History and Physical Exam

Name at least FIVE major history questions to ask for a cardiovascular case.

Coughing

Dyspnea

Syncope

Weakness

Ascites

Paresis

Heart rhythm "off"

Current on HW medication

True or False: Both cats and dogs normally cough when in heart failure.

False! CATS do NOT generally cough, but dogs do.

What kind of heart failure is often acute and severe in dogs?

Left-sided heart failure

An enlarged heart can compress the —-.

Trachea

Name the TWO major rule-outs in a coughing cat when doing a cardio workup.

Asthma

Heartworm disease

How does dyspnea first manifest?

What TWO things can it become?

Increased resting RR

Pulmonary edema (increase respiratory effort)

Pleural effusion (increase RR, short and shallow breath)

What is syncope?

How do you differentiate it from a seizure?

Collapse due to inadequate oxygen to brain

Seizures: paddling, urinating, defecating, with postictal state

Ascites is typically related to what kind of heart failure?

Right-sided heart failure

What is ascites? Name TWO causes outside of right-sided heart disease.

Fluid accumulation

Heartworm

Pericardial disease

What causes weakness of 1-2 limbs in cats and is painful, cold/cyanotic limbs/feet/paws that is often confused with a hit by car?

Thromboembolism

What is the first rule-out for coughing in a dog?

Respiratory

What is the most important sign in cardiac cases?

Dyspnea

What arrhythmia can owners often denote as "feeling different?"

Atrial fibrillation (A-Fib)

Name THREE things you should do for a dyspneic dog or cat if it comes in.

Oxygen supplementation on presentation (oxygen cage, incubator, flow by)

Observe breathing pattern in oxygen

Truncated physical (stabilize before diagnostics minus thoracocentesis)

Name FOUR major things you should take note of on your physical exam in a cardio workup.

Observation

Head

Respiratory pattern

Jugular veins (pulse/distention)

Thoracic auscultation

Abdominal palpation

Femoral pulses

Short and shallow, increased respiratory, expiratory grunt, and labored breathing are all ways to describe what?

Character of respiration

What should you focus on the head during the physical exam? (5)

Symmetry

Muscle wasting

Dehydration (sunken eyes)

CRT prolonged with severe heart failure

Pale membranes (anemia/poor perfusion)

True or False: Tracheal response to palpation is more indicative of respiratory disease.

True!

What are THREE major rule-outs in a cardio workup related to the trachea?

Collapsing trachea

Kennel cough

Asthma (cat)

What is S1 caused by? S2? When is S3 and S4 and how is it described?

S1: AV valve closure

S2: aortic/pulmonary valve closure

S3/S4: between S1 and S2; gallop rhythm

What are the THREE major categories of arrhythmias?

Tachyarrhythmia

Irregular arrhythmia (A-fib)

Bradyarrhythmia

What is a heart murmur?

Turbulent blood flow

True or False: Heart murmur loudness corresponds to the severity of the problem.

False! Heart murmur loudness does NOT correspond to the severity of the problem.

What is the difference between a physiologic and pathologic heart murmur?

Physiologic: changes in blood content

Pathologic: structural changes in the heart

What do you expect to see in pathologic heart murmur in terms of AV and aortic/pulmonary valves in S1 and S2?

S1: AV valve insufficiency or aortic/pulmonary valve stenosis

S2: AV valve stenosis or aortic/pulmonary valve insufficiency

Describe the six grades of a heart murmur.

Grade 1: murmur barely audible

Grade 2: audible after a few seconds of auscultation

Grade 3: murmur easily localized

Grade 4: murmur louder than heart sounds

Grade 5: palpable thrill (regardless of loudness)

Grade 6: murmur audible without stethoscope

What animal with what condition often have the loudest crackles on thoracic auscultation?

What should you rule out if your auscultation is quiet?

Cats with asthma

Pleural effusion

True or False: Thoracic auscultation is important to differentiate between congestive heart failure and respiratory disease like pneumonia.

True!

True or False: On abdominal palpation, you should look for ascites (fluid wave) and be careful of masses, especially splenic masses, in case of hemoabdomen.

True!

What are some of the things you should note or rule out regarding femoral pulses?

Synchrony

Occlusion (thromboembolism)

Pulsus pardoxicus

Dropped pulses

True or False: Pulse strength indicates blood flow.

False! Pulse strength does NOT indicate blood flow

What is the difference between a bounding and strong pulse?

Bounding: looks like its dying; often heart failure or hypovolemic shock/anemia/sepsis; laterally recumbent

Strong: excited and happy; standing

What are the major signs that an owner is able to notice? (3)

A-fib

Energy changes

Respiratory signs

What should you think with right-sided versus left-sided heart failure?

Right: jugular distention; ascites

Left: Pulmonary edema

What should you think if you hear quiet heart sounds? Quiet lung sounds?

Quiet heart: Pericardial

Quiet lungs: Pleural

What are the major rule-outs in a coughing cat versus a coughing dog?

Cat: asthma; worms

Dog: respiratory