Exam of the heart and lungs Lecture

Stethescope basics

• Earpiece

• Tubing

• Head (chest piece)

Earpieces

Fit into examiner’s ear canals

Tubing

Transmits sound through stethoscope from chestpiece to earpieces

Head (chest piece)

• Bell → concave side used for low frequency sounds

• Diaphragm —> flat, used for higher frequency sounds

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Stethescope basics

• Hold so earpieces are pointed away from your body

• Adjust head position to optimize listening

• Practice on yourself first

• Clean ear pieces with cotton swabs and disinfect after use fro longevity

Respiratory System Evaluation steps

1. Observation

2. Palpation

3. Auscultation

Step 1 Observation

Respiratory rate, pattern, quality

Step 2 Palpation

Masses, asymmetry, swelling, tenderness; elicit a cough; fractured ribs

Step 3 Auscultation

Trachea, lungs

What is observation done?

Before touching your patient

RR

number of breaths in 15 seconds x 4

Normal canine RR (respiratory raye)

16-28

Normal feline RR

20-28

Respiratory Rate

• Breaths per minute

• Look at flank of animal and count number of times it rises and falls

• Stress, excitement, fever, heart disease, and excessive heat can increase RR

Flank of animal

The side of an animal's body between the ribs and the hip where the respiratory movements can be observed.

Observation

• Inspiration vs. expiration

• Nares

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Inspiration vs. expiration

The process of inhaling and exhaling air in and out of the lungs, allowing for gas exchange

What to observe in inspiration vs. expiration

Equal duration and effort

What to observe with nares

Nasal discharge

• Note color, consistency, unilateral vs bilateral

• May indicate Upper Respiratory Infection (URI), allergies, neoplasia (abnormal cell growth), swelling, or asymmetry

• Check for patency (equal flow through both sides)

Dyspnea

Labored breathing

• Inspiratory

• Expiratory

Inspiratory dyspnea

Upper airway disease

Expiratory dyspnea

Lower airway disease

Palpation

The act of using one's hands to examine the body, particularly to assess the condition of organs and tissues.

What to palpate?

Thorax:

• Fractured ribs

• Masses

• Subcutaneous

• Compliance

• Asymmetry

• Tenderness

Subcutaneous

tissue beneath the skin that contains fat and connective tissue, often assessed for masses or tenderness.

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Auscultation

is the process of listening to the internal sounds of the body, typically using a stethoscope, to assess the heart, lung fields, and other organs.

Auscultating the lung fields

11th intercostal space dorsally to 6th costochondral junction

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Auscultating the Trachea

• Inspiration and expiration clearly audible

• Tracheal or bronchial sounds

Tracheal or bronchial sounds

Those heard when stethoscope is placed over the trachea or hilar region of the lung

Normal sounds during ausculattion

Loud and blowing

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Auscultating the lungs

Vesicular sounds = normal sounds heard when stethescope placed over thoracic wall away from hilar area

Normal sounds when auscultating the lungs

“Wind blowing through trees”

Abnormal sounds when auscultating the lungs

Upper airway vs. lower airway

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Abnormal lung sounds

• Wheezes

• Crackles

• Stridor

• Stertor

• Silence

Wheezes

• Narrowed airways

• High-pitched musical sounds (more pronounced on expiration)

Crackles

• Small obstructed airway openings

• Discontinuous, short bursts of sound (crumpled cellphone)

Stridor

Labored breathing, high-pitched sound that results from rigid tissue vibrations (heard w/out stethescope)

Stertor

Labored breathing; low-pitched sound flaccid tissue vibrating throughout respiratory cycle

Silence

Pleural effusion

Pleural effusion

accumulation of fluid in the pleural space between the lungs and chest wall.

