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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
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-
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0and%20Password%20combination. Early Systolic Pansystolic
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
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!!
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. Weve 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.