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211 Cards in this Set
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What is the order of the Blood Flow through the heart |
1. Cranial and caudal vena cava
2. Right Atrium 3. Tricuspid valve (right AV) 4. Right Ventricle 5. Pulmonary valve 6. Pulmonary arteries 7. Lungs 8. Pulmonary veins 9. Left Atrium 10. Mitral Valve(Left AV, Bicuspid) 11. Left Ventricle 12. Aortic Valve 13. Body |
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What aspects do you examine when evaluating the cardiovascular system?
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Signalment |
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Signalment-Young animals
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Congenital defects
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Signalment-Older animals
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Valvular insufficiency and acquired cardiac diseases
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Signalment Breed
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Congenital defects
Acquired diseases |
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What is the order of the Blood Flow through the heart
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1. Cranial and caudal vena cava
2. Right Atrium 3. Tricuspid valve (right AV) 4. Right Ventricle 5. Pulmonary valve 6. Pulmonary arteries 7. Lungs 8. Pulmonary veins 9. Left Atrium 10. Mitral Valve(Left AV, Bicuspid) 11. Left Ventricle 12. Aortic Valve 13. Body |
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What aspects do you examine when evaluating the cardiovascular system?
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Signalment
History Physical Exam Electrocardiography Thoracic Radiography Echocardiography |
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Signalment-Young animals
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Congenital defects
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Signalment-Older animals
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Valvular insufficiency and acquired cardiac diseases
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Signalment Breed
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Congenital defects
Acquired diseases |
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What is Syncope?
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Transient loss of conciousness
Often mistaken for a seizure Usually associated with exertion or excitement. |
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What are the clinical signs that can be noted by owner?
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Syncope
Cough Respiratory Difficulties Excercise Intolerance |
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What does a cough mean in regards to Cardiovascular system?
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Pulmonary Edema and pressure on mainstem bronchi from cardiomegaly
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What are some signs that the animal is going through some respiratory difficulties?
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1. Dog refuses to lie down
2. Cat sits sternal 3. Cat open mouth breathing 4. Rapid respiratory rate 5. Exaggerated chest movements |
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What do you examine when taking a physical exam/cardiovascular exam?
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Examine...
Entire body Mucous membranes Check jugular vein for distension or pulsation Femoral pulse palpation Thoracic Auscultation |
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What should you note when looking at the mucous membranes?
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Note color and CRT
Used to estimate peripheral perfusion Gums, conjunctive, prepuce, vulva Apply pressure to blanch membrane, count seconds till color returns(<2) Pale mucous membranes Cyanotic mucous membranes |
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What do you check when you perform a femoral pulse palpation?
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Strength
Regularity(pulse deficit) |
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How do you check the regularity of the femoral pulse?
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Listen to heart and evaluate pulses at same time, there should be a pulse for each heart beat
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What do you assess when performing a thoracic auscultation?
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Assess heart rate and rhythm
Identify normal and abnormal sounds Evaluate pulmonary sounds Patient should be standing Need quiet room No panting or purring Auscult both sides of chest-heart sounds, respiratory sounds, valves |
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What are artifacts of thoracic auscultation?
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Respiratory sounds, GI sounds, stethoscope rubbing on hair(crackes), room sounds
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What are the two sides of the stethoscope?
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Diaphragm
Bell |
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What is the Diaphragm?
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Flat piece, high frequency sounds
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What is the Bell?
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Low frequency sounds-Hold lightly on chest
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How do you use a single-sided stethoscope?
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Using light contact for low frequency sounds and using firm pressure for high frequency sounds
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What does the heart sound S1 sound like?
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Lub
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What is S1?
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Closure of AV valves at onset of systole
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What is systole?
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Contraction of the ventricles, this occurs between S1 and S2
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What valves open during S1?
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Aortic and pulmonic valves open
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What does S2 sound like?
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Dub
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What is S2?
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Closure of aortic and pulmonic valves at end of systole
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What does S2 start?
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Diastole.
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What is Diastole?
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Relaxation of ventricles and this occurs between S2-S1
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What valves open during S2?
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Av Valves open
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What Heart sounds should not be heard and means that there is a problem?
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S3 and S4
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What are S3 and S4 sounds?
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Diastolic sounds
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What do they sound like if they are heard?
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Gallop or gallop rhythm
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What should you use to hear it?
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the Bell of the stethoscope.
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Areas to listen to for the pulmonic valve are?
