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cardiopulmonary exam 3 > PE for heart diseases > Flashcards

PE for heart diseases Flashcards

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1
Q

common historical findings

A 
Asymptomatic
non-specific signs: lethargy, anorexia, weight loss, failure to thrive, withdrawn
exercise intolerance
respiratory distress
coughing-at rest, during the night
abdominal distension
syncope
sudden death
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2
Q

syncope

A

brief duration-sudden onset, quick recovery
flaccid or rigid
no muscle movement
pale or blue MM color
urination
may cry at onset
often triggered by activity or excitement

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3
Q

seizure

A 
three phases: pre/ictal/post
muscle movements throughout
continual vocalizing
urination
defecation
hyperthermia
pink MM color
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4
Q

hands off examination

A 
attitude, awareness, demeanor
respiratory rate & effort
coughing
BCS
cardiac cachexia
abdominal distension
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5
Q

when cough is harsh and honking?

A

airway collapse

associated with excitement

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6
Q

when a cough is soft and quiet?

A

fluid in airways

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7
Q

where will you see cardiac cachexia most prominently?

A

spine and temporal region of head

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8
Q

What will the mucous membranes tell you?

A

capillary refill time (>2 seconds)=poor perfusion and peripheral vasoconstriction
hydration status
color

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9
Q

cyanosis

A

decreased oxygen bound to hemoglobin

caused by environment, pulmonary disease, right to left shunts

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10
Q

central cyanosis

A

intracardiac shunts
pulmonary disease
ex: tongue is blue

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11
Q

differential cyanosis

A

ex: MM of mouth=normal, MM of penis-cyanotic

reversed patent ductus arteriosus

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12
Q

normal jugular veins

A

non-distended
empty quickly following compression
pulsations less than 1/3 of neck

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13
Q

abnormal jugular veins

A

increased central venous pressure
pericardial effusion
caval obstruction
third degree AV block-cannon waves

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14
Q

tracheal palpation

A

how easy is it to elicit a cough?

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15
Q

auscultation approach

A 
palpate for apex beat or thrill
auscultate both sides of chest
rhythm and rate analyssi
listen to each valve area
identify all sounds
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16
Q

apex beat

A

low frequency vibration on thoracic wall
contraction and rotation of heart
synchronous with early systole (S1 sound)
start place for auscultation-mitral valve location
strength not useful assessment

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17
Q

location of apex beat

A

normal: left side at 5th ICS, CC junction

abnormal-right side-right side enlargement, caudal=cranial mediastinal mass

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18
Q

where should you listen to a cat on auscultation?

A

sternal, right and left parasternal regions

most murmurs are heard at 4-5th ICS over or just to the right or left of the sternum

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19
Q

where should you listen to a dog on auscultation?

A

left axillary region-cranial dorsal to pulmonic valve region, murmur of PDA
right cranial region-2nd to 3rd ICS, murmurs often radiate to this region (aortic stenosis)

