PDx 1 - Cardiopulm Lecture

animalscientist's version from 2016-10-10 22:06


Question Answer
4 steps of resp. examInspection, palpation, auscultation, percussion
Exam is systemic. Start from _________ & work _________Nose, caudally
3 major symptom/signs to look out for when taking history?(1) Weakness/exercise intolerance
(2) Syncope
(3) Coughing
What is syncope? Associated w/? What must it not be confused w/?Collapse due to insufficient O2/glucose to brain (temporary loss of consciousness caused by a fall in blood pressure). Associated w/exertion or excitement. Don't confuse w/ a seizure.
What are possible cardiopulm causes of syncope?DCM (dilated cardiomyopathy), severe mitral valve insufficiency, excessive vasodilators or diuretics
How could a cough be cardiogenic?Mechanical compression or pulmonary edema of heart
What animal is coughing infrequent in?Cats
The 2 possible categories of causes of coughing?Cardiogenic & respiratory
Signs of dyspnea?Bulging eyes, flaring nostrils, open mouth breathing, abdominal breathing, unwilling to lie down, forelimbs abducted
What is orthopnea?Difficulty breathing while recumbent
Signs of orthopnea?Sit or stands w/ elbows abducted (out to sides) & head extended
What is the best way to obtain respiratory rate? Ideal way for most accurate result?From afar, before you handle. Ideally/accurately, have owners take it at home
Norm resp rate for dog? Cat?Dog = 15-30BPM. Cat = 20-30BPM
4 possible reasons for tachypnea as a result of a dz process?Fever, COPD, Pulmonary injury, Left-sided heart failure
4 respiratory patterns?Normal, ↑ inspiratory effort, ↑ expiratory effort, Restrictive pattern
What is an ↑ inspiratory effort associated w/?Associated w/ upper airway obstruction or parenchymal disease
Signs of ↑ inspiratory effort?Slow, deep breaths, Open mouth, flared nostrils, Extension of head & neck
What is an ↑ expiratory effort associated w/?Lower airway obstruction (Intra-thoracic trachea, bronchi, or small airway obstruction)
Signs of ↑ expiratory effort?Grunt or wheeze, Normal or slow, Active abdomen
What is a respiratory pattern shes interested in?Restrictive pattern
What is the result of a restrictive pattern, & what are the signs?↓ chest excursion - rapid, shallow breaths, almost a pant
What is a restrictive pattern associated w/?Associated w/ pleural disease, chest wall diseases, or diaphragm diseases
What is a sneeze? Can be _________ or _________Protective reflex - Explosive release of air from lungs thru nasal cavity & mouth (can be normal or abnormal)
What is a reverse sneeze? Can be _________ or _________, _________Inspiratory effort that clears material from nasopharynx to oropharynx. (Can be Idiopathic, or FB, epiglottic entrapment)
What is a stertor? Cause?Snoring/snorting inspiratory sound, Upper airway obstruction
What is a stridor? Cause?Inspiratory high-pitched “wheeze” Upper airway obstruction or narrowing (Most often cervical trachea or larynx)


Question Answer
If it's a nocturnal cough, what is it most likely? (2)Cardiac insufficiency, collapsing trachea
If it's a daytime cough, what is it most likely? (4)Pneumonia, parasites, allergic, neoplastic
Exertion/pulling on collar causing cough means - (true cause)Collapsing trachea
Exercise intolerance cough means-- (true cause)Cardiac issues
During or after eating cough means-- (true cause)Upper airway obstruction, laryngeal paralysis
No known stimulation of cough means-- (true cause)Pneumonia, bronchitis
Moist cough means what? Possible causes?Alveolar fluid!! (Pneumonia, parasites, allergic disease, pulmonary emboli, pulmonary edema, late stage left sided CHF)
Dry cough means?Cardiac w/out failure (enlarged left atrium pushing on main stem bronchi), bronchitis, tracheobronchitis, allergy)
Goosehonk cough means?Collapsing trachea
What is the terminal retch? What can it be confused w/?Can be confused w/ vomiting. It is when a dog is trying to/does bring up phlegm - usually the dog will swallow the phlegm
What is a voice change specific for?Laryngeal disease
What are the different types of nasal discharge? (3)Serous, mucoid, mucopurulent
Important things to note about nasal discharge? (4)Uni/bi-lateral? Quality (serous, mucopurulent?)? Is there hemorrhage/epistaxis? Food particles?