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Left 3rd intercostal space at costochondral junction.
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Areas to listen to for the Mitral(left AV, Bicuspid) valve?
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Left 5th intercostal space just below costochondral junction
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Areas to listen to for the aortic valve?
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Left 4th intercostal space just above costochondral junction.
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Areas to listen to for the Tricuspid (Right AV) valve?
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Right 4th intercostal space just above costochondral junction
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What are murmurs?
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Abnormal sounds caused by blood flow turbulence
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What is an insufficiency murmur?
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A leaky valve. Turbulence from backflow thru valve not fully closed
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What is a stenosis murmur
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Narrowing. Constriction of opening causes turbulence.
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When does a Systolic murmur occur?
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During systole
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Between which sounds does the Systolic murmur occur?
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Between S1 and S2
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Systolic murmur occurs when which valves open and which valves close?
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When the AV valves close and the Aortic/pulmonic open
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Diastolic Murmur occurs when?
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During Diastole
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Between which heart sounds does the Diastolic murmur occur?
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between S2 and S1
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Which species is the Diastolic murmur uncommon in?
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Dogs and Cats
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Diastolic murmur occurs when which valves open and which valves close?
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When the aortic/pulmonic close and av opens
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What is the most common cause of a continuous murmur?
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PDA
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What does PDA mean?
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Patent ductus arteriosus
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What is PDA?
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Failure of ductus arteriosus to close at birth. It is heard on left side above pulmonic valve area
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Where does a continuous murmur occur?
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Throughout the cardiac cycle
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How do you perform a precordial palpation
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Palpate chest by placing hands on side of patient's chest wall over heart.
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Where should you feel the strongest impulse when conducting a Precordial palpation?
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Between the 5th intercostal space.
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What is the precordial thrill?
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A palpable thrill...
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How do you grade a murmur?
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The grading goes from Grade I to Grade VI
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What is Grade I of a murmur?
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Very soft murmur- heartd only in quiet room after minutes of listening
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What is a grade II of a murmur?
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Soft murmur but easily heard
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What is a grade III of a murmur?
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Moderate intensity murmur
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What is a grade IV of a murmur
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Loud murmur-->no thrill
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What is a grade V of a murmur
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loud murmur-->with thrill
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What is a grade VI murmur?
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Very loud murmur it can be heard with stethoscope off the chest wall.
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What does Electrocardiography do?
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Assess rate and rhythm and gives some info on heart enlargement.
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What is Thoracic radiography used for?
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The best way to evaluate heart size/enlargement
Evaluates signs and severity of heart failure, pulmonary edema, pulmonary effusion |
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What is echocardiography?
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Ultrasound waves used to visualize the heart, direction and velocity of blood flow.
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What does echocardiography do?
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It assesses cardiac structure and function to determine type and severity of cardiac disease.
Also used to evaluate therapy |
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In regards to Blood pressure what does systolic mean..?
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Peak pressure
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In regards to blood pressure what does the mean mean?
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average
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In regards to blood pressure what does diastolic mean?
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Lowest pressure
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What are different ways that blood pressure can be measured in?
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Doppler, oxcillometric, pressure plethymography
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What is a doppler?
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U.S. echo from RBC's, Systolic BP only
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What is an Oscillometer?
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Pressure oscillations in cuff bladder due to volume changes of limb as artery pulses detected.
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What is a pressure plethysmography?
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Inflatable cuff occludes arterial flow, pressure sensor band(gel) detects arterial pulsations.
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What is Mitral vavle insufficiency?
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Leakiness due to endocardiosis.
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In which animal is mitral valve insufficieny commin in?
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old dogs especially small breeds.
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What can a mitral valve insufficiency cause?
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congestive heart failure, pulmonary edema.
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Tx for LCHF(congestive heart failure)
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Diuretics, O2, vasodilators, sedatives, inodilators,(inotropic&vasodilatory)ACEI, Na+ restriction, +/- positive inotropes, +/- antiarrhythmics
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What are the goals of dietary management of heart management?
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Sodium restriction
Control weight loss and debilitation. |
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What should the diet also have?
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High-biologic-value protein
Simple sugars and emulsified fats |
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What diets are used to help with heart management?
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Hill's canine H/d g/d k/d
Hill's Feline |
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What is Tricuspid Valve insufficiency?
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Leakiness due to endocardiosis
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Which condition is it less common than?
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Mitral valve insufficiency.
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Where is the systolic murmur loudest on an animal with Tricuspid valve insufficiency?
