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73 Cards in this Set
- Front
- Back
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What kind of heart failure is indicated with pulmonary edema?
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left
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What kind of heart failure is indicated with ascites or pleural effusion?
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right
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Noturnal and/or paroxysmal dyspnea indicates what type of heart failure?
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left
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What is orthopnea?
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dyspnea when lying down
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Why does orthopnea occur?
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altered gravitational forces when patient is recumbent - increase intrathoracic blood volume - increased pulmonary venous and capillary pressure, increased pulmonary blood volume, reduced vital capacity of the lung
Also elevation of diaphragm reduces lung volume |
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What is cardiac asthma?
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noturnal dyspnea with bronchial narrowing due to edema, hyperplasia and increased reactivity secondary to heart disease
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What is the first stage in the pathogenesis of pulmonary edema? What are the clinical signs?
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1. compensatory - increase in left atrial pressure and pulmonary venous pressure causes engorgement of pulmonary vasculature and increased pulmonary capillary pressure
Interstitial edema - lungs less compliant, increased resistance, increased lymphatic drainage - tachypnea NO ausculatory or radiographic signs of edema |
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What happens when compensatory mechanisms are overwhelmed in pulmonary edema?
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accumulation of interstitial fluid, worsening tachypnea, cough, radiographic pulmonary edema evident - interstitial pattern
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What is the final stage of pulmonary edema? How are the radiographic findings different from earlier stages?
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further elevations in intravascular pressure - destruction of tighter junctions - flooding alveoli
Radiographs have alveolar pattern (instead of interstitial) |
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What accounts for the blue color in cyanosis? What are 2 possible causes?
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Increased amount of reduced Hb
1. increased venous blood in skin - dilated venules/venous ends of capillaries 2. reduced O2 saturation in capillaries |
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Is cyanosis a sensitive indicator of hypoxemia? At what arterial O2 saturation is it apparent?
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No - it is insensitive
Needs to get to less than 85-90% saturation before you see it |
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What areas are affected by central cyanosis?
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MM and skin
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What causes peripheral cyanosis?
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Vasoconstriction - diminished peripheral blood flow from cold, shock, low-output heart failure
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What is a pathopneumonic sign of PDA?
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Differential cyanosis where....
Normal front half of body Cyanoic back half of body |
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What is the difference between global and regional cyanosis?
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global - V/Q mismatch or R to L shunt can be causes
regional - just one region is not being perfused |
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If you see pleural effusion or ascites what are 3 signs that confirm CHF is the cause?
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1. cardiac enlargement
2. jugular venous distention 3. gallop rhythm |
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How can you tell the difference between syncope and collapse or weakness?
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Syncope - loss of consciouness
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What are 3 general reasons for syncope?
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1. poor cerebral circulation
2. decrease in cardiac output/blood pressure 3. shortage of energy substrates delivered to brain |
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How can you tell the difference between syncope and a seizure?
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No post-ictal period w/ syncope - recovery is usually rapid
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Is syncope common in cats? What are 2 specific causes of syncope in cats?
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No - relatively rare
1. hypertrophic obstructive cardiomyopathy - dyamic worsening of obstruction to left ventricular outflow during excitement 2. thromboembolism - aortic (cerebral blood supply is compromised) OR coronary arterial embolism (myocardial dysfunction or arrhythmia) |
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How long does cerebral blood flow need to be disrupted for syncope to take place?
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6-8 seconds
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How do dysrhythmias cause syncope?
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Bradyarrhythmias - drop in HR and BP - decrease blood flow to brain
Tachyarrhythmias - increased HR causes decreased filling and CO |
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What does examination of the jugular vein tell you about diastole and systole?
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Diastole - right ventricular filling pressure
Systole - right atrial pressure during systole |
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How can you estimate central venous pressure by examining the jugular vein?
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height of venous distention above the level of the atrium is estimated and is an accurate estimation (3 to 5 cm is normal)
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What do the following represent on jugular venous pulse wave?
a wave x descent c wave v wave y descent |
a wave = right atrial contraction
x descent = right atrial relaxation c wave = T valve closing - not see on normal animals v wave = right atrial filling + right ventricular contraction y descent = T valve opening |
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Why might an a wave be absent?
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atrial fibrillation or atrial standstill w/ AV nodal or ventricular rhythm
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How does inspiration affect venous pulse waves? Why?
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increased visibility, exaggeration of x and y descents because right side of the heart fills more during inspiration leads to more vigorous right ventricular contraction
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When would you see giant a waves on jugular venous pulse waves?
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1. decreased right ventricular compliance - right ventricular hypertrophy
2. right atrium is contracting against closed T valve - ventricular, atrial or AV junctional premature beats |
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When does an x descent appear deeper and more prominent on jugular venous pulse waves?
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vigorous ventricular contraction
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When does an x descent disappear on a jugular venous pulse wave? What wave becomes dominant?
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tricuspid regurgitation
v wave dominates |
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Under what circumstances would a v wave increase in prominence in a jugular venous pulse wave?
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tricuspid regurgitation, exaggerated inspiration, mild exercise OR congestive heart failure
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When is y descent exaggerated in a jugular venous pulse wave?
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whenever venous pressure is elevated
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Under what sub-clinical pathological conditions would we be able to elicit a response with hepathojugular reflex (3 conditions)?
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1. borderline elevated jugular venous pulse
2. latent right ventricular failure 3. minimal tricuspid regurgitation |
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Describe a positive hepatojugular reflux test.