When inspecting the face, what are you looking for?Symmetry
3 most common causes of facial abnormalities/asymmetry?(1) Dental disease- tooth root abscesses
(2) Neoplasia
(3) Fungal infections (dog = aspergillosis; cat = cryptococcus)
2 ways to check for nostril patency?(1) Condensation on a cold slide
(2) Gently occlude 1 nostril at a time & feel & listen for air flow
Mucous Membrane Color/CRT is used to eval what? What is the average time? Locations for test?Eval peripheral perfusion. Color should return in <2 seconds. Oral, preputial, & vaginal mucosa
What are some atypical mucus membrane presentations?Pale- Anemia, Peripheral vasoconstriction, Petechia, icterus, ecchymosis, cyanosis
2 things that might cause a slow CRT?Dehydration, ↓ cardiac output
Would anemia cause a slow CRT?Should be normal, unless it includes hypoperfusion
What can the jugular vein reflect?Systemic venous & right heart filling pressures
What are the 3 abnormal signs the jugular vein can show?(1) Pulsations higher than 1/3 up the neck
(2) Persistent vein distension
(3) Hepatojugular reflex
What is hepatojugular reflex test?An alternate test for measuring jugular venous pressure through the distension or swelling of the internal jugular vein.
What does a positive hepatojugular reflex indicate?Impaired right ventricular filling, reduced pulmonary blood flow, tricuspid regurgitation
How do you conduct a hepatojugular reflex test?Animal Stands, Apply firm pressure to cranial abdomen to ↑ venous return, any persistent jugular distension is abnormal
Ascites or enlargement of abdominal organs may indicate?Venous hypertension, Right sided HF– passive congestion
Aside from ascites, what else could cause abd. Distension?Primary disease of abdominal organs, Primary GI disease, Aerophagia
What should you palpate the head for? (3)Symmetry, Pain, Airflow
What should you palpate the trachea for? (3)Symmetry, Inducible cough, Masses
What should you palpate the thorax for? (4)Symmetry, pain, rib fractures, murmur thrills
Where is the heart located in terms of intercostal spaces?3-6 intercostal spaces
Is the base of the heart mobile or fixed?Ffixed by great arteries
Is the apex of the heart mobile or fixed?Moves w/in the pericardial sac
What is the apex beat? Where is it located?Caused by impact vibration as heart hits chest wall at beginning of ventricular contraction. Left, ventral, 5th intercostal space
How do you determine ascites during your abdominal palpation?Fluid ballottement
What will you palpate for (probs) during your abdominal palpation?Ascites, organomegaly, 1* GI dz, neoplasia
2 most common places to take arterial pulse?Femoral a or dorsal pedal a
How many pulses for each heart beat?1
You palpate pulse & auscultate heart beat...but when?Simultaneously
What is a pulse deficit?When there are fewer pulses than heart beats
How do you perform a technique per Hamlin palpation?Stand behind pt, put hands in axilla & move ca, stop at:
(1) 2-3rd intercostal space
(2) 4-6th intercostal space
(3) Just Ca to ribs
(4) Abdomen
(5) Femoral pulses
What is the bell of the stethoscope used for?Low-pitched sounds... (3rd, 4th heart sounds, diastolic murmurs (uncommon) )
What is the diaphragm of the stethoscope used for?High-pitched sounds (Most heart/lung sounds, majority of murmurs)
What are the lung borders? The lung fields?BORDERS = Cranial - Thoracic inlet Caudal– 7th intercostal space ventrally & 9th intercostal space dorsally. FIELDS = cranioventral, central, dorsal
What are normal lung sounds called?"Bronchovesicular sounds"
Crackles aka? Where do these sounds come from? What do they mean?"Rales" discontinuous sounds. From smaller airways (<2mm). It means Edema or exudate w/in airways (i.e. Pulmonary edema, pneumonia)
Wheezes- where do these sounds come from? What do they indicate?Larger airways, >2mm. indicate airway narrowing
Dog HR as quiet/resting?50-90
Dog HR as stressed/exam?80-160
Dog HR exercise?230
Cat HR quiet/resting?90-120
Cat HR as stressed/exam?140-220
Cat HR as exercise?230
