The document provides an overview of cardiology basics and the physical exam of the heart. It discusses the importance of the heart in pumping blood and removing waste. Key points include: - The heart's function is determined by cardiac output, which depends on stroke volume and heart rate. - Auscultation of heart sounds can detect murmurs or arrhythmias while lung sounds may reveal crackles or wheezes. - Physical exam also involves assessing vital parameters and looking for signs of dyspnea or weakness. - Common cardiac conditions addressed include murmurs, arrhythmias, congestive heart failure, and atrial thromboembolism in cats.

1. CARDIOLOGY BASICS:
AT THE HEART OF THE
MATTER
Jason M . Chin, DVM
Oradell Animal Hospital

2. Why is the heart so important?
 It pumps blood to organs to provide:
 Oxygen
 Nutrients
 Removes waste (biproducts of metabolism)
 Provides means for signaling/communication

3. Perfusion
 Determined by Cardiac Output:
CO = SV x HR
SV = Preload x Contractility
Afterload
 Why are these important to think about?

4. A & P

5. A & P

6. A & P – Electrical Conduction
 Basic Pathway: SA node to AV node to Bundle of
His/Purkinje fibers (ventricles)

7. A & P – Electrical Conduction
 Systole: The ‘active’, contraction phase of the
heart cycle
 Diastole: The ‘relaxed’, filling phase of the
heart cycle

8. A & P – Electrical Conduction

9. The Physical Exam
 History: As important as any physical parameter
 Syncope
 Exercise intolerance
 Difficulty/Labored breathing
 Weight loss (cachexia)
 Observation: What does your patient look like?
 Dyspnea
 Coughing
 Weak
 Abduction of elbows/Extended head
 Cheek puffing/Open mouth breathing

10. Dyspnea
http://www.youtube.com/watch?v=aqWiWlKv7OE

11. Dyspnea
http://www.youtube.com/watch?v=Zp7CiC7SXjk

12. PE – Vital Parameters
 http://www.cvmbs.colostate.edu/clinsci/wing/fir
staid/vital.htm
Dog Cat
Heart Rate 70-160 bpm 160-240 bpm
Respiratory Rate 10-30 bpm 20-30 bpm
Temperature 100.0 – 102.5 F 100.0 – 102.5 F

13. PE – Vital Parameters
 Pulses
 Strong and Synchronous
 Mucus Membranes
 Pink and Moist
 CRT < 2s

14. PE - Auscultation
 Cardiac:
 Murmurs
 Arrhythmias
 Pulmonary:
 Crackles (rales)
 Wheezes (rhonchi)
 r/o Upper Airway (referred)

15. Murmurs
 How do you describe a murmur?
 Intensity (Grade 1-6)
 Location (PMI – point of maximal intensity;
right/left/sternal, apical/basilar)
 Timing (Systolic v. Diastolic v. Continuous)
 Pitch/Frequency (high/med/low, musical/harsh)
 Shape (plateau v. decrescendo v. crescendo-
decrescendo)

16. Murmurs
 Grading System: Freeman and Levine
 I/VI – Very focal; faint
 II/VI – Faint, but more easily heard than a grade I
 III/VI – Moderately loud and easily heard (over
larger area on same side)
 IV/VI – Loud murmur heard over large area
including the opposite side (discern
between 2 murmurs)
 V/VI – Palpable thrill over PMI
 VI/VI – Audible with stethoscope off of body wall

17. Murmurs
 http://www.littmann.com/wps/portal/3M/en_US/3M-
Littmann/stethoscope/littmann-learning-institute/heart-
lung-
sounds/?mmmSsoError=1010|Invalid%20Username%2
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 Early Systolic
 Pansystolic

18. Murmurs
 Some Causes…
 Valve insufficiency/regurgitation (Chronic Valve
Disease)
 Valve stenosis
 Septal defects
 Anemia (physiologic murmur)

19. Lung Sounds
Location of sounds is important to note…
 Normal bronchovesicular sounds
 Crackles (rales)
 Wheezes (rhonchi)
 r/o stridor & stertor (upper airway)

