Cardiorespiratory Disease

Question 1

PQRST wave

Answer 1

QRS - ventricular depolarisation
T - ventricular repolarisation

normal - regular rhythm, P for every QRS

Question 2

sinus arrhythmia

Answer 2

irregular pace but in time with breathing

HR up when breathing in - stimulates vagus nerve - common and normal

Question 3

1st degree A-V block

Answer 3

P with no QRS

Question 4

2nd degree A-V block

Answer 4

QRS with no P

pause between beats with S4 sound in pause

Question 5

3rd degree A-V block

Answer 5

regular rhythm but QRS slower than P so gets out of sync

normal atrial contraction sound with slower ventricular bear

Question 6

Atrial fibrillation

Answer 6

high rate, squiggly line, no regular pattern

rapid irregular beat - bongo sounds
common cause of poor performance in horses

Question 7

heart failure

Answer 7

when the heart can no longer meet the metabolic needs of the body

Question 8

common breed heart problems

Answer 8

corgi - patent ductus arteriosus
kcc - mitral valve disease
male cats - HCM
female cats - PDA

Question 9

heart disease signs

Answer 9

non-specific
exercise intolerance
weakness
syncope/presyncope
cyanosis
coughing
paresis
neurological signs - blindness
shifting lameness (endocarditis)

heart failure - tachypnoea, weight loss, swollen abdomen, peripheral oedema

Question 10

heart disease exam

Answer 10

BCS
RR and effort
ascites
distended jugular - right sided heart disease
pulsating jugular
peripheral oedema

Question 11

exam - mm

Answer 11

pale - shock, vasoconstriction
slow CRT - poor CO
cyanosis - right-to-left shunt
- 3 types - body wide, differential (head membranes normal, caudal pale), peripheral (only affecting certain regions)

Question 12

exam - jugular

Answer 12

pulsating - eg arrhythmia
tricuspid regurgitation - back flow of blood up vena cava
collapsed right atrium - pericardial effusion
distension - elevated systemic venous pressure

Question 13

exam - auscultation

Answer 13

both sides at apex and base
heart murmur
gallop rhythm
arrhythmia
HR
all lung fields
compare dorsal and ventral
muffled sounds
crackles

Question 14

exam - palpation

Answer 14

apex - should not be prominent on right
thrill
compression - decreased compressibility in cats with heart disease

Question 15

Abdominal examination

Answer 15

palpation - ascites, splenomegaly, hepatomegaly, pain
hepatojugular reflex - blood flow up jugular when squeeze under ribs - high right side filling pressure

Question 16

exam - arterial pulse

Answer 16

femoral - does it match HR
pulsus alternas - alternating weak and strong - myocardial failure
pulsus paradoxus - decreased pulse quality on inspiration - pericardial effusion

Question 17

Gallop rhythm

Answer 17

extra sounds - S3 and/or S4

S3 - early diastolic filling - systolic dysfunction
S4 - atrial contration - forced atrial ejection of blood

Question 18

Heart murmur

Answer 18

systole - between lub and dub
dyastole - between dub and lub
continuous - both/all the time

turbulent flow over an obstruction

Question 19

heart murmur - grading

Answer 19

1 - barely audible
2 - audible but quieter than heart sounds
3 - clearly audible and loud as heart sounds
4 - louder than heart sounds
5 - thrill present
6 - audible with stethoscope lifted off chest

Question 20

apical systolic murmurs

Answer 20

left side - mitral regurgitation - DCM or myxomatous mitral valve disease
right side - tricuspid regurgitation - tricuspid vlave dysplasia, pulmonary hypertension, degeneration of valve
musical/whooping sound

Question 21

basilar systolic murmurs

Answer 21

under axilla
harsh sound

Question 22

innocent/functional murmurs

Answer 22

innocent - in puppies/kittens - resolves on its own
functional - as side effect of another disease process

Question 23

diastolic murmurs

Answer 23

aortic regurgitation - heart base, quiet
pulmonic regurgitation - uncommon, left base of heart
mitral stenosis - rare, left apex
continuous - PDA

Question 24

heart murmur investigation

Answer 24

BP
bloods - CBC, Biochem, electrolytes, NT-proBNP, cardiac troponin 1

Question 25

Acquired heart disease

Answer 25

mitral valve disease (dogs) - thickened mitral valve, dilated left atrium and ventricle, bowing of interarticular and intraventricular septums DCM (cats) pericardial effusion (dogs) HCM (cats) - LV hypertrophy, slightly dilated LA, mitral regurgitation Hypertrophic obstructive cardiomyopathy (Cats) restrictive cardiomyopathy (cats)

Question 26

Normal heart sounds

Answer 26

S1 - atrial filling - closure of mitral and tricuspid - start of systole - QRS S2 - ventricular emptying - aortic valves close - start of diastole - T S3 - blood from atria to ventricles - P (inaudible) S4 - slowing of blood with atrial contraction - T (inaudible)

Question 27

systole and diastole

Answer 27

systole = ventricular contraction (blood out) diastole = ventricular relaxation (blood in)

Question 28

gallop rhythm

Answer 28

3 sounds abnormal in dogs and cats

Question 29

indications for endoscopy

Answer 29

cough difficulty breathing after exercise snotty or bleeding nose abnormal breathing sounds poor performance

Question 30

endoscope controls

Answer 30

up/down lock - has an F on it left/right direction lock - smaller water/air suction for clearing lens - blue suction valve - red

Question 31

tracheal aspirate

Answer 31

tracheal and tracheobronchial changes pros - quick, easy, less invasive and well tolerated, bacteriology, visual assessment cons - lack of specificity for lower airway inflammation, normal cell counts vary between horses

Question 32

bronchoalveolar lavage (BAL)

Answer 32

assessment of lower airway inflammation pros - cytology, cheap and equipment easily available cons - can't use for bacteriology, more invasive (sedation), more technically challenging, causes transient inflammation

Question 33

eupnoea

Answer 33

normal respiration

Question 34

tachypnoea

Answer 34

increased rate

Question 35

apnoea

Answer 35

no respiration

Question 36

dyspnoea

Answer 36

sensation of difficult or laboured breathing - use increased respiratory effort instead

Question 37

hypo/hyperventilation

Answer 37

alterations to ventilation at alveolar level

Question 38

changes to respiratory pattern

Answer 38

variations in tidal volume engaging of extra-thoracic muscles increased abdominal effort forced nasal flaring posture open mouth breathing neck stretching and abduction of elbow

Question 39

upper tract obstruction

Answer 39

increased inspiratory effort inspiratory stridor and stertor

Question 40

lower tract obstruction

Answer 40

increased expiratory effort early collapse during expiration

Question 41

stridor

Answer 41

wheezing/whistle sound

Question 42

stertor

Answer 42

lower pitched gurgling noise

Question 43

nasal discharge

Answer 43

serous - allergic rhinitis, acute inflammation, viral infection mucoid - chronic disease purulent - bacterial infection haemorrhagic - traume, clotting disorder, vascular disase mucopurulent - secondary infection mixed - inflammation + mucosal haemorrhage + secondary infection LRT - unilateral URT - bilateral

Question 44

Coughing

Answer 44

URT - harsh dry cough, often productive - trachieitis or tracheobronchitis (eg kennal cough) LRT - soft, chesty cough - lower airway inflammation or pneumonia, can be cardiogenic

Question 45

Lung auscultation

Answer 45

wheezing - air passing through narrowed airways crackles - air passing through fluid dull/absent - no air movement pleural rubs - friction between pleural surfaces