Fine Crackles synonym

Rales

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Thoracic Percussion

Technique using hands to tap or wrap on patient’s thoracic body wall while listening to resultant echoes

Normal percussion

“Resonant”

Resonant

The sound of a patient’s voice heard through the stethoscope when listening to the ches

Abnormal percussion

“Flat/dull” or “hyper-resonant”

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Cardiovascular System Evaluation steps

1. Observation

2. Palpation

3. Auscultation

Cardiovascular Observation Step 1

• Mentation

• Respiratory rate/effort

The steps before were respiratory system evaluation

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Mentation

Assessing the patient's level of consciousness and mental status to determine cognitive function.

Cardiovascular Palpation Step 2

• Abdominal distension (right-sided heart failure)

• Femoral pulses

Abdominal distension (right-sided heart failure)

An abnormal swelling of the abdomen due to fluid accumulation, which can indicate heart failure on the right side.

Femoral pulses

The palpation of the femoral artery to assess blood flow and circulation in the lower extremities, important in cardiovascular evaluations.

Cardiovascular Auscultation Step 3

• Heart sounds

• Heart rate

1st observation in the cardiovascular system

Mucous Membrane Color

Normal Mucous Membrane Color

Uniformly pink

Abnormal Mucous Membrane Color

• Pale

• Cyanotic

• Jaundiced

• Hyperemic

Cyanotic

refers to a bluish discoloration of the skin and mucous membranes due to insufficient oxygen in the blood.

Jaundiced

refers to a yellowish discoloration of the skin and mucous membranes, typically caused by an accumulation of bilirubin due to liver dysfunction or hemolysis.

Hyperemic

refers to an excess of blood in the vessels supplying an organ or tissue, often resulting in redness.

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Pale mucous membrane menaing

Anemia

Cyanotic mucous membranes meaning

Cardiopulmonary problem

Cardiopulmonary problem example due to cyanotic mucous membranes

A condition such as hypoxia or respiratory failure that results in insufficient oxygenation of tissues.

Jaundice mucous membranes meaning

Liver disease

Hyperemic mucous membranes meaning

Increased peripheral perfusion

Increased peripheral perfusion

refers to a higher than normal blood flow to the skin and extremities, often resulting in reddened or flushed mucous membranes.

Peripheral Perfusion

Capillary refill time

• CRT <2 sec is normal

• Prolonged refill time suggests cardiovascular compromise

Temperature of extremities signaling a problem

may indicate inadequate perfusion or poor circulation, often assessed through warmth, coolness, or temperature differences.

Normal hydration status sign in mucous membranes

• Moist to touch

• Shiny

Dehydration status sign in mucous membranes

• Tacky

• Dry

Pulse

Systolic pulse pressure - diastolic pulse pressure

Systolic vs. diastolic pressure

Systolic pressure is the maximum pressure in the arteries during heartbeats, while diastolic pressure is the lowest pressure between beats.

Femoral pulse

Rate and quality of pulse; synchronous with heart rate

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Palpation

Find apex beat of heart at ~5th-6th intercostal space (point of elbow)

Apex beat

L ventricle striking chest wall during systole

Absence of Apex Beat

Obesity, fluid, air, or mass in pleural space or pericardial abnormality

Systole

The phase of the cardiac cycle when the heart muscle contracts, pumping blood out of the ventricles.

Pericardial abnormalities signalled by absence of Apex Beat

can include conditions like pericardial effusion or cardiac tamponade, which can decrease cardiac output and impact heart function.

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HR (Heart Rate)

Number beats in 15 sec. x 4 (per minute)

Normal canine heart rate

70-160

Normal feline heart rate

140-210

“Normal” heart rate

Depends on breed

What can hinding auscultation

Purring, panting, breathing

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In auscultation, heart sounds =

heart valves closing

S1

AV (atrioventricular) valves closing (beginning of systole)

Systole

the phase of the cardiac cycle where the heart muscle contracts, pumping blood into the arteries.

S2

Pulmonary and aortic valves closing (beginning of diastole)

Diastole

the phase of the cardiac cycle where the heart muscle relaxes, allowing the chambers to fill with blood.