Computer test - Cardiac system Flashcards
1
Q
What are the charasteristics of the pulse pressure ?
A
- Difference between systolic and diastolic blood pressure
- Determined by HR, stroke volume, and peripheral resistance
2
Q
What are the indications of an ECG ?
A
- Irregular heartbeats noted during physical exam
- Bradycardia
- Tachycardia
- …
- Evaluation of cardiac arrhytmias
- Detect enlarged cardiac chambers (echocardiography is better)
- Show cardiac disturbances of electrolytess and systemic diseases
- Aid cardiac diseases diagnosis
- Monitor anaesthesia
- Evaluate effectiveness of cardiac drugs (digitalis glycosides…)
3
Q
In dogs, right sided heart failure can lead to (F/T) :
- Ascites
- Pulmonary oedema
- Distended jugular
- Dyspnoaea
A
True : Ascites, pulmonary edema, distended jugular
4
Q
What is true about pre-cordial thrill (fremitus) ?
A
Pathological, grade 5 murmur
5
Q
When is fremitus heard ?
A
Dry pleurisy, bronchitis, fibrinous pericarditis, stenotic cardial valves, valve insufficiency
6
Q
Where can the heart be palpated ?
A
Between the 3rd and 6th ICS, all species on both sides except Ru, Pig (only on the left)
7
Q
Where is the apical beat located on the dog ?
A
Over the edge of the sternum, left 3-6 ICS, right 3-5 ICS
8
Q
Where can the pulse be measured on the cow ?
- A. facialis
- A. transversa faciei
- A. coccygea
- A. auricularis caud
- A. femoralis
- A. digitalis lat and med
A
- A. facialis
- A. transversa faciei
- A. coccygea
9
Q
Where can the pulse be measured on the horse ?
- A. facialis
- A. transversa faciei
- A. coccygea
- A. auricularis caud
- A. femoralis
- A. digitalis lat and med
A
- A. facialis
- A. transversa faciei
- A. digitalis lat and med
(+ median arteries in the axillary region)
10
Q
Pericardial tamponade in cows signs ?
A
Pulse changes with respiration
Positive veinous stasis test → no emptying below the compression point
11
Q
What is grade 5/6 of cardiac murmurs ?
A
Very loud murmur with precordial thrill
12
Q
Puncta maxima of the dog on the left side ?
A
For heart apex : 3-6 ICS
For murmur : 3P-4A-5M
13
Q
In which species can you feel the heart on the right side ?
- Cat
- Cattle
- Goat
- Dog
- Horse
- Swine
- Rabbit
A
- Cat
- Dog
- Horse
- Rabbit
14
Q
In which species can’t you feel the heart on the right side ?
- Cat
- Cattle
- Goat
- Dog
- Horse
- Swine
- Rabbit
A
- Cattle
- Goat (+ sheep)
- Swine
15
Q
Apical beat location in the dog and cat ?
A
Left 3-6 ICS
Right 3-5 ICS
16
Q
Arterial palpation standpoints ?
A
Rhythm
Symmetry
Rate
Quality → Size, strenght, duration of pulse wave, fullness of artery
17
Q
Type of examination commonly carried out together with ECG ?
A
PhonoCardioGraphy PCG
18
Q
What is true concerning the systolic heart murmur in horses ?
- Can be physiologic
- Graded 1-3/6
- Can be heard on the left side of the thorax
- Localized and brief
- Intensity may change with exercise
- Due to ventricular filling
- Happens in late systole
- Crescendo
A
- Can be physiologic
- Graded 1-3/6
- Can be heard on the left side of the thorax
- Localized and brief
- Intensity may change with exercise
19
Q
What could cause a cardiac beat dislocation ?
A
Pneumothorax
Hydrothorax
Abscess
Tumour
20
Q
In dogs, left-sided heart failure can lead to
- Ascites
- Dysponea
- Coughing
- Tachypnoe
A
- Dysponea
- Coughing
- Tachypnoe
21
Q
In what kind of conditions would you hear a stronger heartbeat ?
A
Thin thoracic wall
Exercise
Cardiac hypertrophy
Dislocation
22
Q
What causes enlarged P-wave ?
A
Atrial enlargement
23
Q
Examination of heart ?
A
Inspection, palpation, percussion, auscultation
Further exams :
HISTORY (+++ important)
X rays
US +/- Doppler
Blood work (ANP, BNP, troponin, endothelin, cTr-l, AST, CK, LDH1, LDH2
ECG, Holter ECG
Blood pressure measurement
Phonocardiography PCG
Non selective angiography
Cardiac catheterization (intracardiac pressure, oxymetry, selective angiography)
Radionucleide imaging
Serology (Lyme, ANA, Dirofilaria, Trypanosoma…)
CT, MRI
24
Q
Examination of vessels ?
