Cardiovascular Physical Exam

Question 1

what are some clinical findings consistent with cardiovascular disease?

Answer 1

grade III-IV/VI or louder systolic murmur
diastolic murmer
gallop heart sound
precordial or peripheral cutaneous thrill
venous distension
localized absence of arterial pulse
cardiac enlargement on chest radiographs or echocardiogram
markedly elevated NT-proBNP
ECG arrhythmias, left bundle branch block

Question 2

what are some differentials for pale mucous membranes?

Answer 2

anemia
poor perfusion

Question 3

what are some differentials for injected mucous membranes?

Answer 3

vasodilation: activity, excitement, septic shock
breed variation
polycythemia

Question 4

what are some differentials for central cyanosis?

Answer 4

arterial oxygen desaturation:
V/Q mismatch
right to left shunt

Question 5

what are some differentials for peripheral cyanosis?

Answer 5

reduced cardiac output, regional vasoconstriction
regional cyanosis- vascular obstruction

Question 6

what are some jugular venous waveforms?

Answer 6

A wave
X descent
C wave
V wave
Y descent

Question 7

what are the appearances of the jugular vein?

Answer 7

normal jugular vein appearance
distended
pronounced A wave
pronounced V wave

Question 8

what is normal jugular vein appearance?

Answer 8

normal pulsations in lower 1/3 of neck

Question 9

what is a hepatojugular reflux?

Answer 9

cranial abdominal pressure: increased venous return to right atrium

Question 10

what is a normal response to a hepatojugular reflux?

Answer 10

minimal jugular vein elevation, immediate return to normal

Question 11

where can you palpate cardiac impulse/apex beat?

Answer 11

left ventral thorax
normally left more than right

Question 12

when is cardiac impulse intensity increased?

Answer 12

hyperdynamic conditions: mitral regurgitation, left-to-right shunts, anemia, sympathetic stimulation, hyperthyroidism, bradycardia, sepsis

Question 13

when might cardiac impulse intensity be decreased?

Answer 13

systolic dysfunction
shock

Question 14

what might large displacement of the thoracic wall with cardiac contraction suggest?

Answer 14

hypertrophy

Question 15

what is the sensation that allows us to feel arterial pulses due to?

Answer 15

difference between systolic and diastolic pressure

Question 16

what can cause hyperdynamic arterial pulses?

Answer 16

increased stroke volume
diastolic run-off
also called bounding or waterhammer

Question 17

what are some arterial pulse abnormalities?

Answer 17

bounding pulses
weak pulses: pulsus parvus
pulsus alternans: varying pulse quality
bigeminal pulse
pulsus paradoxus

Question 18

what is a bigeminal pulse?

Answer 18

alternating strong/weak pulse from bigeminal arrhythmia

Question 19

what do cardiac stroke volume and pulse strength depend on?

Answer 19

greatly on time for cardiac filling

Question 20

what can decrease time for cardiac filling?

Answer 20

premature beat: atrial or ventricular

Question 21

how are pulse deficits determined?

Answer 21

pulse palpation with simultaneous cardiac auscultation

Question 22

what is the diaphragm on the chest piece better for compared to the bell?

Answer 22

higher frequency sounds: most murmurs

Question 23

what is the order from cranial to caudal of the valves on the left side of a dog?

Answer 23

pulmonic valve region
aortic valve region
mitral valve region

Question 24

what does the first heart sound coincide with?

Answer 24

closure of mitral and tricuspid valves

Question 25

when does the first heart sound split abnormally?

Answer 25

asynchronous ventricles

Question 26

what does the second heart sound coincide with?

Answer 26

closure of semilunar (aortic and pulmonic) valves

Question 27

can the second heart sound be split normally?

Answer 27

yes: asynchronous closure of aortic and pulmonic valves

Question 28

what is a pathologic split of the second heart sound like?

Answer 28

less subtle

Question 29

what is a pathologic split of the second heart sound caused by?

Answer 29

delayed closure of either aortic or pulmonic valve: prolonged ejection of either ventricle

Question 30

when is the second heart sound intensity accentuated?

Answer 30

hypertension: systemic hypertension, pulmonary hypertension

Question 31

what can prolong right ventricle ejection?

Answer 31

pulmonic stenosis or pulmonary hypertension

Question 32

what does the third heart sound (S3) coincide with?

Answer 32

end of rapid ventricular filling in early diastole, right after S2

Question 33

what is a pathologic S3 heart sound referred to as?

Answer 33

S3 gallop

Question 34

gallops are _____________ sounds

Answer 34

diastolic

Question 35

when is an S3 gallop pathologic?

Answer 35

small animal patients may be normal in large animals

Question 36

what does the fourth heart sound (S4) coincide with?

Answer 36

atrial contraction, late diastole, just before S1

Question 37

what is a pathologic S4 heart sound referred to as?

Answer 37

S4 gallop

Question 38

what is an S4 gallop in small animals suggestive of?

Answer 38

myocardial disease hypertrophied, stiff ventricle sometimes iatrogenic fluid overload

Question 39

what is a summation gallop?

Answer 39

events corresponding to S3 and S4 sounds coincide in timing rate dependent gallop

Question 40

what is a midsystolic click associated with?

