Topic 25 - Examination of the heart. Physical and additional methods. Examination of the veins. Flashcards
Aim of cardiac examination:
- To decide whether the cardiovascular system could cause the observed clinical signs?
- To decide whether a symptomless animal has any cardiac disease?
What is the order of a cardiovascular system examination?
- History
- General condition
- Detailed examination of the cardiovascular system
What to examine during the detailed examination of the cardiovascular system?
Heart
Blood vessels
Blood
What do hear about in an animals history?
- Fatigue
- Exercise intolerance
- Dyspnea
- Tachypnea
- Ascites
- Syncope
- Coughing
- Cardiac cachexia
What can cause dyspnea or tachypnea?
- Pulmonary edema (left sided heart failure)
- Thoracic fluid accumulation (right sided heart failure)
- Anaemia
What can cause coughing?
Heart failure does not cause coughing, but worsening of it can be du to failure.
Can also indicate heart worm
What can cause ascites?
- Right sided heart failure (mostly dogs)
- Hypoproteinaemia
- Peritonitis
- Neoplasma
- Liver cirrhosis
- Thrombosis
- Bleeding
What is cardiac cachexia?
Animals with chronic, severe heart disease loose weight,
they are not obese
Additional examination of the heart:
– x-ray
– Echocardiography
– Electrocardiography (ECG)
– Blood pressure measurement
– Bloodtest
- Heart CT, MRI
What can we see when doing an X-ray?
Differentiate between heart failure and respiratory disease
What can we see when doing an ECG?
Not often used.
Used in case of severe heart problems, can see valves working, blood, flow, size, shape etc
What can we see when doing an blood pressure measurement?
Not used for heart failure
Measures the pressure in the arteries,
Which paramters is important in a blood test when examining the heart?
ANP = Atrial natriuretic peptide
BNP = B-Type Natriuretic Peptide
Troponin
Endothelin
What can you see?
Cardiac enlargement
What can you see?
Pulmonary oedema
Diagnostic method in cardiology, the order:
- History physical exam (IMPORTANT)
- Thoracic X-ray and Echocardiography
- Bloodwork
- Holter-ECG
- Blood pressure measurement
- Cardiac catheterization
- Diagnosis
Methods for physical examination of the heart:
Inspection (heart, vessels)
Palpation (heart, vessels)
Percussion (heart)
Auscultation (heart)
What can we find with inspection of the cardiac region?
- Abnormalities of the thorax (injury, malformation)
- Heart beat: apex beat in the dog and cat
What can we find with palpation of the cardiac region?
- Location of the heart beat
- Detection of pain in the cardiac area
- Strength of the heart beat
- Fremitus
Where can we locate the heart beat?
Over the edge of the sternum.
Left side: 3-6 ICS
Right side: 3-5 ICS
What can dislocation of the cardiac beat be caused by:
- Tumor
- Abscess
- Pneumothorax
- Diaphragmatic hernia
- Malformation
Increased strength in heart beat, what can be the cause?
Exercise
Cardiac hypertrophy
Decreased strength in heart beat, what can be the cause?
Heart disease
Pericardial/pleural fluid
Thickened chest wall
What is fremitus, and how can we detect it?
It is a palpable thrill.
We detect vibrations or change in resonance by placing hands on the dogs chest while it breaths
Percussion of the cardiac area, what is the primary goal?
To detect:
- Fluid accumulation
- Space occupying lesions
- PTX (Pneumothorax)
What are the cardiac boundaries?
Hard to tell, since the heart is covered by the lungs, but we can detect cardiac dullness - Either absolute or relative
Does dogs have absolute or relative cardiac dullness? What does it mean?
Absolute
= the heart is in contact with the thoracic wall
+ horse
Does cats have absolute or relative cardiac dullness? What does it mean?
Relative
= Lung lobes are in the way
In dogs, where can we locate absolute cardiac dullness
Right side: 4-5 ICS
Left side: 4-6 ICS
In cats, where can we locate relative cardiac dullness
Usually difficult to detect
Name some alterations of the area of cardiac dullness:
- Enlargement of the cardiac dullness
- Cardiac enlargement
- Pericardial effusion
- Cardiac dislocation
- False enlargement
- Fluid accumulation
What is enlargement of the cardiac dullness?
Dullness in the lower part of the chest
What is false enlargement?
other organs, space occupying lesions, such as: tumor, abscess, hernia
How can we detect fluid accumulation in the heart?
- Horizontal line of dullness
- Diernhofer-triangle disappear
Almost impossible to detect in small animals!
What is the horizontal line of dullness?
No sound can be heard under the line
What is the Diernhofer-triangle?
Diernhofer triangle is normally filled with air, but in case of free fluid in the abdomen it will disappear.
Even in heart enlargement it remains.
Methods for examination of veins
Inspection
Palpation
Measurement of central venous pressure
Which veins can we examine?
V.jugularis
Parameters to examine with a vein:
- Degree of fullness
- Movement within veins
How can we examine the degree of fullness of the vein?
We use the venous compression stasis test
Jugular is normally empty
Saphenous is normally dilated
What gives a positive venous compression stasis test?
no emptying below the compression point or no disappearance of venous undulation
How can we determine the movement within the veins?
With the A, C, V wave
What is the A wave?
right atrial contraction
Ends synchronously with the carotid artery pulse.
What is the C wave?
right ventricular contraction
What is the V wave?
venous filling
Occurs during and following the carotid pulse.
Causes of abnormal movements within the veins:
- Undulation (influenced by breathing /dyspnea)
- Negative or atrial venous pulse
Can be normal or due to right sided heart failure - Positive or ventricular pulse
Always pathological - Hepatojugular reflux
Physiological movements within the vein:
- respiratory, diastolic, false (carotis pulse)
- max. ventr. 1/3 of neck
- disappears with compression test
Pathological movements within the vein:
- systolic
- pronounced (over the ventral third of the neck)
- persists after compression test
- Congested jugular vein