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at the tricuspid valve.
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Which disease can Tricuspid valve insufficiency cause?
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RCHF
ascites pleural effusion |
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How do you treat RCHF?
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Diuretics, O2, vasodilators, sedatives, inodilators(inotropic and vasodilators), ACEI, Na + restriction, +/- positive inotropes, thoracocentesis, +/- antiarrhythmics
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Which location is endocarditis most common in?
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Mitral valve
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What is endocarditis?
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valvular insufficiency bacterial infection of a valve
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Endocarditis is less common than _____________?
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endocardiosis
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What is the intermediate host of Heartworm?
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Mosquitos
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Where does Dirofilaria immitis live in the definitive host?
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Lives in the pulmonary artery outflow tract
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What does a heartworm infection cause?
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Cough, ascites, dyspneas, weakness
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What is the tx for heartworm in dogs?
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Melarsomine (Immiticide)
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What is the tx for heartworm in cats?
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Symptomatic(Lethal pulmonary thromboembolism if kills worms)
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What are the different HW prevention drugs?
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Ivermectin
Milbemycin Moxidectin Selamectin Diethycarbamazine |
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Ivermectin
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Heartgard products (D&C)
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Milbemycin
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Interceptor, Sentinel (D)
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Moxidectin
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Proheart-D
Advantage Mulit-D&C |
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Selamectin
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Revolution- D&C
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Diethylcarbamazine
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Filarabits-D
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What breeds are more prone to Dilated Cardiomyopathy?
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Doberman, Boxer, Cocker spaniel
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What causes Dilated Cardiomyopathy?
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It is Idiopathic/Genetic
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What can cause Dilated Cardiomyopathy in cats?
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Taurine deficiency
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What happens to the heart if there is Dilated Cardiomyopathy?
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Heart chambers enlarged, muscle walls thing, Prone to rhythm abnormalities.
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What is the tx for Dilated Cardiomyopathy?
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ACEI, Beta blockers(cardioprotective), +/- tx as for CHF, +/- antiarrhythmics
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What species is Hypertrophic Cardiomyopathy common in?
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Cats and it is rare in dogs
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What may cause Hypertrophic Cardiomyopathy?
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Idiopathic or secondary to hyperthyroidism
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What happens to the heart if the animal has Hypertrophic Cardiomyopathy?
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Muscle wall thick, chambers get smaller
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What does Hypertrophic cardiomyopathy result in?
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Respiratory distress due to pulmonary edema or pleural effusion
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What is the tx for Hypertrophic cardiomyopathy?
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Beta blockers, Ca channel blocker, CHF tx
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What is Pericardial effusion?
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Fluid within pericardial space
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Hemangiosarcoma?
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Cardiac cancer
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Pericardial effusion is _________.
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idiopathic
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What does Pericardial effusion cause?
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causes pressure on the heart
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What is the treatment for Pericardial effusion?
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Tx: pericardiocentesis followed by surgery (subtotal pericardectomy)
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What is the most common congenital heart defect in dogs?
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Patent ductus arteriosis
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What is Patent Ductus arteriosis?
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A Continuous machinery murmur left base
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What are some symptoms of PDA?
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Left to Right (systemic to pulmonary) shut, volume overload, LVH, Pulmonary Hypertension
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What is the most common heart defect in cats?
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Ventricular septal defect(VSD)
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What is Ventricular septal defect?
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Systolic murmur right base
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What are some symptoms(signs) of Ventricular Septal Defect?
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Left to right(systemic to pulmonary) shunt, volume overload, LVH, pulmonary hypertension
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What Heart disease is common in Labrador retrievers?
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Congenital Heart diseases such as Mitral dysplasia, and Tricuspid dysplasia
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What is mitral dysplasia and Tricuspid dysplasia?
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Congenital malformation of AV valve
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What disease is similar to Mitral dysplasia and tricuspid dysplasia? (results)
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Degenerative AV valve conditions.
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What is Pulmonic or subaortic stenosis?
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Narrowing of outflow tract, causes overwork during systole
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What are the tetrology of Fallot?
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PS, VSD, RVH, Over-riding aorta
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What are some signs and symptoms of Congenital heart disease (Fallot)
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Right to left shunt
Cyanosis |
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What is persistent right aortic arch?
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Regurgitation in weanlings due to constriction of the esophagus.
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When can murmurs occur and not be a threat?
