Examination of the cardiovascular and respiratory system Flashcards
(39 cards)
Physical exam - observation from a distance
Observation of respiratory effort
- stance
- coughing
Nostrils
- discharge (uni/bilateral, character, odour)
- excessive dilation
- check for normal airflow (unilateral -> obstruction)
What is orthopnoea?
- standing with elbows abducted (when breathing)
What can excessive dilation of the nostrils indicate?
- poor lung function
- respiratory distress
- pain
Lymph nodes - assessment
Palpate
- size
- heat
- pain
- discharge
What are the only LN palpable in the (normal) horse?
- submandibular
- many others of the head are difficult to differentiate from salivary glands
Auscultation at rest and re-breathing - points to consider
- is the air moving throughout the entire lung field?
- are there any abnormal sounds?
- does the horse tolerate and recover from re-breathing rapidly?
- is there a tracheal rattle?
What do areas of dullness on auscultation suggest?
- pleural effusion or pulmonary consolidation/abscessation/masses
What do large airway sounds on auscultation suggest?
- consolidation
What do wheezes and crackles on auscultation suggest?
- airway narrowing, or discharges in airways
If the horse coughs or shows distress during/after re-breathing what does it suggest?
- pleural pain
What does a tracheal rattle suggest?
- discharge pooling in the thoracic inlet
Rebreathing bag - how to and what it does
- large garbage bag
- rebreathe air: build up of CO2
- drives respiratory centres
- deeper, more rapid breaths
- rebreathe until animal starts to become distressed
- continue to listen
Use of cardiac assessment
- assessment of tissue oxygen delivery
- assessment of cardiac function
- identification of cardiac dz
- diagnose pericardial dz
Arterial blood gas analysis - use, hypoxia & hypercapnia
- tests respiratory function
- hypoxia = PaO2 <80mmHg
- hypercapnia = PaCO2 >45mmHg
Is poor performance due to cardiac dz common in horses? What else should you consider?
- no, rare - they have a considerable cardiac ‘reserve’
- consider lameness, lower respiratory, upper respiratory, muscular
Is collapse / sudden death common in horses? CauseS?
- rare
- concurrent (secondary ventricular dysrrhythmias
- vascular catastrophe (e.g. vascular rupture)
Is congestive heart failure common in horses?
- rare
What is jugular distension an indicator of?
- reduced cardiac return
– right sided cardiac failure
– thoracic disease
– pericardial disease
What is peripheral oedema an indication of?
- right sided heart failure
- hypoproteinaemia
- vascular disease
Where is jugular pulsation normally visible?
- distal 3rd of neck
— dependent on head and neck position
Oedema and CHF - which side shows what? causes?
Left sided heart failure
- pulmonary oedema
— ruptured chordae tendonae
— bacterial endocarditis
— congenital cardiac dz
Right sided heart failure
- peripheral oedema
— chronic endocardial dz
Auscultation tips
Start on left
- listen just behind the triceps
- 1/2 way between elbow and shoulder ICS 5 = mitral valve
- under triceps, ICS 4 = aortic (& pulmonic valve)
Listen on right
- under triceps, move left forward = tricuspid valve
Normal heart sounds
S4 (shh)
- onset of atrial systole
- audible in 60% of TB
S1 (lub)
- onset of ventricular systole
- closure of AV valves opening up semilunar valve
- loudest over L ICS 5
— hypertension, adrenaline, MVD
S2 (dub)
- onset of diastole
- closure of semilunar valves, open AV
- loudest of L ICS 4
— fever, adrenaline, anaemia
S3 (de)
- rapid ventricular filling
- loudest over cardiac apex (low L ICS 5)
– 40% of TBs
Assessment of cardiac murmurs
Cardiac auscultation
- timing & PMI
- determine valve affected
- determine a tentative diagnosis
Hx & CE
- determine which horses require further investigation
Echocardiography
- confirm diagnosis, prognosis & safety
Electrocardiography
- concurrent dysrhythmias -> safety