20. Arrhythmias
 Causes of arrhythmias:
 Primary conduction disturbance
 SA Node, AV Node, fibers (blocks)
 Secondary to heart disease
 Enlarged heart (dilated, thicker, etc)
 Secondary to systemic illness
 Endocarditis, GDV, splenic disease, hyperthyroid,
pheochromocytoma, anemia
 Secondary to electrolyte imbalances
 Potassium, Calcium, Sodium
 Secondary to toxin/drug ingestion

21. Arrhythmias
 Sinus rhythm (normal)
 Respiratory sinus arrhythmia (normal)
 Faster on inspiration – vagal tone is inhibited
 Tachyarrhythmia
 SVT, V-Tach/AIVR, A-Fib
 Bradyarrhythmia
 AV Blocks, Sick Sinus Syndrome, SA disease, escape
rhythms
 Premature Beats
 APC v. VPC
 Gallop Rhythm

22. Arrhythmias
 Normal ECG

23. Arrhythmias
 VPC’s, (Ventricular Premature Contractions)

24. Arrythmias
 V-Tach (Ventricular Tachycardia)

25. Arrhythmias
 APC’s (Atrial Premature Contractions)

26. Arrhythmias
 AV Block (1st Degree & High Grade 2nd
Degree)

27. Arrhythmias
 A-Fib (Atrial Fibrillation)

28. Gallop Rhythm
 Gallop (S3 sound)

29. Types of Cardiac Disease
 Congential Defects (ASD/VSD, PDA, Tetrology
of Fallot)
 Endocardiosis/Chronic Valve Disease
(insufficiency)
 Valvular Stenosis (congenital v. acquired)
 Dilated Cardiomyopathy (dogs)
 Hypertrophic Cardiomyopathy (cats)
 Pulmonary Hypertension
 Systemic Hypertension (primary v. secondary)

30. Pathophysiology of Disease
 Abnormal blood flow (can be d/t arrhythmia,
cardiomyopathy, etc)  decreased perfusion
 Stimulates RAAS (Renin-Angiotensin-
Aldosterone System)
 Hormones increase preload, vascular tone,
and affect heart myocytes
 Structural changes ensue:
 Eccentric hypertrophy
 Concentric hypertrophy
 Chamber dilation

31. Pathophysiology of Disease

32. Congestive Heart Failure (CHF)
 Left sided
 Dyspnea
 Pulmonary Edema
 Nasal fluid/discharge
 Right sided
 Dyspnea
 Ascites
 Jugular Pulses

33. CHF
 Chest rads (needed for diagnosis)

34. CHF

35. CHF
 Treatment:
 Oxygen Therapy
 Lasix (furosemide)
 2mg/kg IM or IV (dog)
 1mg/kg IM or IV (cat)
 Nitroprusside CRI
 Sedation (Torb – beware Ace and Dexdomitor)

36. Atrial Thromboembolism
 aka “Saddle Thrombus” - Cats!!
 Gallop rhythm, often underlying heart disease
like HCM/RCM/HOCM
 Due to hypercoagulable blood in chambers
(pooling)
 Hind end paralysis (bilateral > unilateral),
usually deep pain negative
 Cold limbs, cyanotic pads
 Painful!!

37. ATE
 Negative Prognostic Indicators:
 Decreased Temperature, HR
 Bilateral (versus unilateral)
 In CHF
 Treatment:
 Pain management (hydromorphone, fentanyl)
 Oxygen therapy
 Lasix (if in CHF – 1mg/kg)
 +/- Thrombolytic therapy (aspirin, clopidogrel,
heparin)

38. What does it all mean??
 Do we have lung disease or is it something
else?
 Primary v. secondary diseases
(asthma/pneumonia v. non-cardiogenic pulm
edema/pleural effusion/pericardial effusion v.
CHF)
 Is cardiac disease the underlying cause?
 What diagnostics and treatments are

39. “We’ve got a code 1 trouble
breathing…”

40. References
Braunwald, E. Heart Disease: A Textbook of
Cardiovascular Medicine – 5th Ed. Philadelphia:
W.B. Saunders Co., 1997
Fox, Sisson, Moise. Textbook of Canine and Feline
Cardiology: Principles and Clinical Practice – 2nd
Ed. Philadelphia: W.B. Saunders Co., 1999.
Drobatz, J.K. Emergency Management of
Respiratory Distress. In: Proceedings of the
District of Columbia Academy of Veterinary
Medicine; 2004.

41. Questions?