What does the acronym RAM stand for when performing an observational CV exam?
- rate/effort, posture, mouth breathing (mm)
Ambulation and Abd distention
- thromboembolism, hypotension, ascites
- depression, anxiety, thromboembolism, systemic hypertension, hypotension
T/F: A patient with pink mm and CRT of < 2s does not have heart disease.
*Although these are normal parameters, mm exams have poor sensitivity in heart disease patients.
What pathology of the eyes can be caused by systemic hypertension?
A patient presents laterally recumbant with jugular vein pulsation along the entire vein. What is causing this finding?
The entire vein is at the level of the heart in recumbant patients. This can be seen in normal patients and does not indicate a pathological process.
A patient presents with pulsation of the entire jugular vein while standing with head erect. What 2 disease processes can cause this?
Severe tricuspid valve regurgitation
*It is normal to see jugular pulsation in standing patients in the lower 1/3 of the vein only.
A patient presents with jugular vein distension, which you know indicates elevated systemic venous pressure. What 3 diseases should you consider in this patient?
Right heart disease
Obstruction of the cranial vena cava
What is the first method for locating the apex beat during a CV exam?
On what side of the chest and at what location is the apex beat strongest?
Left side at the mitral valve region (5th intercostal space)
A dog with cardiomegaly presents for CV exam. When auscultating the apex beat, what changes do you expect?
It may be exaggerated
When performing a thoracic auscultation, where should you begin to hear the loudest heart sounds and determine the heart rate?
While auscultating the chest of a 9 year old dog, you find that the femoral pulses aren't synchronous with the heart beats. What does this indicate?
Where can you auscultate the Aortic and Pulmonary valves?
A: Left side, 4th intercostal space (near the axilla)
P: Left side, 3rd intercostal space (in the axilla)
Where should you auscultate the Tricuspid valve?
Right side, 4th intercostal space
*Palpate first to find apex beat
The heart sound S1 is lower and duller, and occurs at.....
The onset of ventricular systole
*isovolumetric contraction, increased pressure, and closure of the AV valves
The heart sound S2 is higher pitched and more crisp, and occurs at...
The end of ventricular systole
*Aortic and Pulmonary vales close after ventricular contraction
A sound generated by turbulent flow within the cardiac chambers and/or great vessels:
A 9 year old Cavalier King Charles presents for lethargy and anorexia. The patient is about 5% dehydrated. You see in the history that the patient has a pre-existing heart murmur, but when you listen to the chest you don't hear one. Why is this?
Since the patient is dehydrated, blood viscosity is increased. An increase in viscosity will decrease turbulence in the vessels and you may not hear the murmur.
*As viscosity increases, Reynold's number decreases
You hear a heart murmur in a 6 year old dog with chronic anemia. Should you send this dog for cardiology referral?
Not necessarily. Chronically anemic patients will have increased blood volume, which decreases blood viscosity and can create turbulence in the vessels.
You are auscultating a patient's chest and think you hear a very faint murmur after several seconds of listening in a certain spot. You can't seem to find the murmur in any other part of the chest. What grade murmur does this patient have?
*Very faint, takes several seconds to hear, doesn't radiate
You auscultate a patient's chest and hear a faint murmur after a few seconds. You can't hear the murmur in any other part of the chest. What grade murmur is this?
*Faint, takes a few seconds to hear, usually doesn't radiate
You are auscultating a patient's left chest and immediately hear a murmur. While moving your stethoscope along the chest you continue to hear the murmur on that same side. The murmur is absent upon auscultation of the right side of the chest. What grade murmur is this?
*Readily heard, radiates on the same side of the chest as the PMI (point of maximal intensity)
You are auscultating a patient's chest and hear a loud murmur on the left side. You move along to the right side of the chest and can still hear the murmur. What grade murmur is this?
*Loud, radiates to opposite side of PMI (bilateral)
You are auscultating the chest of a dog who has a palpable thrill on the left side. You are able to hear the murmur on both sides when your stethoscope is pressed against the chest. What grade murmur is this?
You are about to auscultate the chest of a dog who has a palpable thrill on the right side. Before you even get your stethoscope pressed against the dog's chest, you can hear the murmur. What grade is it?
*Palpable thrill, audible with stethoscope lifted off chest
What are the three factors for describing a murmur?
In medium and large breed dogs, it is possible to state the location of a murmur by valve. In cats and small dogs it is acceptable to state the location of a murmur by ______.
Region (apical vs basilar vs parasternal/sternal border)
If you hear a murmur after S1 and before S2 heart sounds, what is the timing?
If you hear a murmur after S2 and before S1 heart sounds, what is the timing?
What is the timing of a murmur that peaks at systole, but is audible at all times in the cardiac cycle?
What is another term for a murmur that is heard during systole and diastole?