Cardio2- Cardio PE/ Ausc

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  1. Degenerative valve disease does NOT occur in _______.
    cats
  2. What are 3 diseases that boxers have a predilection for?
    aortic stenosis, arrhythmogenic RV cardiomyopathy, chemodectoma (aortic body tumor)
  3. What breeds of cat have a genetic predilection for HCM? (5)
    persian, ragdoll, norwegian forest cat, maine coon, sphynx
  4. What are signs of low cardiac output? (3)
    exercise intolerance, weakness, syncope
  5. What are signs of CHF? (4)
    signs of low cardiac output plus pulmonary edema or body cavity effusions, +/- respiratory signs
  6. Describe syncope and its characteristics (how you can differentiate it from seizures).
    sudden loss of consciousness and postural tone; syncope is precipitated by activity or excitement and the recovery is VERY quick, may stiffen with head dorsally flexed and urinate
  7. What are causes syncope? (6)
    arrhythmia, reflex-mediated (vasovagal), decreased CO, severe structural heart disease (limits CO), pulmonary hypertension, drugs (diuretics, vasodilators)
  8. Describe reflex-mediated syncope.
    from inappropriate activation of cardiac baroreceptor reflex--> bradycardia + vasodilation; often precipitated by excitement (increases SNS activity)
  9. Superficial venous engorgement almost always means ___________.
    right-sided HF
  10. 3 drug classes that tend to lower BP.
    diuretics, vasodiuretics, ACEi
  11. Arterial BP should be measured in cardiac patients to identify... (3)
    hypertension, hypotension, monitor drug effects (diuretics, vasodilators, ACEi)
  12. By what method can you NOT measure arterial BP?
    palpation of arterial pulse
  13. What is pulse pressure?
    systolic pressure minus diastolic pressure (what you feel when you palpate pulse)
  14. What are methods to directly measure ABP? When are these methods used?
    needle or catheter inserted into artery; invasive measures are useful in some anesthesia and critical care situations
  15. What are methods of indirectly measuring ABP? (2)
    oscillometric devices (measures oscillations in artery), Doppler systems (detects blood flow through artery)
  16. Describe how oscillometric devices work.
    small doppler crystals that detect blood flow through and artery using the doppler principal; not very accurate
  17. Oscillometric devices are better for measuring ___________.
    high pressures than lower pressures
  18. Describe how Doppler flow detector methods of measuring BP work.
    place a small doppler crystal over an artery (usually a distal artery)--> listen for flow going through the artery
  19. What are some technical aspects of using Doppler flow to measure BP?
    if you use too small of a cuff, the artery won't be compressed enough and BP will be overestimated; vice versa if you use too large of a cuff
  20. Where are locations at which you can palpate arterial pulse? (3)
    femoral triangle (SA), facial artery (horses), coccygeal artery (cows)
  21. The HR as calculated by stethoscope os faster than what you palpated. What does that usually mean?
    arrhythmia
  22. What are the ranges for normal arterial BP?
    140-110/ 70-90
  23. What factors determine pulse strength and quality? (5)
    rate, rhythm, increased or decreased stroke volume, decreased diastolic BP (vasodilation, PDA, aortic regurgitation), LVOT obstruction
  24. Systolic BP will increase with... (2)
    increased stroke volume, decreased aortic compliance (increase stiffness)
  25. Diastolic BP decreases with... (3)
    decreased HR, decreased vascular resistance (vasodilation), abnormal diastolic runoff (PDA, AR) [same as increased pulse pressure]
  26. Pulse pressure increases with... (3)
    decreased HR, decreased vascular resistance (vasodilation), abnormal diastolic runoff (PDA, AR) [same as decreased diastolic BP]
