Clinical examination of the cardiovascular system Flashcards
(61 cards)
Breed predisposition of mitral valve disease
CKCS
Breed predisposition of cardiomyopathy
Dobermans
Breed predisposition of aortic stenosis
Boxers
Cause of syncope/lethargy
Reduced cerebral perfusion
Cause of weakness/reduced stamina
Reduced skeletal muscle perfusion
Cardiac causes of a cough
Mitral valve insufficiency with left atrial enlargement and compression of the left main-stem bronchus
Often in the abscence of heart failures
Softer and moister than resp cough
Cardiac dyspnoea/wheeze/orthopnoea
Due to pulmonary oedema or pleural effusion
What can cause abdominal distension in patients with cardiac disease?
ascites and/or hepatomegaly or splenomegaly
Possible physical exam findings in heart failure
Slow capillary refill time
Pale or cyanosed MM, dry/tacky MM
Jugular venous distension
‘Resp’ signs
Thrill on precordial palpation
Hepatomegaly and/or splenomegaly
Abdominal effusion/ascites
Subcut oedema
Pulse deficits
What causes cyanosed MMs?
Increased quantity of deoxygenated haemoglobin
Arterial saturation less than70% or pAO2 less than 40mmHg
Abdominal effusion/ascites in cadiac patients
Right-sided heart failure produces ascites in dogs
Ascites is less common in cats
The presence of ascitic fluid implies an increase in pressure on the right side of the heart i.e. impairment of pumping of blood into the pulmonary vasculature
What could cause weaker pulses?
Decreased pressure in heart failure or hypovolaemia
What could cause increased pulses?
Anaemia, PDA, aortic regurgitation
What are pulse deficits?
Pulse deficits are present when the pulse rate is less than the heart rate.
This occurs because a cardiac contraction or several contractions take place prematurely not allowing enough time for ventricular filling (preload).
This results in heart beats that do not eject enough blood to generate a palpable pulse.
The presence of pulse deficits should alert you to the occurrence of premature ectopic beats.
These may be either supraventricular or ventricular in origin, only the ECG can distinguish these.
What is a hepato-jugular reflux?
This test checks for the presence of jugular distention or jugular pulsations when pressure is placed in the region of the cranial abdomen in a ventral to dorsal direction.
The animal should be standing or in sternal recumbency to perform this test.
A positive test result indicates that there is moderate elevated pressure in the right atrium or right ventricle.
What does a positive heapto-jugular reflux test show?
Indicates that there is elevated pressure in the right atrium or right ventricle.
Venous distention indicates a severe elevation in pressure, a positive HJR indicates a moderate elevation in pressure.
Patients with a mild elevation in pressure to the right heart cannot be identified on physical examination.
How to determine strength of the pulse:
Pulse pressure = systolic pressure - diastolic pressure
What is the arterial pulse affected by?
Left ventricular stroke volume
Ejection velocity
The relative compliance and capacity of the arterial system
When do exuberant (bounding) arterial pulses occur?
Patent ductus arteriosus and aortic valve insufficiency
Palpation of the heart
Palpate the precordial impulse – left side 4th –5th intercostal space
Feel for a precordial thrill – caused by vibrations created by turbulence within the heart through the chest wall
What can be identified on heart auscultation?
heart murmurs
gallop rhythms
dysrhythmias
count heart rate - tachycardia/bradycardia
muffled heart sounds due to pleural or pericardial effusions
Diaphragm of the stethoscope used for?
High frequency sounds
Bell of stethoscope used to accentuate:
low-frequency sounds - 3rd and 4th heart sounds in dogs
Where is the apex beat heard?
Over the mitral valve (left apex)
The stethoscope is moved towards the left heart base (2 rib spaces forward and 1/4 chest height up)
