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Questions and Answers
What does a hyperkinetic pulse indicate?
What does a hyperkinetic pulse indicate?
Which of the following factors does NOT influence arterial pulse palpation?
Which of the following factors does NOT influence arterial pulse palpation?
What is a characteristic of a hypokinetic pulse?
What is a characteristic of a hypokinetic pulse?
Which condition is associated with a pulse deficit?
Which condition is associated with a pulse deficit?
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What component of pulse pressure is defined as the difference between systolic and diastolic pressure?
What component of pulse pressure is defined as the difference between systolic and diastolic pressure?
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Which of the following is NOT a factor when assessing abdominal fluid abnormalities?
Which of the following is NOT a factor when assessing abdominal fluid abnormalities?
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Which heart sound is generally not detectable in small animals during auscultation?
Which heart sound is generally not detectable in small animals during auscultation?
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Which condition may indicate right-sided congestive heart failure as evidenced by abdominal fluid?
Which condition may indicate right-sided congestive heart failure as evidenced by abdominal fluid?
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What is the normal capillary refill time (CRT) indicative of?
What is the normal capillary refill time (CRT) indicative of?
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Which color of mucous membranes indicates possible anemia or reduced tissue perfusion?
Which color of mucous membranes indicates possible anemia or reduced tissue perfusion?
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A bluish discoloration of the mucous membranes is referred to as which of the following?
A bluish discoloration of the mucous membranes is referred to as which of the following?
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Which condition could cause abnormal jugular pulsation and distension?
Which condition could cause abnormal jugular pulsation and distension?
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Where should you auscultate to assess the mitral valve in dogs?
Where should you auscultate to assess the mitral valve in dogs?
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What is the expected heart rate range for a healthy cat?
What is the expected heart rate range for a healthy cat?
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An increase in venous pressure can lead to which of the following conditions?
An increase in venous pressure can lead to which of the following conditions?
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During a cardiac auscultation, where is the aortic valve best heard?
During a cardiac auscultation, where is the aortic valve best heard?
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What does a prolonged capillary refill time (CRT) usually indicate?
What does a prolonged capillary refill time (CRT) usually indicate?
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Which of the following could cause mucous membranes to appear hyperemic?
Which of the following could cause mucous membranes to appear hyperemic?
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What does S1, also known as 'Lub', signify in cardiac auscultation?
What does S1, also known as 'Lub', signify in cardiac auscultation?
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What is the primary characteristic of a Grade II murmur?
What is the primary characteristic of a Grade II murmur?
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Which of the following best describes a pathologic S3 sound?
Which of the following best describes a pathologic S3 sound?
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Which heart sound is associated with atrial contraction and abnormal ventricular relaxation?
Which heart sound is associated with atrial contraction and abnormal ventricular relaxation?
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What is the main cause of a cardiac murmur?
What is the main cause of a cardiac murmur?
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In which area is mitral regurgitation most often localized?
In which area is mitral regurgitation most often localized?
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Which type of murmur occurs due to turbulence from a narrowed region?
Which type of murmur occurs due to turbulence from a narrowed region?
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Which of these statements correctly differentiates systolic and diastolic murmurs?
Which of these statements correctly differentiates systolic and diastolic murmurs?
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What characteristic is NOT associated with high-grade murmurs?
What characteristic is NOT associated with high-grade murmurs?
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What type of murmur is typically continuous?
What type of murmur is typically continuous?
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Study Notes
Cardiovascular Physical Examination
-
Mucous Membranes:
- Assess peripheral perfusion and tissue oxygenation.
- Commonly examined are gums and tongue.
- Capillary refill time (CRT):
- Normal is less than 2 seconds.
- Prolonged CRT suggests decreased cardiac output.
- Color:
- Normal is pink.
- Pallor: due to anemia, peripheral vasoconstriction, reduced tissue perfusion, or combination of factors, such as shock, dehydration, heart failure, or cardiac tamponade.
- Hyperemic, injected: increased blood flow, potentially due to breed variation, high PCV, activity, excitement, or septic shock.