A
Inspection, palpation
25
What can you evaluate during inspection of the cardiac area ?
```
Abnormalities of the thorax
Heart beat (ictus cordis) : apex beat (dog+cat), location, intensity
```
26
What can you evaluate during palpation of the cardiac area ?
Intensity/location of the heart beat
Pain
Fremitus (endo/peri/extraperi -cardial)
27
Normal place of the heart apex in horse ?
Left 3-6 ICS
| Right 3-4
28
Normal place of the heart apex in cattle ?
Under the shoulder line
| Left 3-5 ICS
29
Normal place of the heart apex in sheep/goat/swine ?
Left 3-5 ICS
30
Normal place of the heart apex in dog & cat ?
Over the edge of the sternum
Left 3-6 ICS
Right 3-5 ICS
31
Normal place of the heart apex in rabbit ?
Over the edge of the sternum
Left 2-4 ICS
Right 2-4 ICS
32
What can you evaluate during percussion of the cardiac area ?
Pain
| Cardiac dullness, Diernhofer triangle
33
Area of cardiac dullness and type of cardiac dullness in horse ?
Left 3-5 ICS
Right (ventral third) 3-4 ICS
ABSOLUTE
34
Area of cardiac dullness and type of cardiac dullness in cattle & small ruminants ?
Left 3-4 ICS
| Relative
35
Area of cardiac dullness and type of cardiac dullness in swine ?
Left 2-3 ICS
| Relative
36
Area of cardiac dullness and type of cardiac dullness in dog ?
Left 4-6 ICS
Right (ventral third) 4-5 ICS
ABSOLUTE
37
Area of cardiac dullness and type of cardiac dullness in cat ?
Left not easily detected
| Relative
38
How is absolute dullness of the cardiac area ?
Dull
| Due to direct contact between heart and thorax
39
How is relative dullness in cardiac area ?
+/- dull
| Due to thin lung tissue between heart and thorax
40
Enlargement of cardiac dullness area possible causes ?
Cardiac enlargement
Cardiac dislocation
Pericardial effusion
41
False enlargement of cardiac dullness area possible causes ?
Dullness in neighbouring organs
| Frictional (rubbing) auscultation
42
Decreasing of cardiac dullness area possible causes ?
Lung emphysema
Emphysema of the skin
Pneumothorax
Cardiac dislocation
43
How many normal heart sounds ?
4
44
What is the cause for the first heart sound ?
Beginning of systole, caused by the initial movement of the ventricle, the abrupt arrest of blood flow as AV valves tense, and the early part of ejection
45
What is the cause for the 2nd heart sound ?
End of systole, caused by the change in direction of blood flow, closing the semilunar valves
46
What is the cause for the 3rd heart sound ?
Termination of rapid ventricular filling, commonly heard at or caudal and dorsal to the apex beat
47
What is the cause for the 4th heart sound ?
Atrial contraction and sudden arrest of the distended ventricle
48
In which species can the 4 heart sounds be audible ?
Horse
49
In horses, when heart rate is <35 / min, how many heart sounds can be heard ? Which ones ?
4
| 4-1 2-3 4-1 2-3
50
In horses, when heart rate is [35-80] / min, how many heart sounds can be heard ? Which ones ?
2
| 4+1) (2+3) (4+1) (2+3
51
In horses, when heart rate is >80 / min, how many heart sounds can be heard ? Which ones ?
```
3
1 2 (3+4) 1 2 (3+4)
```
52
What are the possible changes of heart sounds (5 keywords) ?
```
FRIDA
Frequency
Rhythm
Intensity
Demarcation
Adventitious sounds
```
53
Physiological changes in heart rhythm in horses ?
```
Intermissio cordis (dropped heart beat)
2nd degree AV block
```
54
What is respiratory arrhythmia ?
Slower heart rare during expiration (vagus effect, cranial nerve X)
55
Changes in frequency (examples) ?
Tachycardia, bradycardia
56
What heart sounds can be heard in the case of a cardiomyopathy ?
4 - 1 - 2
57
2 types of adventitious sounds ?
Endocardial & extracardial murmurs
58
Causes for endocardial murmurs ?
```
Morphological changes (valve deformities, septal/vessel malformations..)
Functional changes (innocent murmurs, anemia..)
```
59
Causes for extracardial murmurs ?
Pericardial or pleuropericardial murmurs → pericardial splashes, rubbing, pleuropericardial rubbing (tested with Valsalva probe)
60
What is the Valsalva probe ?
