Signs Of Heart Disease Flashcards
Signs of heart disease
Cardiac mumurs
Rhythm disturbances
Jugular pulsations
Cardiac enlargement
Other clinical signs of heart failure
Syncope
Excessively weak or strong arterial pulses
Cough or respiratory difficulty
Exercise intolerance
Abdominal distension
Cyanosis
Weakness and exercise intolerance
Inadequate raise in cardiac output to sustain increased levels of activity
Increased pulmonary vascular pressure and oedema
Arrhy-thmias
Syncope
Transient unconsciousness
Loss if postural tone (collapse)
Insufficient oxygen or glucose delivery to brain
Associated with exertion or excitement
Syncope tests (6)
ECG recordings (rest, exercise, vagal maneuver), 24ht holter
CBC, biochem (lytes and BG)
Neuro exam
Thoracic radiographs
Heartworm testing
Echo
LSCHF Signs
Pulmonary venous congestion
Pulmonary oedema- cough, cyanosis, dyspnoea, pulmonary crackles, orthopnea, hemoptysis
Cardiac Arrhythmias
Secondary RSCHF
RSCHF Signs
Systemic venous congestion- increase central venous pressure, jugular vein distension
Hepatic +/- splenic congestion
Pleural effusion (increase RE, orthopnea, cyanosis)
Ascites
Small pericardial effusion
Subcutaneous oedema
Cardiac arrhythmias
Low output signs
Tiring
Exertional weakness
Syncope
Prerenal azotemia
Cyanosis (poor peripheral circulation)
Cardiac arrhythmias
Cause of syncope or intermittent weakness
Cardiovascular causes
Pulmonary causes
Metabolic and hematologic causes
Neurologic causes
Neuromuscular disease
Cardiovascular causes of syncope
Arrhythmias (very fast or slow HR)
Obstruction to ventricular outflow
Cyanotic congenital heart defects
Acquired diseases that cause poor CO
DCM and severe mitral insufficiency
Coughing and other respiratory signs causes (9)
CHF
Pulmonary vascular pathology
Pneumonitis in HWD
Non-cardiogenic oedema
Pleural space disease
Pericardial effusions- cough
LA enlargement
Heartbase tumour
Enlarged hilar LNs
Cardiovascular examination (6)
Respiratory pattern
Peripheral circulation (MM)
Systemic veins (jugular veins)
Systemic arterial pulses (femoral arteries)
Precordium
Palpate and percussing for abdominal fluid accumulation (pleural, ascites, subcutaneous oedema)
Observation of respiratory patterns
Dyspnoea - appear anxious
Increased R effort
Flared nostrils
Rapid rate of breathing
Increased depth of respiration (hyperpnea)- hypoxemia, hypercarbia, acidosis
Rapid and shallow breathing (oedema)
Exaggerated respiratory motions - pleural fluid or air accumulation
Prolonged, labored inspiration- upper airway disorders (obstruction)
Prolonged expiration - lower airway obstruction or pulmonary infiltrative disease (oedema)
Refuse to lie down
Stand or sit with elbows abducted to allow maximal rib expansion
Orthopnea (discomfort)
Cats crouch in sternal position with elbows abducted
Open-mouth breathing in cats
Mucous membrane and CRT
Evaluate peripheral perfusion
Oral, prepuce, vagina, conjunctiva
Slow refill time- dehydration, decreased cardiac output, high peripheral sympathetic tone and vasoconstriction
Pale MM- anemia, peripheral vasoconstriction
Differential cyanosis
Petechiae (platelet disorders)
Jaundice- hemolysis or hepatobiliary disease in cats
Pale MM
Anemia
High peripheral sympathetic tone
Poor cardiac output
Injected, brick-red MM
Polycythemia (erythrocytosis)
Sepsis
Excitement
Other causes of peripheral vasodilation
Cyanotic MM (10)
Pulmonary parenchynal disease
Pleural space disease
Airway obstruction
Pulmonary oedema
Hypoventilation
Shock
Cold exposure
Methemoglobinemia
Right-to-left shunting congenital cardiac defect
Differential cyanosis
Reversed patent ductus arteriosus (head and forelimbs oxygenated blood)