Answer 40

mitral valve prolapse may occur in early in degenerative mitral valve disease

Question 41

what are heart murmurs caused by?

Answer 41

turbulent, disturbed blood flow

Question 42

in whom are "innocent" heart murmurs common in?

Answer 42

young animals: relative anemia and decreased body fat

Question 43

what are the murmur characteristics?

Answer 43

intensity location timing

Question 44

a __________ occurs when murmur intensity is great enough to be palpable on the thoracic wall

Answer 44

thrill

Question 45

what classifies a grade I murmur?

Answer 45

veery soft murmur heard (with difficulty) in one specific location after minutes of listening in a quiet room or stall

Question 46

what classifies a grade III murmur?

Answer 46

moderately loud murmur that is readily heard and radiates slightly

Question 47

what may murmurs do with increasing disease severity?

Answer 47

increase or decrease

Question 48

when do holosystolic murmurs occur?

Answer 48

starts with S1 and continues to end of S2

Question 49

what are the disease associations of systolic ejection murmurs?

Answer 49

subaortic or pulmonic stenosis hypertrophic cardiomyopathy

Question 50

what are some causes of diastolic murmurs?

Answer 50

aortic insufficiency pulmonic insufficiency mitral stenosis

Question 51

what can cause a continuous murmur?

Answer 51

patent ductus arteriosus

Question 52

where do you need to have your stethoscope for a continuous murmur?

Answer 52

far cranial left heart base

Question 53

what grades of systolic and diastolic murmurs are associated with cardiovascular disease?

Answer 53

grade III-IV/VI systolic any grade diastolic

Question 54

what can cause injected mucous membranes with vasodilation?

Answer 54

activity excitement septic shock

Question 55

what are the jugular venous waveforms?

Answer 55

A wave X descent C wave V wave Y descent

Question 56

what is the V wave in the jugular venous waveforms?

Answer 56

atrial filling

Question 57

why might a pronounced A wave occur?

Answer 57

incompliant right ventricle cannon A waves: AV dissociation

Question 58

what does caudal displacement of the cardiac impulse suggest?

Answer 58

cardiac enlargement if to right: right-sided enlargement

Question 59

what can large displacement of thee thoracic wall with cardiac contraction suggest?

Answer 59

hypertrophy

Question 60

what can cause diastolic run-off?

Answer 60

aortic insufficiency PDA

Question 61

when might pulses be hyperdynamic?

Answer 61

increased stroke volume diastolic run-off

Question 62

what can cause decreased stroke volume and therefore diminished pulses?

Answer 62

marked systolic dysfunction hypovolemia tachycardia

Question 63

what is pulsus alternans associated with?

Answer 63

severe myocardial dysfunction tachyarrhythmias with variable cardiac filling

Question 64

what is pulsus paradoxus?

Answer 64

decreased pulse strength on inspiration resulting from cardiac tamponade (pericardial effusion)

Question 65

what do pulse deficits have the same clinical implication as?

Answer 65

premature beats: reason to investigate for cardiac disease

Question 66

what is the bell of the stethoscope best for?

Answer 66

low frequency sounds: normal heart sounds, clicks, gallops

Question 67

what valve can be auscultated on the right side?

Answer 67

tricuspid valve

Question 68

when is the intensity of S1 (closure of AV valves) increased?

Answer 68

hyperdynamic conditions

Question 69

what is physiologic splitting of S2 (closure of pulmonic and aortic valves)?

Answer 69

normally right ventricle takes longer to eject than left accentuated with inspiration and subtle

Question 70

what is an S2 pathologic split caused by?

Answer 70

delayed closure of aortic or pulmonic valve: prolonged ejection

Question 71

what can cause an S2 pathologic split?

Answer 71

right ventricle prolonged: pulmonic stenosis or pulmonary hypertension left ventricle prolonged: aortic stenosis or systemic hypertension

Question 72

what can cause a fixed split of S2?

Answer 72

atrial septal defect

Question 73

what can accentuate S2 intensity?

Answer 73

hypertension: pulmonary more common than systemic

Question 74

what is an S3 gallop (S3 sound) suggestive of in small animals?

Answer 74

myocardial disease sometimes iatrogenic fluid overload

Question 75

what is a summation gallop dependent on?

Answer 75

rate

Question 76

what is the equation for reynolds number?

Answer 76

radius x velocity x density/blood viscosity

Question 77

what classifies a physiologic heart murmur?

Answer 77

normal cardiac structure with hyperdynamic state or small aorta

Question 78

what does murmur intensity relate to?

Answer 78

pressure and rate of flow

Question 79

what grades of heart murmurs include a thrill?

Answer 79

V or VI/VI

Question 80

what diseases are associated with a holosystolic murmur?

Answer 80

mitral or tricuspid regurgitation VSD

Question 81

what diseases are associated with a systolic ejection murmur?

Answer 81

subaortic or pulmonic stenosis hypertrophic cardiomyopathy

Question 82

what can cause a diastolic murmur?

Answer 82

aortic insufficiency pulmonic insufficiency mitral stenosis (rarely audible)

Question 83

what commonly causes a continuous murmur?

Answer 83

patent ductus arteriosus

Question 84

where do you need to listen for a patent ductus arteriosus?

Answer 84

far cranial left heart base