Cardio 1

Question 1

Left base, continuous murmur

Answer 1

PDA. Typically small dogs and herding breeds

Question 2

Left base, systolic ejection murmur

Answer 2

SAS or PS or possibly physiologic murmur (softer)
PS more cranial than SAS
PS: small breeds, brachiocephalics, terriers
SAS: large, sporting breeds

Question 3

Left base diastolic, blowing murmur

Answer 3

Aortic regurgitation
sometimes SAS or VSD
Rarely- high velocity pulmonic regurgitation

Question 4

Left apex systolic ejection murmur

Answer 4

Early mitral regurgitation - harsher sound

SAS- best heard over the CCJ due to lesion location (SUB aortic)

Question 5

Right apex to sternum, systolic ejection

Answer 5

VSD- best heard at right sternal border (most common congenital heart defect in cat, horse, cow!)

Occasionally high velocity tricuspid regurgitation may have ejection quality, but PMI should be higher at right apex

Question 6

Right apex to sternum, systolic plateau

Answer 6

Tricuspid regurgitation. Consider endocardiosis, or TR secondary to Pressure overload (i.e. pulmonary hypertension or PS, congeital valve dysplasia (Labs, Gr Dane, Borzoi, Boxer, large sporting breeds)

Question 7

What are normal respiratory sounds?

Answer 7

Bronchial and vesicular

Question 8

Bronchial sounds

Answer 8

Tubular sounds (centrally)

Question 9

Vesicular sounds

Answer 9

Soft, breezy (peripherally)

Question 10

Left sided congestive heart failure (pulmonary edema) sounds

Answer 10

End- inspiratory/ initial expiratory fine crackles

Lung sounds may be harsh or quieter than expected (esp cats)

Question 11

Listen to stenosis and regurg sounds on class files!

Answer 11

!

Question 12

Stertor and stridor

Answer 12

discontinuous sounds and wheezes, heard without stethoscope

Question 13

Crackles

Answer 13

Nonmusical, discontinuous sounds (crumpled paper)

Question 14

Wheezes

Answer 14

Musical, continuous sounds

Question 15

Pale MM

Answer 15

Anemia, peripheral vasoconstriction

Question 16

Bright red MM

Answer 16

excitement, peripheral Vasodilation, sepsis, polycythemia

Question 17

Blue or gray MM

Answer 17

airway disease, pulmonary parenchymal disease, R to L cardiac shunt, hypoventilation, shock, methemoglobinemia

Question 18

Icteric MM

Answer 18

Hemolysis, hepatobiliary disease

Question 19

Are jugular veins normal in standing small animals?

Answer 19

NO

Question 20

What do jugular pulses indicate?

Answer 20

They do NOT indicate congestive HF

They DO indicate: Elevated R heart filling PRESSURES or obstruction to right heart filling

Question 21

Causes of jugular pulsations

Answer 21

Tricuspid insufficiency
Hypertrophied R ventricle (e.g. pulmonic stenosis, pulmonary hypertension)
Certain arrythmias (e.g. complete heart block)

Question 22

Causes of jugular distension (+- pulsations)

Answer 22

Occlusion of Cranial VC or RA by: external compression, mass, thrombosis
Very high right heart filling pressures (severe pericardial effusion)

Question 23

What is hepatojugular reflux?

Answer 23

One presses on liver and sees a jugular pulse

Question 24

What is pseudo jugular pulsation?

Answer 24

Carotid artery pulsation sometimes seen at thoracic inlet in thin dogs- mistaken for jugular pulse

If you palpate, you will feel an arterial pulse (you won’t feel jugular pulses)

Question 25

How do you palpate the precordium?

Answer 25

Palpate the heart beat on the chest wall, normally felt strongest on the LEFT

Question 26

Shifted precordial impulse (to the right)

Answer 26

Cardiac enlargement (e.g. R heart hypertrophy) Mass lesions that displace heart Collapsed lung lobes displacing heart Air or fluid accumulations

Question 27

Decreased intensity of precordial impulse

Answer 27

Obesity, pleural and pericardial effusion, weak cardiac contractions, thoracic masses, Pneumothorax

Question 28

Precordial Thrill

Answer 28

Some loud murmurs have palpable buzzing sensation on the chest wall over the heart (palpable murmur)

Question 29

Abdomen exam findings

Answer 29

Distension, organomegally, fluid wave

Question 30

Peripheral pulses

Answer 30

Hyper kinetic, hypokinetic, deficits

Question 31

Hyperkinetic pulses

Answer 31

Result of wide separation between systolic and diastolic arterial pressure Common causes= High adrenergic tone, PDA, aortic regurgitation

Question 32

Hypokinetic pulses

Answer 32

Feel weaker than normal, caused by reduced Stroke volume or narrowed pulse pressure Occurs with: heart failure, hypovolemia, some arrhythmias

Question 33

Pulse deficit

Answer 33

Fewer femoral pulses than heart beats, indicating arrhythmia such as VPC Use ECG!

Question 34

S1

Answer 34

AV valves close | S1 is longer and lower pitched than S2

Question 35

Split S1

Answer 35

Heard with conduction alterations between the 2 sides (Right bundle branch block, VPCs) or normal in very large dogs

Question 36

S2

Answer 36

Closure of SL valves | best heard over aortic area

Question 37

Split S2

Answer 37

Heard due to delayed closure of the pulmonic valve (Right bundle branch block, VPCs, RV hypertrophy) Or of the aortic valve (left BBB, VPCs, LV hypertrophy)

Question 38

S3

Answer 38

Rapid ventricular filling (normal in horses, other large animals)

Question 39

S3 gallop

Answer 39

Dogs/cats, hear S2 with very dilated ventricles (i.e DCM)

Question 40

S4

Answer 40

Atrial contraction- normal in large animals

Question 41

S4 Gallop

Answer 41

In dogs cats, S4 is heard with contraction of very DILATED atria - secondary to ventricular hypertrophy (i.e. HCM)

Question 42

Systolic Click

Answer 42

Transient click heard over AV valves in mid-late systole due to delayed closure or valve prolapse

Question 43

Systolic clicks most commonly heard with what diease

Answer 43

Early endocardiosis of mitral valve (before regurgitation) | Occasionally tricuspid valve