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Innocent murmurs in puppies and kittens
Murmurs secondary to anemia, fever etc. |
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What is Electrocardiography?
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Graphic representation of the changing electrical activity of the heart.
Provides info on rate, rhythm, and conduction of impulses through the heart Can show evidence of chamber enlargement, electrolyte imbalances, and drug toxicities |
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Why would you perform an ECG?
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to diagnose an arrhythmia detected on physical exam.
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What can an ECG rule out?
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can rule out arrhythmias or conduction disturbances in patients with history of syncope, seizures or exercise intolerance
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What can an ECG monitor?
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Anti-arrhythmic therapy
can also monitor animals under anesthesia, post-op, or with severe heart disease |
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What can an ECG evaluate?
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can evaluate patients with suspected cardiac drug toxicities or electrolyte distrubances
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What does idiopathic mean?
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Of, relating to, or designating a disease having no known cause.
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What does each cycle start with (electricity of the heart)?
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Each cycle starts with impulse from SA node in right atrium
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Electricity of the Heart....
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Sinoatrial node
Each cycle starts with impulse from SA node in right atrium Depolarization of atria follows Waves spreads through AV (atrioventricular) node Depolarization spreads from AV node through ventricles via the left and right bundles branches, and the Purkinje fibers Repolarization of ventricles follows- return to resting state in preparation for next stimulus |
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What is the P wave?
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depolarization and contraction of atria- starts at SA node
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What is the P-R interval?
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Time from onset of atrial muscle activation thu conduction to ventricles (via AV node) - ventricles fill with blood from the atria
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What is the QRS complex?
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Depolarization and contraction of the ventricles
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What is Q?
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negative deflection which precedes the R wave
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What is R?
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first positive deflection?
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What is S?
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Negative deflection which follows the R wave
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What is the T wave?
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repolarization of ventricles, can be positive or negative-->Filling of atria occurs
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How many cables are put on the patient?
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4
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What are cables?
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Electrical leads which view the electrical activity of the heart between two points
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What does the ECG machine measure?
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measures electrical potentials as they pass from one electrode to another
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What does P wave in relation to ECG waveform in Lead II?
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Activation of atria- electrical activity down and to left toward positive pole of lead II-upward deflection.
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What is the P-R interval in relation to ECG waveform in Lead II?
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delay at AV node-no activity-no deflection
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What is the Q wave in relation to ECG waveform in Lead II?
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depolarization on inter-ventricular septum from right to left -negative deflection
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What is the R wave in relation to ECG waveform in Lead II?
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Depolarization of both ventricles- left has larger mass- electical activity travels down and to left- large positive deflection
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What is the S wave in relation to ECG waveform in Lead II?
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Last area of ventricles to depolarize is base- electical activity in an upward direction- negative deflection
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What is the ST segment in relation to ECG waveform in Lead II
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No activity between depolarization and repolarization of ventricles flat line
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What is the T wave in relation to ECG waveform in lead II
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Repolarization of ventricles- follows same direction as depolarization- positive deflection
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What is the position that you should use for an ECG?
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Right lateral recumbency.
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What can be evaluated while the animal is standing or sternal for an ecg?
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rate and rhythm.
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What should you use to conduct the electrodes?
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alcohol
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What is the standard setting for an ECG?
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1mV = 1 cm
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Each small box on an ECG vertical axis is how equivalent to how many mV
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0.1 mV
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How fast does each small box go on the horizontal axis...?
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0.02 sec at 50 mm/sec
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How fast should the ECG fun to get a longer rhythm strip?
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25 mm/sec
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Sixty-cycle interference?
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Electical interference pattern
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What are two different reasons for artifacts due to the animal?
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muscle tremors and respiratory movements
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A wandering baseline is caused by..?
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respiratory movements
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Rapid irregular movements of baseline is caused by..?
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Muscle tremors
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How do you calculate a heart rate with an ecg strip?
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Count complexes in 3 seconds(2 sets of time markers at 50 mm/sec; 1 set at 25 mm/sec) and multiply by 20
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What does it mean that the P wave increased in duration?
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Increase in LA=P mitrale
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P wave increased in amplitude?
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increased RA = P pulmonale
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R wave increased in amplitude?
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Increased LV
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S wave increased in amplitude?
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Increased RV
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What is the normal heartrate of dogs?
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60-160 bpm
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What is the normal heartrate of cats?
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120-240 bpm
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A regular rhythm means that...?
