CHAPTER 31. Cardiovascular Disease
Rebecca S. McConnico
CARDIAC EXAMINATION
I. Locations
A. Pericardium
1. Infectious pericarditis
2. Pericardial tamponade
B. Myocardium
1. Myocarditis
2. Myodegeneration
3. Myocardial fibrosis: Infective, parasitic, embolic, ischemic, monensin toxicity, vitamin E-selenium deficiency, neoplasia
C. Cardiac valves
1. Bacterial endocarditis
2. Degenerative thickening of the valves
3. Valvular dysfunction
4. Ruptured chordae tendinae
D. Endocardium
E. Cardiac and vascular anomalies
1. Patent ductus arteriosus (PDA)
2. Atrial and ventricular septal defects (VSDs)
3. Tricuspid or pulmonic valve atresia
4. Complex cardiac defects
II. Function
A. Low cardiac output
B. Weakness
C. Exercise performance
D. Syncope
E. Organ or limb ischemia
F. Arrhythmia
G. Secondary organ function
III. Cardiac database
A. Signalment (age, breed, sex)
B. History (use, exercise intolerance, fitness, drug history, complaints)
C. Physical examination
1. Heart rate and rhythm
2. Arterial pulse rate, rhythm, character
3. Jugular venous pulse and pressure
4. Inspection for subcutaneous edema, palpation of the cardiac region
5. Auscultation of the heart and lungs
6. Cardiac rhythm
7. Heart sounds
8. Cardiac murmurs
9. Respiratory sounds
D. General physical examination
E. Examination during and following work
F. Diagnostic tests
1. Complete blood count
2. Coggins test
3. Blood cultures
4. Biochemical and cytologic examination of effusates
5. Electrocardiogram, resting and post-exercise
a. To determine rate, rhythm, and conduction time
b. Lead II or base-apex: For heart rate determination
c. P wave: Bifid (double peaked) and positive wave
d. QRS complex
6. Cardiac imaging
7. Thoracic radiographs, scintigraphy, echocardiography
8. Cardiac catheterization
9. Angiocardiography
IV. Auscultation
A. Cardiac rhythm
1. Regular sinus rhythm with rate of 26 to 50 beats/min
2. Sinus bradycardia = less than 25 beats/min and usually resulting from high vagal tone
3. Sinus tachycardia = more than 50 beats/min
B. Arrhythmias
1. Physiologic arrhythmias
a. Sinus arrhythmia
b. Sinus block
c. Secondary atrioventricular (AV) block is physiologic if it goes away with the administration of vagolytic drugs, startling motions, or exercise
d. Functional systolic murmur
2. Abnormal arrhythmias
a. Frequent atrial premature complexes
b. Junctional premature complexes
c. Ventricular premature complexes
d. Atrial tachycardia
e. Atrial fibrillation and flutter
C. Location of valves
1. Mitral valve: Located at the left fifth intercostal space just dorsal to halfway point between the shoulder and sternum
2. Aortic valve: Left fourth intercostal space just ventral to the point of the shoulder at the caudal border of the triceps muscle
4. Tricuspid valve: Left third intercostal space just dorsal to the halfway point between the shoulder and sternum deep to the triceps muscle.
5. AV valve closure: Best heard below the valves
D. Heart sounds
1. First heart sound
a. Located at the left apex, heard best over and just below the mitral and tricuspid area
b. The first heart sound occurs simultaneously with the apex beat and is immediately followed by the arterial pulse
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