Land marks to find heart?Heart medial to triceps when dog is standing. Draw a horizontal line through point of shoulder – just above level of heart
How do you find the apex of the heart?By palpation
Where do AV valves (tricuspid & mitral) sounds tend to radiate?Ventrally to apex
Where do Murmurs of semilunar valves (aortic & pulmonic) tend to radiate?Towards heart base
Where do you find the pulmonic valve?Left, 2-3rd ICS, just above sternum
Where do you find the aortic valve?Left, 4th ICS, just above CCJ
Where do you find the mitral valve?Left, 5th ICS, just above CCJ
Where do you find the tricuspid valve?Right, 3-5th, near CCJ
How to remember where each valve is?PAM-T (2, 4, 5-3) ← according to her
What are heart sounds made by?Made by the turbulent blood flow & the corresponding vibrations in adjacent soft tissues during cardiac cycle
How would you describe a murmur as compared to a reg heart sound?Longer duration during a normally silent part of cardiac cycle
When is systole? What is happening during it?Interval b/t S1 & S2. Electrical depolarization, Contraction of ventricles
When is diastole? What is happening during it?Interval b/t S2 & the following S1. Electrical repolarization, filling of ventricles
What is S1?“Lub” - Closure of AV valves (mitral & tricuspid), Onset of systole
What does it mean if S1 is louder? Quieter?Louder = Thin chest wall, high sympathetic tone, tachycardia. Quieter = obese, pericardial effusion, diaphragmatic hernia
What is S2?“Dub” - Closure of pulmonic & aortic valves after ventricular ejection. End of systole
What does it mean if S2 is louder?Louder = Pulmonary hypertension (heartworm disease).
What does a split/sloppy S2 mean?May be normal in large dogs, abnormal w/ VPCs (ventricular premature complexes) or conduction delays
What is S3? Is it heard in sm animals? Heard when what happens, & where?End of ventricular filling. Not usually heard in sm. ani. Usually heard w/ ventricular dilation w/ myocardial failure. Heard over cardiac apex
What is S4? Is it heard in sm animals? Heard when what happens?Blood flow into ventricles during atrial contraction. Not usually. ↑ ventricular stiffness or hypertrophy. Usually heard w/ HCM or hyperthyroidism in cats
How are murmurs related to viscosity of blood?Inversely related to blood viscosity (↓ viscosity, ↑ turbulence)
How are murmurs related to velocity of blood?Directly related to velocity (↑ velocity, ↑ turbulence)
What should you know about an "innocent puppy murmur"?Disappear by 6 months of age
What would be causes of physiologic murmurs?Anemia, fever, hyperthyroidism
What should you describe in a murmur?(1) Timing
(2) Intensity-Scale I-VI
(3) Localization – point of maximal intensity (Need to know your valve locations/anatomy - Apex (5th ICS) vs. base (2th ICS) )
(4) Which hemithorax
(5) Phenographic shape
What does "pan" in regards to a murmur mean?Obliterates both heart sounds (can be through systole or diastole)
What does "holo" in regards to a murmur mean?Lasts throughout systole or diastole, does not obliterate heart sounds
Grade 1 murmurVery soft murmur; heard only in quiet surroundings after intently listening
Grade 2 murmurSoft murmur, but easily heard
Grade 3 murmurModerate- intensity murmur
Grade 4 murmurLoud murmur; but not accompanied by precordial thrill
Grade 5 murmurLoud murmur w/ a precordial thrill
Grade 6 murmurVery loud murmur that can be heard w/ stethoscope off the chest wall; accompanied by a precordial thrill
P wave is?Atrial depolarization
QRS complex is?Atrial repolarization & ventricle depolarization
T wave is?Ventricle repolarization
What do you do if you palpate/auscultate an arrhythmia?ECG
What is a Sinus arrhythmia?“Normal” irregularity in conjunction w/ respirations (↑ w/ inspiration ↓ w/ expiration)
What is percussion used for?Used to assess density of structures beneath by “thumping” on thorax
Hyper-resonant vs dull sounds during percussion relate to what structures?Hyper = air filled structures (lungs etc), dull = sold structures (plural effusion)