Icteric MM
Hepatobiliary disease
Haemolysis
Biliary obstruction
Jugular vein distension
Systemic venous and right heart filling pressures reflected at jugular veins
RSCHF
External compression of cranial vena cava or jugular vein
Cranial vena cava thrombosis
Visible palpations- tricuspid insufficiency, stiff and hypertrophied R ventricle
Arrhythmia (atria contract against closed AV valves)
Arterial pulses
Strength and regularity
Hyperkinetic, hypokinetic
Absence or weaker pulse on one side- thromboembolism
Fewer femoral pulses than heartbeats= pulse deficit- cardiac arrhythmias causing heart to beat before adequate ventricular filling
Weak arterial pulse during inspiration- cardiac tamponade
Precordium
Strongest impulse during systole over L apex (5th IC space, costochondral junction)
Cardiomegaly
Space occupying mass
Obesity
Weak cardiac contractions
Pleural effusion
Pneumothorax
R ventricular hypertrophy
Precordial thrill - cardiac murmur
Ascultation
Abnormal heart sounds
Heart rhythm and rate
Pulmonary sounds
Attention to valve areas
S1 and S2
Point of maximum intensity of abnormal heart sounds
Transient heart sounds
S1 - closure and tensing of AV valves, onset of systole
S2 - closure and tensing of aortic and pulmonic valves following ejection
S3, S4 - diastolic sounds
Systole (between S1 and S2)
Diastole (after S2 until the next S1)
Audible S3
Gallop rhythm
-Nothing to do with heart’s rhythm
-Usually indicated ventricular dilation with myocardial failure
-Audible S4 associated with increased ventricular stiffness and hypertrophy (HCM, hyperthyroidism).
- transient S4 sometimes heard in stressed or anemia cats
Locations of various valve areas
Left side PAM
PA (mid) heart base
M heart apex
Right tricuspid (heart apical)
Cardiac mumurs
Systolic or diastolic
Intensity (I- VI)
PMI on precordium
Radiation over cheat wall
Quality and pitch
Systolic murmurs (protosystolic, mesosystolic, telesystolic, holosystolic)
Noisy, harsh
Holisystolic, crescendo-decrescendo, systolic decrescendo, continuous (machinery)
Holosystolic: AV valve insufficiency or interventricular septal defects
- crescendo-decrescendo = ejection murmur- ventricular outflow obstructiom
Physiologic murmurs
Anemia
Fever
High sympathetic tone
Hyperthyroidism
Marked bradycardia
Peripheral arteriovenous fistulae
Hypoproteinemia
Athletic hearts
Diastolic murmurs
Aortic insufficiency from infective endocarditis endocarditis
Continuous mumurs
Patent ductus arteriosus- left base above pulmonic valve area
Mitral insufficiency
Plateau murmur
Holosystolic timing
Systolic ejection murmur
Ventricular outflow obstruction
Usually fixed narrowing
Subaortic or pulmonic valve stenosis
Dynamic muscular obstruction
May be louder as CO or contractile strength increases
Subaortic stenosis (Left base, also radiates up aortic arch, which curves toward the right)
Pulmonic stenosis murmur
Low left base
Tricuspid valve insufficiency murmur
R apex
Often accompanied by jugular pulsations
Ventricular septal defects
Holosystolic murmurs
PMI: R sternal border (L to R)
Healthy cats
Systolic murmurs 15-34%
Many subclinical structural cardiac disease
Parasternal region
L or R ventricular outflow obstruction
Diastolic murmur
-Aortic insufficiency from infective endocarditis most common cause
- congenital malformation, degeneration aortic valve disease
- pulmonic insufficiency rare, but more likely in the face of pulmonary hypertension
Continuous murmur
-Substantial pressure gradient exists continuously
-Patent Ductus Arteriosus
-Softer towards end of diastole
-Loudest L base above pulmonic valve area
-Systolic component usually louder
