Hx and PE

Question 1

What are the cardiac signalments to look out for?

Answer 1

Species
Age
Breed/type
sex

Question 2

Small breed dogs/CKCs are prone to what?

Answer 2

Mitral valve disease
* more likely in males and with age

Question 3

Large breed dogs/Dobermans/irish wolfhounds are prone to what?

Answer 3

Dilated cardiomyopathy

Question 4

What do cats often develop?

Answer 4

myocardial disease
hypertrophic cardiomyopathy is the most prevalent

Question 5

What is the difference between heart dz and heart failure?

Answer 5

Heart dz: animal with detectable abnormality of heart
heart failure: animals with clinical signs of forward/backward failure

Question 6

What are the most common hx complaints for heart dz?

Answer 6

dyspnoea
cough
exercise intolerance
lethargy
ascites
oedema
syncope
collapse
weight loss

Question 7

What are the ddx for dz presenting like cardiac dz?

Answer 7

respiratory
neuro
musculoskeletal
metabolic

Question 8

What are the 4 steps of a cardia PE?

Answer 8

observation
palpation
percussion
auscultation

Question 9

What are the main things to observe in cardiac PE?

Answer 9

demeanour
respiratory effort and rate
mucous membranes
BCS
venous congestion (jugular pulses/distention)
ascites

Question 10

What does the mucous membrane colour indicate?

Answer 10

moist/salmon pink: normal
pale: poor peripheral circulation or reduced haemoglobin in circulation
blue: inadequate oxygenation

Question 11

What does the capillary refill time indicate?

Answer 11

estimates tissue perfusion
<3s = normal

Question 12

What do we need to palpate in a cardiac PE?

Answer 12

apex beat
location
intensity
rate and rhythm
presence of thrill
abdomen (ascites, concurrent dz)

Question 13

What is important to ask when palpating the pulse?

Answer 13

are pulse rate and heart rate the same
is the pulse regular, if irregular is that regular or irregular
describe the quality of the pulse

Question 14

What is percussion for?

Answer 14

fluid lines
areas of dullness
in abdomen: detection of fluid thrill

Question 15

Describe the position of the heart’s valves

Answer 15

Left side of body
pulmonic valve (R heart)
aortic valve
mitral valve

R side of body
tricuspid valve

Question 16

What can we auscultate on the left side?

Answer 16

apex of heart: caudal, mitral valve more audible S1 loudest

base of heart: cranial, pulmonic and aortic valve more audible S2 loudest

Question 17

What can we auscultate on the right side?

Answer 17

tricuspid valve
possibly aortic valve
ventricular septal defects

Question 18

When is systole/diastole during the heart beats?

Answer 18

S1 to S2: systole
S2 to S1: diastole

Question 19

When hearing a murmur near the left heart base we suspect?

Answer 19

pulmonic/aortic valve

Question 20

When hearing a murmur near the left heart apex we suspect?

Answer 20

mitral valve

Question 21

When hearing a murmur on the right side we suspect?

Answer 21

tricuspid valve
VSD loudest on right

Question 22

What is important to remember about murmur in. cats?

Answer 22

can be dynamic
most audible at the sternum
not all murmurs are pathological

Question 23

What are the characteristics to properly describe a murmur?

Answer 23

timing/duration
location
intensity/audibility
radiation
pitch
shape

Question 24

What is a systolic murmur?

Answer 24

between S1 and S2: lub-woo-dup

Question 25

What is a diastolic murmur?

Answer 25

After S2: lub-dup-woo

Question 26

What is a continuous murmur?

Answer 26

Through S1 and S2, can muffle the heart sounds: woosh-woosh

Question 27

What is a crescendo-drecrescendo murmur?

Answer 27

between S1 and S2 with loudest moment in the middle

Question 28

What are the causes of systolic murmurs on the left side?

Answer 28

Apex: mitral insufficiency
Base: Aortic stenosis, Pulmonary stenosis

Question 29

What are the causes of systolic murmurs on the right side?

Answer 29

Sternal border: VSD
Cranial: Tricuspid stenosis, Aortic stenosis

Question 30

What are the causes of diastolic murmurs on the left side?

Answer 30

Apex: mitral stenosis
Base: Aortic insufficiency, pulmonic insufficiency

Question 31

What are the causes of diastolic murmurs on the right side?

Answer 31

Cranial: aortic insufficiency, tricuspid stenosis

Question 32

What are the 6 grades of murmurs?

Answer 32

Grade 1: barely audible
Grade 2: clearly audible at PMI, does not radiate
Grade 3: clearly audible, as loud as S1 and S2, may radiate
Grade 4: Louder than S1 and S2
Grade 5: precordial thrill palpable
Grade 6: Audible with stethoscope off thorax

Question 33

What is radiation of murmur?

Answer 33

describes the fact that the murmur continues to be more clearly audible in a particular direction as you go away from the point of maximal intensity

Question 34

Where can aortic murmurs radiate?

Answer 34

up the carotid arteries

Question 35

Where can mitral murmurs radiate?

Answer 35

dorsally

Question 36

What is murmur pitch?

Answer 36

subjective description of the frequency of the audible sound associated with a murmur

Question 37

What is murmur shape?

Answer 37

description of appearance on phonocardiogram
ex: diamond shaped = crescendo-decrescendo, plateau = pan/holosystolicW

Question 38

What is a gallop sound?

Answer 38

Additional heart sound, not a murmur, audible in diastole in small animals
du-lub-dup

Question 39

What does a gallop sound in SA indicate?

Answer 39

S3 or S4 audible may indicate poor diastolic relaxation of the ventricle

Question 40

What are lung crackles associated with?

Answer 40

pulmonary oedema
indicate that alveoli and small airways are snapping open at the end of inspiration
can also occur with respiratory dz

Question 41

What are wheezes/stertor associated with?

Answer 41

respiratory dz more likely cause of clinical signs