  27. Hyperkinetic pulse occurs with __(2)__.
    increased SV or increased pulse pressure
  28. Hypokinetic pulse occurs with __(2)__.
    decreased SV or obstruction
  29. Describe PE findings consistent with PDA. (2)
    continuous heart murmur and extremely strong pulses
  30. So-called "weak pulse" occurs when there is a(n) ____________.
    narrower pulse pressure
  31. Elevated jugular venous pressure is usually indicative of... (2) Less commonly... (4)
    right CHF or pericardial disease; large pleural effusion, volume over-infusion (iatrogenic), cranial mediastinal or pulmonary mass (vena caval compression), cranial VC thrombosis
  32. Increased jugular venous pulses can be caused by... (5)
    pulmonic stenosis, tricuspid regurgitation, pulmonary hypertension, an arrhythmia with atrioventricular dissociation (AV block and Vtach), right-sided CHF
  33. What are causes of pallor? (2)
    anemia, systemic vasoconstriction (hypotension)
  34. What are the types of cyanosis? (3)
    central (decreased pO2), peripheral (increased oxygen extraction), differential (reversed PDA)
  35. Give an example of peripheral cyanosis.
    child in cold water with blue lips- vasoconstriction but they are not desaturated
  36. Describe what differential cyanosis would look like in a dog.
    pink MMs in the head but the prepuce/penis is blue
  37. Describe how differential cyanosis occurs.
    pulmonary artery pressure is equal to or higher than in the aorta--> blood goes from the pulmonary artery to the descending aorta; deoxygenated blood goes into circulation to the caudal body (the ascending aorta is not affected to the head is still getting oxygenated blood)
  38. __(2)__ are common consequences of systemic hypertension in dogs and cats.
    Retinal hemorrhage and detachment
  39. Has dental disease been proven to be important as a cause of heart disease in dogs?
    No
  40. Hyperthyroidism result in __________ of the heart because __________ is increased, _______ is activated.
    hypertrophy; protein synthesis; SNS
  41. Thyrotoxicosis clinical consequences. (7)
    LV hypertrophy, tachycardia, increased pulse, ejection murmur, gallop, HTN, and possibly CHF (if prolonged)
  42. What are some non-cardiac causes of edema? (4)
    inflammation (vasculitis), low serum albumin, venous obstruction, and lymphatic diseases (lymphedema)
  43. How does bacterial (infective) endocarditis lead to peripheral vascular disease?
    thrombus forms on the heart valves and dislodges
  44. What are causes of peripheral arterial vascular disease? (7)
    aortic thrombosis, bacterial endocarditis, increased coagulation, degenerative arterioscleorsis, atherosclerosis, trauma, parasitic arteritis
  45. What can lead to atherosclerosis in dogs?
    severe hypothyroidism and hypercholesterolemia
  46. If you tap the fluid from a body cavity of an animal with CHF, what will you find?
    transudate or modified transudate, (abdomen0 high protein fluid, (thorax) many small lymphocytes
  47. Why does chyolothorax occur in cats?
    impaired drainage of lymph into systemic venous circulation
  48. What is an example of a disease that sounds normal on auscultation but had marked abnormalities on echo?
    heart muscle disease
  49. What 2 diseases can you almost definitively diagnose by cardiac auscultation?
    PDA, mitral regurgitation
  50. What does diastolic dysfunction sound like on auscultation?
    gallop sound
  51. Most heart sounds are below _________.
    audible frequency
  52. The bell of the stethoscope is used to hear ________.
    low pitched, diastolic sounds
  53. What and where are the valves areas in a dog?
    • mitral: at and dorsal to the left apical impulse
    • aortic: craniodorsal to MV, second sound is loudest
    • pulmonic: one intercostal space cranioventral to aortic valve
    • tricuspid: on the right, just cranial to MV
  54. ID heart murmurs based on their ____________.
    point of maximal intensity
  55. Why is it so important to listen carefully on the right side of cattle?
    VSD and tricuspid valve endocarditis are common in cattle
  56. What animals don't we use valve areas in? What do we do instead?
    cats, ferrets, birds; auscult along each side of the sternum, apically, and cranially (palpate apex beat for orientation)
  57. What are the heart sounds, and what does each represent?
    • S1: MV and TV closure
    • S2: AV and PV closure
    • S3: rapid ventricular filling (normal in LA only)
    • S4: atrial contraction (normal in LA only)
  58. Why can we feel an apex beat?
    during isovolumetric contraction as wall tension is developing, the heart actually twists, and as it twists, it hits the chest wall
  59. The apical impulse occurs during ___________.
    early systole
  60. What does the ventricular gallop sound indicate in small animals?
    S3- abnormal ventricular filling; high atrial pressure and a poorly compliant ventricle (CHF)
  61. What are "clicks"?
    sound like gallops but occur in systole; higher pitched
  62. "Clicks" are abnormal heart sounds that usually result from ___________.