- Cyanosis: bluish discoloration due to increased deoxygenated hemoglobin (over 5 g/dL). Less than 80% Oxygen saturation indicates a problem with oxygenation. Can be central, peripheral, or differential.
- Icteric: yellowing from bilirubin.
- Petechiae: pinpoint hemorrhages, suggesting platelet disorder.
-
Jugular Veins:
- Normal: pulsation up to one-third of the neck.
- Increased jugular venous distension/pulsation:
- Possible lesion on the right side of the heart.
- Increased right atrial pressure.
-
Cardiac Auscultation:
- Equipment: stethoscope.
- Stethoscope parts: binaurals, ear pieces, tubing, diaphragm, bell.
- Placement locations (Dogs):
- Mitral: at and dorsal to left apical impulse.
- Aortic: craniodorsal to mitral valve, second sound is loudest.
- Pulmonary: One ICS cranioventral to aortic valve.
- Other locations: over great vessels (left craniodorsal thorax), right sternal edge, thoracic inlet.
- (Other species: see the corresponding slides for additional location details)
- Rate/Rhythm:
- Count beats for 15 seconds multiplied by 4 for beats per minute (BPM).
- Normal heart rate ranges for each species are provided.
- Assess if heart rate is appropriate for patient, activity level, or sympathetic drive.
- Determine if tachycardia (fast heart rate) or bradycardia (slow heart rate) exists.
- Assess if the rhythm is regular or irregular.
- Heart Sounds:
- S1 ("Lub"): closure of atrioventricular valves (mitral and tricuspid). Lower pitch.
- S2 ("Dub"): closure of semilunar valves (aortic and pulmonary). Higher pitch.
- S3: rapid ventricular filling due to poorly compliant ventricle, early diastole; abnormal in some species.
- S4: atrial contraction ("kick"), abnormal ventricular relaxation, late diastole; abnormal in some species.
- Cardiac Murmurs:
- Definition: prolonged audible vibrations during a normally quiet period of the cardiac cycle.
- General causes: high velocity/turbulent flow, ejection of large stroke volume, decreased blood viscosity, narrow region causing large area.
- Intensity/Grade: categorized from I to VI (as described), localized, radiating to parts of the heart.
- Location: categorized as base or apex (as described).
- Timing: categorized as systolic, diastolic, or to-and-fro.
-
Arterial Pulse Palpation:
- Influenced by: ventricular stroke volume, ejection velocity, arterial compliance, vascular resistance, heart rate, body condition score (BCS).
- Pulse quality: difference between systolic and diastolic pressure, related to "pulse pressure."
- Hyperkinetic: stronger than normal, "bounding" or "waterhammer," indicates issues like aortic insufficiency or PDA.
- Hypokinetic: weaker than normal, "pulsus parvus," reduced pulse pressure. Indicates severe myocardial dysfunction.
- Pulse Deficit: difference between palpated pulse and cardiac contractions (indicates premature heartbeats, atrial fibrillation, or ventricular tachyarrhythmia).
-
Abnormal Fluid:
- Abdomen: distension, palpable fluid wave, hepatomegaly, ascites. Possible Right sided and or Biventricular heart failure.
- Pericardial/Pleural: assess other aspects of PE (physical exam), respiratory rate/effort, heart rate/rhythm, pulses, use of TFAST.
- Peripheral Edema: visual assessment of swelling in limbs (note pictures).
-
Summary:
- Mucous membranes, jugular veins, heart sounds (S1, S2, S3, S4), and palpation of arterial pulses are all crucial components of a cardiovascular physical exam for various species.
- Different species have specific criteria.
- Always consider breed variations, activity level, and other influencing factors when evaluating findings.
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Description
This quiz covers key aspects of cardiovascular physical examination, focusing on mucous membranes and peripheral perfusion. Learn to identify normal and abnormal findings such as capillary refill time, color variations, and signs of potential cardiovascular issues. Test your knowledge on these essential examination skills.
