Examination of the heart and circulatory system Flashcards Preview

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Flashcards in Examination of the heart and circulatory system Deck (18):
1

What are the major steps in the examination of the heart and circulatory system (9)?

  • Temp
  • Pulse
  • Respiration
  • Mucous membranes
  • Thoracic palpation
  • Auscultation 
  • Heart percussion
  • Abdominal palpation
  • Observatino of peripheral blood vessels

2

What problems/diagnostic info can be determined from temperature?

  • Normal/subnormal: heart failure
  • Elevated: infection (myocarditis, valvular endocarditis), hyperthyroidism (myocardial hypertrophy in cats)

3

Pulse evaluation:

Which vessel is usually used?

What can cause tachycardia? Bradycardia?

What are the 4 quality types and causes of each?

 

  • Femoral artery is usually used: rate, rhythm, quality
  • Tachycardia
    • Heart failure, fear/excitement, exercise, pain, elevated temp
  • Bradycardia
    • Sleep, excessive parasympathetic tone, diseases of conduction system of the heart
  • Quality
    • Hyperkinetic (large, strong)--after exercise, anemia
    • Hypokinetic (small, weak)--decreased left ventricular stroke volume
      • Dilated cardiomyopathy, shock, aortic stenosis, pericardial effusion
    • Waterhammer--arterio-veno shunts, severe anemia
    • Alternating--arrhythmias

4

When might respiration be elevated?

 

Elevated with left and right heart failure

5

What will left CHF cause during respiration?

End inspiratory crackles (ventral thorax)

6

Mucous membrane evaluation--name DDx for the following:

Pale

Cyanotic

Brick red

Delayed CRT

  • Pale = fear, left herat failure, shock
  • Cyanotic = R-L shunts, severe left heart failure
  • Brick red = erythrocytosis (red cell leukemia)
  • Delayed CRT = decreased L ventricular output or peripheral vasoconstriction (fright, shock)

7

Name some DDx for the following changes noted during thoracic palpation:

Cranially shifted

Caudally shifted

Strong beat

Weak beat

  • Cranial shift = tumors, abscesses or hernias in caudal thorax
  • Caudal shift = cranial thoracic tumors (thymus, pre-sternal lymph nodes), or abscesses and cardiac enlargement
  • Strong beat = young/thin animals, as well as animals w/ anemia, yrexia, excitement, fear, pain, hyperthyroidism, shunts, enlargement
  • Weak beat = shock, heart failure, obesity, emphysema/tumors of the lungs, diaphragmatic hernias and pleural/pericardial effusion

8

What is found on abdominal palpation that indicates R CHF?

What can sometimes be felt?

Rounded liver edges

Fluid

9

When observing peripheral blood vessels, what does distension of the jugular veins indicate?

Right CHF

10

Which 3 characteristics of the pulse are considered in a physical examination?

Rate, rhythm, quality

11

What information do mucus membranes provide on the cardiovascular system (general)?

Color and CRT can give an indication on the oxygenation and circulation; moisture indicates hydration status

12

What are the normal heart sounds? Differentiate between them

  • S1
    • Closure of AV valves
    • Best heard over site of apical beat
    • Lub sound
    • Longer duration, lower pitch, louder than S2
  • S2
    • Closure of aortic and pulmonary valves
    • Shorter duration, softer
    • Best heard over aortic and pulmonary valves

13

Gallop sounds

What are they?

Which beats are heard and what do they represent?

 

  • Result of extra heart sounds
  • S3
    • Rapid passive ventricular filling
    • In dogs/cats only heard with left ventricular enlargement (normal in large animals)
  • S4
    • Contraction of atria
    • Heard in small animals with reduced ventricular compliance--HCM (cats), 2o ventricular hypertorphy (dogs)

14

What are the 5 types of gallop sounds?

  • Protodiastolic gallop = S1, S2, S3
  • Presystolic gallop = S4, S1, S2
  • Summation = faster heart rates when one cannot distinguish if there is an S3 or S4
  • Split S1 = result of left and right AV valves closing at different times
  • Split S2 = pulmonary and aortic valves closing at different times (may be result of systemic or pulmonary hypertension)
  • Systolic click = early sound of mitral valve degeneration and occurs when cordae tendinae snap tight as the degenerative mitral valve protrudes into the left atrium in mid systole

15

What are heart murmurs?

What causes them (4)?

  • Audible vibrations produced by turbulent blood flow
  • Caused by:
    • Narrowing of a vessel (pulmonic or aortic stenosis)
    • Valvular insufficiencies (endocardiosis, idiopathic dilated cardiomyopathy, valvular endocarditis)
    • Increased rate of blood flow (anemia, fever, shunts, hyperthyroidism)
    • Decrease in viscosity of the blood (hyperproteinemia)

16

What are the 4 types of murmurs?

Where are murmurs usually heard?

  • Physiological--young animals, anemia, fevor, fright
  • Systolic--during systole--early, mid-, late-, holo-, or pan-systolic
  • Diastolic--rare in small animals
  • Continuous--systole and diastole

 

  • Murmurs are usually loudest over a valvular area and may radiate and be heard in different areas of the thorax

17

Differentiate between the grades of murmurs

  • 1/6 = soft, not easily heard
  • 2/6 = soft, heard after a few seconds of auscultation
  • 3/6 = heard immediately, may be heard over a louder area
  • 4/6 = heard over most of the chest--both sides
  • 5/6 = loud, palpable thrill
  • 6/6 = very loud; can be heard when stethoscope is held slightly off the chest wall

18

What special diagnostic tests are available for the cardiovascular system and what abnormalities do they best characterize?

  • Radiograhy--x-ray 
    • Useful in detecting blood vessel, airway, lung parenchyma, pleural space abnormalities, changes in heart size
  • Electrocardiogram--measurement of electrical potentials created by various parts of the heart during contractions
    • Used to characterize arrhythmias and conduction disturbances
    • Can measure heart chamber sizes, but not most reliable test
    • Electrolyte disturbances
  • Echocardiography--ultrasound
    • Provides info on heart size and motion of various chambers
    • Measures blood flow and objectively estimates contractility, densibility and CO
  • Cardiac catheterization and angiocardiography
    • Measures pressures and oxygen saturation levels in various chambers
    • Injection of radio-opaque dyes to measure blood flow
  • Phonocardiogram--graphic representation of the heart sounds on an ECG
    • More accurate determination of location of murmurs in the cardiac cycle