    mitral valve prolapse (or tricuspid)
  63. What are the auscultation findings with atrial fibrillation?
    rapid heart rate, irregular rhythm, and with variable intensity heart sounds- "tennis shoes in the dryer"; S4 is absent
  64. What does the atrial gallop sound indicate in small animals?
    S4- abnormal ventricular relaxation and increased atrial contraction pressure (larger kick)
  65. Relate the following to each other in terms of timing: apical/cardiac impulse, arterial pulse, first heart sound, and second heart sound.
    S1- [apex beat]- [pulse]- S2
  66. The pulse is palpated ___________ (timing, as observed during PE); the precordial impulse is felt at...(timing)
    between S1 and S2; the onset of ejection, which is closely after S1
  67. What are approximate normal pulse rates of horses, cows, dogs, and cats?
    • Horses- 30-40
    • Cows- 60-80
    • Dogs- 60-180
    • Cats- 140-240
  68. Compare S1 and S2 with regard to timing, duration, pitch, and PMI.
    • S1: timed with closure of mitral/ tricuspid valves; long sound that extends almost to the opening of the aortic valve; lower pitched than S2; PMI is low at 6th ICS
    • S2: timed with close of aortic/ pulmonic valves; shorter in duration; higher pitched; PMI is high in 4th ICS
  69. What is the definition of cardiac murmurs?
    prolonged audible vibrations heard during a normally quiet period of the cardiac cycle
  70. What are pathophysiologic reasons for heart murmurs?
    increased velocity flow, increased SV, decreased viscosity (anemia)--> flow of high pressure to low pressure chamber
  71. What are the 3 most important factors when evaluating a heart murmur?
    timing within the cardiac cycle (systolic, diastolic, continuous, to-and-fro), point of maximal intensity, grade (loudness on 1-6 scale)
  72. What heart murmurs occur during systole? (3)
    aortic/pulmonic stenosis, mitral/tricuspid regurg, ventricular septal defect
  73. What heart murmurs occur during diastole? (1)
    aortic regurgitation
  74. What heart murmur is continuous throughout the cardiac cycle? (1)
    PDA
  75. What causes a vibration sound during the cardiac cycle?
    function systolic murmurs- unrelated to structural heart disease (innocent)
  76. What is the point of maximal intensity of mitral regurgitation?
    apex or mitral area
  77. What is the point of maximal intensity of aortic/pulmonic stenosis?
    aortic/pulmonic valve systolic ejection murmurs
  78. Aortic regurgitation is most common in ___________ due to ___________.
    horses >10 years old; valve degeneration
  79. What is the point of maximal intensity of PDA?
    left base dorsocranial over the pulmonic artery
  80. What are friction rubs, and what causes them?
    muffled or distant heart sounds with pericardial disease
  81. What is a functional heart murmur?
    "Functional" heart murmurs are either physiological or innocent; musical; unrelated to structural heart disease
  82. Define the term "pathologic" or organic heart murmur.
    occurs with structural heart disease, causing increased velocity flow, increased SV, or decreased viscosity (anemia)
  83. Describe the typical functional cardiac murmur in terms of timing during the cardiac cycle, PMI, and loudness.
    functional murmurs usually occur between S1 and S2, closely after S1 [most common is proto-mesosystolic]; functional ejection murmurs are most often loudest over the aortic and pulmonic valves and the great vessels; usually musical or vibratory
  84. Contrast physiologic and innocent heart murmurs.
    • Innocent: unknown cause- common in very young animals, usually gone by 6 months of age
    • Physiologic: athletic heart and bradycardia (large SV); anemia, fever, hyperT4 (increased SNS and peripheral vasodilation allows inc SV); high adrenergic tone (stress or drugs)

Card Set Information

Author:
Mawad
ID:
317275
Filename:
Cardio2- Cardio PE/ Ausc
Updated:
2016-03-27 17:56:12
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vetmed cardio2
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vetmed cardio2
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