Examination of the Cardio-Respiratory System in dogs and cats

Question 1

Certain conditions are more likely in certain breeds:

a. Myxomatous degenerative valvular disease (= Mitral valve disease)
b. Tracheal collapse
c. Dilated cardiomyopathy

Answer 1

a. CKCS or small breeds
b. Yorkshire terriers
c. Dobermanns and giant breeds

Question 2

What information needs to be gathered when assessing cardio-respiratory history?

Answer 2

• Coughing: when? dry or productive?
• Laboured breathing (dyspnoea)
• Tachypnoea
• Exercise
• Collapse

Question 3

What is orthopnoea?

Answer 3

Standing/sitting to breathe, air-hunger stance

Question 4

If an animal is dyspnoeic how can this be further refined?

Answer 4

• Inspiratory / Expiratory or Both
• Obstructive versus Restrictive
• Upper vs Lower airway
• If airway noise (stridor, stertor etc. will be upper airway problem)

Question 5

How can dyspnoea localised if it is upper vs lower?

Answer 5

Upper (inspiration) vs Lower (expiration e.g. bronchial collapse) airway

Question 6

What can be assessed in the hands-on portion of a cardio-respiratory exam?

Answer 6

• CO signs
• Peripheral perfusion
• Pulse quality
• CRT
• MM colour
• Warmth of extremities

Question 7

What are the main signs of forwards HF?

Answer 7

• Lethargy, exercise intolerance
• Weak femoral pulses, unable to detect distal pulses (metatarsal)
• Pale MM, slow CRT
• Cold extremities
• Possibly hypothermia
• “Cardiogenic shock”
• Heart sounds “quiet” or “distant” on auscultation

Question 8

How is cardiogenic shock different to normal shock? How is it treated?

Answer 8

Due to cardiac disease – need to treat differently to normal shock as the heart is failing to pump properly, so giving fluids is not the treatment needed – positive inotropic drug needed

Question 9

What are the signs of left sided congestive (backwards) HF?

Answer 9

Pulmonary oedema:

• Tachypnoea, both inspiratory and expiratory, restrictive breathing pattern
• Cough in dogs due to left atrial enlargement
• +/- soft inspiratory crackles on auscultation – might not always be audible

Question 10

What are the signs of right sided congestive (backwards) HF?

Answer 10

• Ascites (positive fluid wave on ballotment)
• Distended jugular veins – pulsating more than normal
• Positive hepatojugular reflux
• Loss of condition
• +/- pleural effusion

Question 11

What are the normal HRs of dogs and cats?

Answer 11

Dog = 80-140
Cat = 120-200

Question 12

How can heart murmurs be characterised?

Answer 12

• Location: Left vs Right; Apex vs Base
• Timing: Systolic vs Diastolic vs Continuous
• Grade

Question 13

What is the most common cause of a continuous murmur?

Answer 13

Patent ductus arteriosus

Question 14

The left apex of the heart is the point of maximum intensity for which heart valve?

Answer 14

Mitral valve

Question 15

The left base of the heart is the point of maximum intensity for which heart valve?

Answer 15

Pulmonic and aortic valve

Question 16

Listening at the left cranio-dorsal portion of the heart in puppies is important for what reason?

Answer 16

To check for a patent ductus arteriosus

Question 17

What occurs at the heart sounds S1 and S2?

Answer 17

S1: closure of AV valves
S2: closure of semilunar valves

Question 18

What is the cause of a heart murmur?

Answer 18

Heart murmurs are detected when Turbulent versus Laminar flow is present in the heart / great vessels

Question 19

Describe innocent murmurs

Answer 19

• Young puppies (and kittens)
• Usually < grade 3/6
• Diminish with growth
• Disappear by 16 – 20 weeks old
• Due to change in foetal to adult haemoglobin
• Can be difficult to distinguish from congenital heart disease
• Low pitched
• Get less loud as the puppy grows

Question 20

Which type of murmurs are never innocnet?

Answer 20

Loud and continuous

Question 21

Describe a Mitral Regurgitation (Myxomatous degenerative valvular disease) murmur

Answer 21

o	Left Apical
o	Systolic
o	Loud pan-systolic
o	Plateau
o	Grade 4/6

Question 22

Which part of the stethoscope is used to listen to heart sounds?

Answer 22

Diaphragm for S1 and S2

Bell for S3 and S4

Question 23

When would S4 be heard in small animals?

Answer 23

Detected in animals which depend on atrial contraction to achieve ventricular filling – e.g. with abnormal LV relaxation, in feline hypertrophic cardiomyopathy

Question 24

When would S3 be heard in small animals?

Answer 24

When early diastolic filling is abruptly decelerated in a stiff, poorly compliant LV, and filling pressures are high (e.g. DCM)

Question 25

Give 2 examples of adventitious lung sounds

Answer 25

• Crackles (inspiratory): smaller airways opening

- Wheezes (expiratory): narrowed airways

Question 26

When can thoracic compressibility be used?

Answer 26

To check for mediastinal masses in cats

Question 27

Describe the main features of respiratory disease

Answer 27

• Normal or decreased HR
• Sinus arrhythmia
• Coughing on excitement
• No heart murmur

Question 28

Describe the main features of cardiac disease

Answer 28

• Normal or increased HR
• Sinus rhythm or sinus tachycardia or arrythmias
• Coughing at night
• Possible murmur