Pleuropericardial-pleuropleural rubbing (disappears if breathing stops). Pericardial rubbing is increased if breathing stops at the end of inspiration (increased intrathoracic pressure)
61
Normal (functional) heart murmurs in horses ?
→ Caused by vibrations (ejection of blood from the heart during early systole → blood flow in aorta and pulmonary artery)
Left side of thorax, Grade 1-3, PMI over aortic or pulmonary valves, early-to-midsystolic, crescendo-decrescendo or decrescendo, localized and brief, intensity may change with exercise
→ OR Rapid filling of the ventricles during early diastole (ventricular filling). Common in young horses and thoroughbreds. Left side of thorax, Grade 1-3, PMI over mitral area, early diastolic (S2-3), or late diastolic (S4-S1). Quality is often musical/squeaking
62
PMI in horses ?
Pulmonary : left 3rd ICS below point of shoulder
Aortic : left 4th ICS below point of shoulder
Mitral : left 5th ICS halfway between shoulder and sternum
Triscuspid : right 4th ICS
63
Number of murmurs grades ?
6
64
Description of murmurs grades ?
I - Very soft murmur, heard only after a few seconds in a quiet room
II - Soft murmur but easily heard directly upon auscultation
III - Moderate intensity murmur with good audibility
IV - Loud murmur, very good audibility but without precordial thrill
V - Very loud murmur with precordial thrill
VI - Loudest murmur, even audible with stethoscope lifted from the chest wall
65
Classification of endocardial murmurs standpoints ?
```
Localization
Grade/Intensity
Timing (related to the cardiac cycle)
Frequency/Pitch
Character (quality, shape : crescendo, decrescendo, continuous, plateau, diamond-shaped)
Conduction (y/n)
Duration
Effect of changing heart rate
```
66
Possible endocardial murmurs "frequency/pitch"
Low, medium, high,
| Blwing, whisthling, crackling, rough, musical
67
Examination of the arteries ?
Digital palpation
BP measurement (direct/indirect via sphygmomanometer)
Blood flow registration (Doppler US)
68
Where can the pulse be measured on the swine ?
- A. facialis
- A. transversa faciei
- A. coccygea
- A. auricularis caud
- A. femoralis
- A. facialis
| - A. femoralis
69
Where can the pulse be measured on dogs and cats ?
- A. facialis
- A. transversa faciei
- A. coccygea
- A. auricularis caud
- A. femoralis
- A. femoralis
70
```
How to qualify these pulse qualities :
Uneven pulse
Irregular pulse
Small, brief & hard pulse
Small, prolonged and weak pulse
Skipping &large pulse
Paradox pulse
```
Uneven pulse = pulsus irregularis (respiratory or true arrhythmia)
Irregular pulse = p.inequalis / alternans (arrhythmia, cardiomyopathy)
Small, brief & hard pulse = p. contractus
Small, prolonged and weak pulse = p. piliformis
Skipping & large pulse = p. celer et magnus (Corrigan-pulse)
Paradox pulse = p. paradoxus = weak during inspiration, strong in expiration, due to cardiac tamponade
71
How to qualify these pulse sizes ?
- Large & hyperkinetic
- Small & hypokinetic
- Large & hyperkinetic = pulsus magnus
| - Small & hypokinetic = p. parvus
72
How to qualify these pulse durations ?
- Sluggish
- Skipping
- Sluggish = pulsus tardus
| - Skipping = p.celer
73
How to qualify these pulse sizes & durations ?
- Full
- Empty
- Full = pulsus plenus
| - Empty = p. vacuus
74
Examination of the veins ?
Inspection palpation
| Measurement of central venous pressure
75
Veins available for examination ?
Jugular
Sapehnous
Episcleral, Mm veins
Subcutaneous abdominal vein (milk vein) in cattle
76
What parameters can be evaluated in veins ?
Degree of fullness (jugular vein is normally empty)
Movement within the veins (normal = undulation; negative/atrial venous pulse, positive/ventricular pulse; hepato-jugular reflux)
77
Define :
Negative/atrial venous pulse
Positive or ventricular pulse
Hepato-jugular reflux
→ Negative/atrial venous pulse : increased right atrial pressure during diastole, can be normal or caused by tricuspid stenosis
→ Positive or ventricular pulse : increased right ventricular pressure and improper valve closure during systole. Always pathological (right sided heart failure)
→ Hepato-jugular reflux: increased CVP causes distended jugular vein seen by pushing liver of small animals
78
Pathological vein pulse description ?
Systolic, pronounced (over the ventral 1/3rd of the neck), persistant after compression test, congested jugular vein