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20
Q

bradycardia in dogs

A

<60 bpm

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21
Q

tachycardia in dogs

A

> 160 bpm

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22
Q

bradycardia in cats

A

<100 bpm

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23
Q

tachycardia in cats

A

> 240 bpm

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24
Q

cyclical, associated with respiration heart rhythm

A

sinus arrhythmia

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25
premature beat (heart rhythm)
often followed by a short pause (cats) extrasystoles sounds like tripping
26
pause or dropped beat (heart rhythm)
sinus arrest, second degree AV block | not associated with respiration
27
chaotic (heart rhythm)
atrial fibrillation | ventricular arrhythmias
28
paroxysmal (heart rhythm)
sudden onset and offset of arrhythmia
29
S1 sound represents?
``` closure of atrioventrical valves during QRS complex S1 loudest over mitral valve low frequency lub sounds ```
30
S2 sound represents?
closure of semilunar valves after T wave loudest over pulmonic or aortic valves dub sound
31
Absent S2 sound?
occurs with pulse deficit
32
muffled heart sound
pericardial or pleural effusion | pneumothorax
33
S3 sound
early diastolic sound immediately after S2 rapid ventricular filling SAM: dilated cardiomyopathy (Dogs)
34
S4 sound
late diastolic sounds (preceeds S1) atrial contraction SAM: hypertrophic cardiomyopathy (cats)
35
characteristics of S3 and S4
``` left apical location dull low intensity-buh sound 3 sounds-horse galloping normal in LA abnormal in SAM=heart disease ```
36
systolic clicks
short to mid-high frequency sounds occur in mid to late systole heard over mitral and/or tricuspid valves result of prolapse of valvular leaflets during systole transient sound quickly replaced by murmur of valvular regurgitation
37
split S2 heart sound
delay closure of the aortic or pulmonary valves-asynchrony | causes: normal, bundle branch blocks, pulmonary hypertension (common)
38
abnormal heart sounds: Educated guesses?
cats-almost always a gallop sound puppies: split S2 sound adult dogs: systolic clicks most likely, split S2 esp in large breed dogs
39
cardiac murmur classification
timing: systolic, diastolic, or continuous localization? intensity (grade 1-6) duration (early, holo, or pan-) shape: plateau, diamond, crescendo or decrescendo
40
plateau shaped murmur
mitral or tricupsid valve pathology
41
diamond shaped murmur
stenosis of aortic or pulmonary vessels
42
grade 1 murmur
very soft murmur detected after very careful auscultation
43
grade 2 murmur
soft murmur that is readily evident
44
grade 3 murmur
moderately intense murmur that is still focal
45
grade 4 murmur
loud murmur that widely radiates over thorax, no thrill
46
grade 5 murmur
murmur associated with a palpable precordial thrill | not audible when the stethoscope is lifted from the thoracic body wall
47
grade 6 murmur
audible even when stethoscope is lifted from thoracic wall
48
murmur intensity
poorly correlated with disease severity factors affecting intensity: environment, stethoscope type, thoracic conformation, blood viscosity, state of contractility, cardiac output, pressure gradient, direction of flow/insufficiency, volume of flow/insufficiency
49
physiologic flow murmurs
not associated with CV disease seen with puppies <5 months of age, increased CO (fever), decreased blood viscosity characteristics: systolic, heart base location, intensity 3/6 or less
50
dx of physiologic flow murmurs
no evidence of CV disease (normal thoracic rads & echo) patient signalment identify etiology murmur characteristics
51
pathologic murmur types
secondary to CV disease | associated with abnormal valves, shunts, vessel diameter
52
characteristics of pathologic murmurs
any timing any location any intensity any age
53
left sided: mitral regurgitation murmur
most common murmur | congenital or acquired diseases (valvular dysplasia, degenerative valve disease, cardiomyopathy, endocarditis)
54
characteristics of left side: mitral regurgitation murmur
holo or pansystolic plateau shaped PMI over left apex: 5th ICS at CC junction, Cats-left parasternum may radiate toward right or cranially (if >4/6) coarse or honking
55
left sided semilunar valve stenosis murmur
congenital disease: aortic/pulmonary stenosis | relative pulmonic stenosis (excessive blood flow)
56
left sided semilunar valve stenosis murmur characteristics
diamond shape PMI: cranial dorsal to apex beat (3-4th ICS) often radiated to right cranial region aortic murmur may also radiate up neck through carotid arteries
57
right sided tricupsid regurgitation murmur etiology
valvular dysplasia, degenerative valve disease, cardiomyopathy, endocarditis
58
right sided tricupsid regurgitation murmur characteristics
holo- or pansystolic plateua shaped PMI: right 3-4th ICS radiate dorsally
59
right sided ventricular septal defect murmur characteristics
pansystolic PMI: right 3-4 ICS young animal
60
right cranial murmurs
aortic stenosis or pulmonic stenosis
61
semilunar valve insufficiency murmur
diastolic etiology: aortic insufficiency (endocarditis, degenerative valve disease, dysplasia), pulmonic insufficiency (pulmonary hypertension, valvular dysplasia)
62
semilunar valve insufficiency murmur characteristics
early-holodiastolic (begins with S2 heart sound, don't heart S2) left sided variable intensity decrescendo shape
63
continuous murmur
murmur of patent ductus arteriosus left basilar location (often focal) typically loud (>3/6)
64
to and fro murmur
systolic and diastolic components (pause between systolic and diastolic components) associated with semilunar stenosis and insufficiency left basilar location
65
crackles
series of short bursts of sounds originating in parenchyma or airways produced by sudden opening of previously collapsed airways or rupture of fluid films or bubbles typically heard on inspiration located in ventral pulmonary fields
66
abdominal palpation
right side congestive heart failure: ascites (fluid wave), hepatomegaly, hepatojugular reflux ventricular arrhythmias commonly caused by abdominal neoplasia (spleen and liver)
67
arterial pulse
assess rate, rhythm and strength | rate and rhythm abnormalities: pulse deficits, arrhythmias
68
pulse strength
difference between systolic and diastolic pressures | rough estimate of stroke volume
69
hypokinetic pulses
``` tachycardia decreased ventricular contractility hypovolemia pericardial effusion shock subaortic stenosis ```
70
hyperkinetic pulses
anemia bradycardia aortic insufficiency patent ductus arteriosis
71
varying pulse strength
paraxodus: pericardial effusion alternans: cardiomyopathy, arrhythmias variable pulse strength-arrhythmias

cardiopulmonary exam 3 (7 decks)

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