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all R-R intervals are the same
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What is a sinus arrhythmia?
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regularly irregular...
Variation in HR and R-R interval related to phase of respiration Increase HR on inspiration Decrease HR on expiration |
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What does Ausculting mean?
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follow chest mov't as listen
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What are some examples of abnormal rhythms? 9
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Sinus Bradycardia
Sinus Tachycardia AV Block Atrial Premature Complexes Atrial Fibrillation Ventricular Premature contractions Ventricular Tachycardia Ventricular Flutter Ventricular Fibrillations |
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What is a sinus bradycardia?
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Slow heart rate generated by SA node
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What is the HR of a dog and cat with Sinus Bradycardia?
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less than 70 in dogs
less than 120 in cats |
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What are the causes of Sinus Bradycardia?
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increased vagal tone (vomiting, intubation), hypothermia, hypothyroidism, toxicities, anesthetic overdose, drugs, hyperkalemia
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What is Sinus Tachycardia?
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Fast heart rate generated by SA node
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What is the HR of a dog and cat with sinus tachycardia?
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HR greater than 160 in large dogs
180 in small dogs 240 in cats |
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What are causes of Sinus tachycardia?
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Excercise, stress, pain, fever, hyperthyroidism, shock, anemia, CHF, drugs
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What is the First degree of AV block?
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"All" of the beats go through the AV node but with delayed conduction
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What is the second degree of AV block?
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"Some" of the beats go through
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What is the third degree?
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"None" of the beats go through
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What happens to the P-R interval when it is first degree AV block?
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It is prolonged
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What is Mobitz type I?
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P-R interval increases until a block P wave occurs
Some P waves are not followed by a QRS complex. |
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What is Mobitz Type II
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Some P waves are not followed by a QRS comples
P-R interval is constant( may be prolonged or not) |
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What is Third degree AV block?
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P waves completely blocked at AV node.
P waves and QRS complexes have no consistent have no consistent relationship |
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What is an escape rhythm?
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QRS complexes wide and bizarre= slow ventricular rhythm
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What are atrial premature complexes?
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Impulse originates from an atrial site other than the SA node.
A premature beat with a normal QRS following... Irregularly irregular rhythm HR ususally normal |
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What is Atrial Fibrillation?
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Numerous disorganized atrial impulses bombarding the AV node.
Rapid and Completely irregular rhythm. No P waves visible QRS complexes usually normal |
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What is Ventricular Premature Contractions?
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Impulse for heart contraction originates from ventricle not SA node
QRST complexes are wide, bizarre shaped and occur before the next expected beat P wave dissociated from the QRS complex |
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What is Ventricular Premature Contractions associated with?
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GDV and cardiomyopathy
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What is Ventricular Tachycardia?
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3 or 4 or more VPCs in a row
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What causes Ventricular Tachycardia?
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heart disease or drug toxicity
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What is a ventricular flutter?
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Rhythm consists of a rapid Sine wave pattern. It is a form of ventricular tachycardia in which the QRS and T waves combine to form
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What does Ventricular flutter precede?
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Ventricular Fibrillation...
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What is Ventricular Fibrillation?
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No recognizable QRS complexes (bizarre undulating baseline with no visible QRS complexes or P waves)
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What is the Mediastinum?
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Space between the left and right pleural cavities.
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What does the Mediastinum contain?
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Contains esophagus, trachea, heart, aorta, vena cava, and assoc. blood vessles and nerves
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What does the Left and right pleural cavities consist of?
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Left cranial, middle and caudal lung lobes
Right cranial, middle and caudal lung lobes plus right accessory lobe |
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What history do you take when assessing a respiratory problem?
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Species
Age Breed Time of Problem (eg after excercise) Duration of problem |
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What are signs of diseases of the pleural space and lungs?
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Dyspnea
Cough +/- fever, weight loss, nasal discharge, crackles, wheezes |
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What do you observe when examining the respiratory system?
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Respiratory rate, depth, rhythm and effort
Sitting or standing normally? breath w/ mouth open? nasal discharge? (color & consistency) Stertor or stridor? |
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What do you auscult when examining the respiratory system?
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Listen to all areas of the lung fields-- you normally hear sounds throughout inspiration and first part of expiration
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What should you prevent when ausculting lungs?
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Prevent panting and purring
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What are the three ideal views for radiography?
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Alveolar pattern
Bronchial pattern Interstitial pattern |
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What is the Alveolar pattern?
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Indicates fluid in lungs
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