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elevation of greater than 1 cm in jugular venous pressure that persists throughout the time positive pressure is applied to the abdomen
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How do you position your hands for precordial palpatation? Where do you feel an apex beat?
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both hands w/ fingers ventrally extend from 2 to 7th intercostal spaces
apex beat = 2cm area in left 5th intercostal space below the costochondral junction |
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What can normally be felt at the apex of the heart upon precordial palpatation?
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Left ventricular apical impulse = early outward thrust during first half of systole
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What differences can you palpate in the apical impulse with volume overload of the left ventricle?
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1. Prolonged impulse
2. Increased force 3. Posterior displacement and enlarged area where it can be palpated |
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Where can the second heart sound be palpated in a thin animal?
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left third intercostal space
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Where could S3 be palpated? Why would you be able to feel it?
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left apex
Large left ventricular EDV and depression of left ventricular function if intense enough |
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Why could S4 be palpated?
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Decreased left ventricular compliance - hypertrophic cardiomyopathy
Also in cats w/ hyperthyroidism, chronic anemia or hypertensive dogs and cats |
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What is a thrill?
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Palpable murmur on the chest wall, associated w/ grade V or VI murmurs
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What 3 locations can thrills be palpated what pathology causes this?
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1. apex - mitral regurgitation
2. pulmonary - pulmonic stenosis, PDA 3. right side - ventricular septal defects |
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What principally determines pulse pressure?
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Left ventricular stroke volume
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What does pulsus parvus imply?
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Decreased stroke volume
increased peripheral vascular resistance, hypovolemia, left ventricular failure, restrictive pericardial disease, pericardial effusion |
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What does an increase in arterial pulse imply?
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Increased stroke volume
increased diastolic runoff - in PDA, leak at aortic valve, peripheral arterio-venous fistula |
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What is pulsus parvus et tardus? What causes it? What other signs do you see?
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diminished and delayed pulse pressure
Aortic stenosis Thrill on chest wall, harsh systolic ejection murmur in aortic valve |
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What is biferiens pulse? What is it characteristic of?
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Two systolic peaks
Aortic regurgitation or hypertrophic obstructive cardiomyopathy |
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What is pulsus alternans? What is it characteristic of?
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Alternating pulse pressure amplitude despite a regular cardiac rhythm
Cause - severe left ventricular dysfunction and heart failure |
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What is pulsus bigeminus? What is it characteristic of?
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Regular alteration in pulse pressure caused by a premature ventricular contraction followed by a normal beat
Cause - premature ventricular contraction |
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What is pulsus paradoxus? What is it characteristic of?
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Marked reduction in amplitude during inspiration
Cause - pericardial effusion, cardiac tamponade |
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What is a pulse deficit? What is another name for this?
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Lack of pulse generated by ventricular contraction
Asynchronous pulses |
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How do arrhythmias affect pulse?
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Diastolic filling is reduced so that no pulse is generated w/ ventricular contration = pulse deficit
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Why can you hear S1 and S2 heart sounds?
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Valves closing results in rapid deceleration of blood NOT from leaflets hitting each other
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What is happening during S1?
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Closure of AV valves
Right - tricuspid Left - mitral |
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What is happening during S2?
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Closure of semilunar valves - pulmonic and aortic
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Why could you hear a split S1 sound?
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asynchronous closing of AV valves, could be hint of possible problems like premature ventricular beat
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If you notice higher intensity S1 sounds on the right as opposed to the left is this normal? Why?
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Not normal - mitral valve should close w/ more intensity because greater vigor of left ventricular contraction
If higher on right then right ventricular disease - hypertrophy should be suspected |
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Under what circumstances is the S1 increased in intensity?
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Increased preload, increased contractility, hyperdynamic conditions - fear, exercise, excitement
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Under what circumstances is the S1 decreased in intensity?
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Decreased preload, decreased contractility, increasing HR
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Which heart sound is higher pitch?
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S2 is higher pitch - dub
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What causes the physiological split of S2?
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Inspiration - more blood is pulled into the heart during inspiration so it takes the right ventricle longer to empty - pulmonic valve closes even longer after aortic
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Do pulmonic and aortic valves close at the same time during S2?
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No, pulmonic occurs slightly after aortic
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What is a condition that could cause S2 split?
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Pulmonic stenosis or pulmonary hypertension - takes even longer for pulmonic valve to close
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What is paradoxical splitting of S2? Does it change in inspiration?
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Delay in left ventricular ejection caused by increased afterload makes it so the split is cause by a delay in aortic valve closure.
Inspiration cause delay in right ventricular emptying so they will actually be closer during inspiration |
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What is a gallop?
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Abnormal diastolic heart sound
S3 - early diastole S4 - late diastole |
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What does an S3 gallop suggest?
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Large dilated failing ventricle
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What does an S4 gallop suggest?
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Ventricular hypertrophy and reduced ventricular compliance
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What causes the S3 gallop sound?
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Sudden decrease in blood flow during EARLY diastole (passive filling stage)
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What causes the S4 gallop sound?
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Sudden decrease in blood flow during LATE diastole (atrial systole stage)
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What are 3 common causes of holosystolic murmurs?
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1. Mitral insufficiency
2. Tricuspid insufficiency 3. VSD |
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What are 4 possible causes of systolic ejection murmurs?
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1. pulmonic stenosis
2. aortic stenosis 3. toF 4. atrial septal defect |
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What is the most common cause of diastolic murmurs?
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aortic regurgitation
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What is the most common cause of continous murmur?
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PDA
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