Approach To Diagnosis And PE Flashcards by Harrie Long

How can age affect CV disease?

Congenital diseases in young

Some acquired diseases in aged animals

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How is gender linked to CV disease?

Give examples

Some cardiac diseases have sec predilection

PDA in bitches
Males have earlier onset with MVD and DCM

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What breeds are susceptible to MVD?

Small breed dogs particularly CKCS

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Why don’t all patients with heart disease go on to develop heart failure?

If its a slow progressive disease they might die of something else first

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What common historical complaints are associated with heart failure?

Dyspnoea 
Cough
Exercise intolerance 
Lethargy
Ascites 
Oedema 
Syncope 
Collapse 
Weight Loss

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In which animals is exercise tolerance easier to detect?

Performance animals e.g. race horses

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What can signs of cardiac disease be confused with?

Respiratory problems
Neurological
Musculoskeletal
Metabolic

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What are the key elements of a CV physical examination?

Observation
Palpation
Percussion (not often done)
Auscultation

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What should you observe?

Demeanour 
Respiratory effort and rate 
Mucous membranes 
BCS 
Venous congestion 
Ascites

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What is a benefit of assessing genital mucous membranes?

Look for differential cyanosis

- cyanosis of the back half of the animal, not the front

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What does cyanosis indicate about the circulation?

Adequate delivery of Hb, by Hb not oxygenated

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How do the colours of the oral mms and conjunctiva usually compare?

Oral often paler than conjunctiva

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What can capillary refill time be used to assess?

What is the most reliable site?

Tissue perfusion

Normally less than three seconds

Oral gum/tooth junction

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Why might an animal with individual ribs and vertebral spinous processes showing have a prominent abdomen ?

ASCITES due to accumulation of fluid in systemic venous circulation

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What vessels can be used to indirectly assess right atrial pressure?

Jugular vein

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What are the principle problems of major blood vessels in horses?

Thrombosis and thrombophlebitis

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What clinical signs are associated with thrombophlebitis?

Distension
Focal swelling 
Latency 
Heat 
Pain

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Why are venous problems common in horses in a veterinary setting?

Catheterisation of veins can result in formation of blood clots which occlude the vein (thrombosis) or cause inflammation (thrombophlebitis)

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What is cranial caval syndrome?

Something occluding the cranial vena cava causes all veins rostral to the CVC to become distended resulting in oedema of the head, neck and forelimbs

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Abroad, what parasite may be associated with RCHF?

Dirofilaria

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What should you do before you auscultate?

Palpate the thorax

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What should you palpate?

precordium and abdomen

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What should you palpate in the precordium?

Apex beat
Location 
Intensity 
Rate and rhythm 
Presence of thrill

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What is meant by the term ‘thrill’ ?

What causes it?

Vibration through the thoracic wall

Vibration of the heart and associated structures due to the very turbulent blood flow through the circulation

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Why would you palpate the abdomen when doing a CV physical exam?

To check for ascites and concurrent disease

What is respiratory sinus arrhythmia? What animal is it normally seen in?

Speeding and slowing of the heart associated with breathing. Dogs = normal

What is pulse deficit?

When an audible contraction is not associated with a palpable pulse

What is the difference between a regularly irregular or irregularly irregular pulse?

Regular - e.g. sinus arrhythmia in dogs | Irregular - not normally observed in a species

What artery is found under the tail of cattle?

Coccygeal artery

What are the four main pulse points in a horse?

External maxillary / facial a Transverse facial a Median a Digital a

What is the ideal position to auscultate a dog? Why?

Ideally standing to ensure the heart is in the normal position in the thorax

What is the left apex?

The area where we hear the mitral valve

How can you identify which sounds are from the mitral valve?

When you palpate the heart, the left apex is what you’ll feel. These sounds are most likely due to the mitral valve

What causes S1? How loud is it compared to S2? Where is it most audible?

Closure of the AV valves Usually loudest Most audible on the left

What can you hear on the right side of the heart?

Tricuspid As the aorta is in the centre, you might also hear these sounds too

What causes S2? Where is it most audible

Closure of the outflow valves Most audible cranially

When would you expect to hear S3 and S4?

Larger animals, e.g horses If in dogs and cats = GALLOP SOUND

What valves are murmurs heard in the left heart base associated with?

Pulmonic and aortic valve

What valves are murmurs heard in the left heart apex associated with?

Mitral valve

What valves are murmurs heard on the right associated with? What else could be identified?

Tricuspid VSD loudest on right

Where are murmurs most audible in cats?

Sternum

What is the point of maximal intensity?

Loudest point of murmur Typically heard over the valve associated with the generation of that murmur

When might you hear murmurs in other areas of the thorax ?

Very loud murmurs may radiate so that they are audible elsewhere on the thorax E.g. loud mitral murmurs can be heard dorsal or on the right side. (PMA should still be over the mitral valve)

What can cause heart murmurs in cats?

Can be valvular | Can be caused by dynamic obstruction of left or right outflow tract

Instead of localising a particular valve, how should auscultation of murmur in cats be approached? Why?

Does it have a murmur? Is it loudest on left or right? How audible is it? Cats have small hearts

How can you describe a murmur?

Timing/Duration Location Intensity (at PMA) / Audibility (Also, radiation, pitch, shape)

What is the most common type of murmur in small animals?

Systolic

What are the AV valves doing during systole?

CLOSED

What kind of murmur is associated with PDA ? Why?

Continuous murmur - present in systole and diastole Aortic pressure is greater than that in the pulmonary artery in both.

What could cause a systolic murmur?

Mitral/ tricuspid insufficiency Aortic and pulmonic stenosis Ventricular septal defect (LV pressure > RV)

What could cause a diastolic murmur

Mitral/tricuspid stenosis A+P insufficiency PDA

What is the main diastolic murmur in horses?

Aortic insufficiency

Describe a Grade I murmur

Barely audible in ideal conditions (i.e. animal not wriggling, owner not talking)

Describe a Grade II murmur

Clearly audible at PMI, does not radiate (not as loud as S1 or S2)

Describe a Grade III murmur

Clearly audible, as loud as S1 and S2 | May radiate

Describe a Grade IV murmur

Louder than S1 and S2 Usually can only hear murmur

Describe a Grade V murmur

Precordial thrill palpable

Describe a Grade VI murmur

Audible with stethoscope off thorax

Where do aortic murmurs tend to radiate?

Up the carotid arteries

Where do mitral murmurs tend to radiate?

Dorsally

What is meant by the term ‘pitch’ in reference to murmurs ?

Subjective description of the frequency of the audible sound associated with a murmur

What is meant by the term ‘shape’ in reference to murmurs?

Description of the appearance on phonocardiogram Crescendo-decrescendo - diamond shaped Pansystolic - plateau

How might you interpret grade I/II / 6 systolic murmurs in a horse? Why?

Non-pathological flow murmur Become more common as they get fitter Large ejection into aorta or slight dilation due to physiological hypertrophy

What are S3 and S4 a result of?

S3 - End of ventricular relaxation/passive filling S4 - Atrial contraction

What is a gallop sound?

Additional heart sound that is NOT a murmur Audible in diastole S3 or S4 audible

What might a gallop sound indicate?

Poor diastolic relaxation of the ventricle

What do crackles indicate?

PULMONARY OEDEMA Indicate alveoli and small airways snapping open at the end of inspiration Can also occur with respiratory disease e.g. PNEUMONIA, PULMONARY FIBROSIS

Approach To Diagnosis And PE Flashcards

(67 cards)