What are 3 general pieces of info to gather for a cardio exam?
Signalment, presenting complaint, and history
What things are included in the signalment?
Species, breed, and age-specific diseases
What things are included in the presenting complaint?
Murmur, collapse or exercise intolerance, respiratory signs
What are some things that are included in the history?
- Onset, duration, progression of presenting complaint
- Changes in weight, appetite, thirst, urination/defecation, vomiting
- Coughing/sneezing/respiratory effort/gagging (frequency, character)
- Activity level and any recent changes in activity or endurance, fainting spells, weakness, collapse
- Travel and vaccine history and any concurrent medical conditions
- Diet and meds and supplements (drug, dosage, route, response)
What is cachexia?
Disproportionate loss in muscle mass that is commonly seen in inflammatory conditions
What are DDx for cachexia?
End stage CV disease, neoplasia, renal disease, chronic inflammatory conditions
What are DDx for abdominal distension?
Abdominal fluid (R-CHF), organomegaly, weakened abdominal muscles
What is a fluid wave?
Vibration of fluid palpated on ballotment of moderate to severe abdominal fluid
What are DDx for a fluid wave?
R-CHF (modified transudate), liver dz, PLE/PLN (transudate), neoplasia (mod transudate), trauma, bleeding mass, coagulopathies (hemorrhagic)
What color are normal mucous membranes?
What are DDx for pale MM?
Poor perfusion, peripheral vasoconstriction, anemia
What are DDx for blue/gray (cyanotic) MM?
R to L shunting, pulmonary parenchymal disease (i.e. pulm edema from L-CHF), airway disease, hypoventilation, shock
What is the appearance of "differential cyanosis" and what does it mean?
Pink MM cranially and blue MM caudally - finding in dogs with R to L shunting PDA (reverse PDA)
What is the Dx for brick red or "injected" MM?
early phases of shock
What are the DDx for yellow (icteric) MM?
hemolysis, hepatobiliary disease
What is a CRT of 0-1 seconds?
Early, hyperdynamic phase of shock
What is a CRT of 2 seconds?
What is a CRT of 3+ seconds?
What is peripheral pitting edema?
Edema (fluid in the tissues) in the ventral extremities or ventral thorax/abdomen
(When you push your thumb into edematous areas it leaves an imprint)
What are DDx for peripheral pitting edema?
R-CHF (uncommon); more common in horses and cattle
Non-cardiac = hypoalbuminemia, renal disease (rare)
What is palpation of the precordium?
Palpating the heartbeat on the chest wall
Where is the precordium normally felt the strongest?
What does it mean if the precordium is felt strongest on the right?
R heart enlargement
(Can also be mass lesions displacing the heart, collapsed lung lobes that displace the heart, or focal accumulations or air or fluid)
What does it mean if the precordium is the same strength on the L as it is on the R?
R and L heart enlargement
What does it mean if the precordium has decreased intensity?
Weak cardiac contractions, pericardial or pleural effusion
(Can also be due to obesity, thoracic masses, or pneumothorax)
What is a precordial thrill?
Palpable fine vibrations of a murmur on the chest wall;
May be palpated in patients with very loud murmurs (grade V or VI)
What are the 2 parts of the end of the stethoscope?
Bell and diaphragm
What is the bell for?
Best for listening to low frequency sounds (heart sounds and gallops)
What is the diaphragm best used for?
Listening to high frequency sounds (murmurs and clicks)
What are transient heart sounds?
Short sounds that may be caused by normally auscultated heart sounds (S1, S2), gallops (S3, S4), or abnormal valve movement (mid-systolic clicks).