mitral insufficiency, mitral stenosis Usually located at PMI
left base murmur assoc. with:*
(listen to aorta and pulmonary a.) pulmonic stenosis pulmonic insufficiency aortic stenosis aortic insufficiency
left cranial murmur assoc. with:*
PDA, arteriopulmonary window
right side murmur assoc. with:*
(listen to tricuspid valve)
tricuspid insufficiency –> heard best at R apex
ventricular septal defect –> heard best at R heart base
auscultate sternum for:*
murmur, especially in cats because they have a lazy aorta
What to listen for on L side of horse*
Heart base, apex, cranial region for pulmonic valve, aortic valve, mitral valve, PDA.
S1 in horse*
apex beat (listen over apex)
AV valve closure
start of systole
longer sound than S2
S2 in horse*
semilunar valve closure
listen over P and A valve area
represents end of systole
What to listen for on R side of horse*
same as right side. Also listen to tricuspid valve
S1 corresponds to:*
AV valves (mitral and tricuspid) closing
S2 corresponds to:*
semilunar (aortic and pulmonary) valves closing
S3 gallop often due to:*
diastolic volume overloading as in dilated cardiomyopathy, PDA, mitral insufficiency, and septal defects
S4 gallop often due to:*
increased ventricular concentric hypertrophy and stiffness
mid-systolic clicks often due to:*
sudden tensing of chordae tendina
possible cause of split heart sounds*
heart worms
atrial fibrillation sounds like*
some beats soft, others loud. Sounds like shoes in washing machine
sinus arrhythmia sounds like*
uneven beats
3rd degree AV block sounds like*
fast pulse then stop
sinus arrest sounds like*
long period of no beats
Murmurs are classified based on:*
- timing (i.e. is it systolic, diastolic?)
- locaiton
- intensity
- pitch
- shape
systolic murmur*
murmur that you hear between S1 and S2
diastolic murmur*
murmur heard after S2
continuous murmur*
murmur heard throughout S1 and S2
Heart mumur intensity:1*
only auscultable in a quiet room with calm dog
Intensity 2*
soft murmur
Intensity 3*
prominent, readily heard upon auscultation
Intensity 4*
loud murmur that isn’t palpable
Intensity 5*
loud murmur that is palpable (thrill)
Intensity 6*
murmur auscultable with the stethoscope off the chest
Does intensity of murmur = severity?*
Not always. Intensity can vary depending on the “direction” of the murmur, or if a defect creates a small or large hole
High frequency pitch of murmur assoc. with:*
degenerative valve dz in EARLY stages
Low frequency pitch of murmur assoc. with:*
degen. valve dz in LATER stages
Diamond shaped ejection murmur assoc. with:*
Subvalvular aortic stenosis (SAS)
Pulmonary Stenosis (PS)
Ventricular Septal Defect (VSD)
Plateau Shaped Murmur assoc. with:*
Mitral/Tricuspid Insufficiency
Diastolic Decrescendo Murmur assoc. with:*
Aortic/Pulmonary Insufficiency. Begins at the end of systole
Pre-systolic murmur assoc. with:*
mitral stenosis. Diastolic, low-intensity murmur
