Difference between revisions of "Heart Failure, Diagnosis"
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+ | |linkpage =Cardiology - WikiClinical | ||
+ | |linktext =Cardiology | ||
+ | |sublink1=Cardiovascular Conditions - WikiClinical | ||
+ | |subtext1=CARDIOVASCULAR CONDITIONS | ||
+ | |maplink1= Cardiovascular Conditions (Content Map) - WikiClinical | ||
+ | |pagetype=Clinical | ||
+ | }} | ||
+ | <br> | ||
+ | ==History & Clinical Signs== | ||
+ | |||
+ | -Cough | ||
+ | |||
+ | -Dyspnea | ||
+ | |||
+ | -Tachypnea | ||
+ | |||
+ | -Orthopnea | ||
+ | |||
+ | -Exercise Intolerance | ||
+ | |||
+ | -Syncope | ||
+ | |||
+ | -Lethargy | ||
+ | |||
+ | -Ascites | ||
+ | |||
+ | -Peripheral Edema | ||
+ | |||
+ | -Weight Loss | ||
+ | |||
+ | -Capillary Refill Time: under 3 seconds is normal; over 3 seconds is abnormal | ||
+ | |||
+ | -Mucous Membrane Color: | ||
+ | |||
+ | Pallor=pale skin/mucus membrane; suggests poor peripheral circulation due to vasoconstriction, decreased hemoglobin in the blood (anemia), or shock | ||
+ | |||
+ | Cyanosis=blue skin/mucus membrane discoloration; Suggests adequate hemoglobin, but inadequate oxygenation; Seen with Pleural effusion/pulmonary edema, right to left shunt within the circulation causing deoxygenated blood to mix with oxygenated blood | ||
+ | |||
+ | |||
+ | *Signs of heart failure are directly related to which side is affected. | ||
+ | |||
− | + | *The above signs are characteristic of cardiac problems, but can also be the signs of other diseases involving different body systems. | |
− | |||
− | + | *A good physical exam including signalment, history, observation, palpation, percussion, and auscultation are necessary to identify true cardiac problems. | |
− | |||
− | + | ===Physical Exam=== | |
+ | ====1. Observation==== | ||
− | + | -Clinical signs: (listed above) | |
− | |||
− | === Palpation | + | ====2. Palpation==== |
− | + | -Precordium:(Left side of the chest behind the elbow where heart contractions are easily palpated and auscultated) | |
− | + | Heart Rate, Rhythm, Character | |
− | + | Apex Beat | |
− | + | Palpable Thrill | |
− | |||
− | + | -Pulse: (Rate, Rhythm, Character) | |
− | + | Dog: Femoral Pulse; Palpate heart | |
− | + | Horse: External Maxillary/Facial Artery; Transverse Facial Artery; Median Artery; Digital Artery; Metatarsal Artery | |
− | + | Cattle: External Maxillary/Facial Artery; Middle Coccygeal Artery; Median Artery | |
− | + | Pulse Deficits (Seen with Arrhythmias) | |
− | |||
− | |||
− | |||
− | + | Jugular Pulses and/or Jugular Venous Distension and/or Enlarged Ventral Abdominal Veins (Indicates High Venous Pressure) | |
− | |||
− | + | -Abdomen: | |
− | + | Pitting Edema | |
− | + | Ascites | |
− | + | Splenomegaly | |
− | + | Hepatomegaly | |
− | + | Fluid Thrill (Fluid movement causes a palpable vibration) | |
− | |||
− | + | ====3. Percussion==== | |
− | + | A method of diagnosis performed by flicking a body part with fingers and the resulting sound helps determine size, position, and density of the underlying structures. | |
− | + | -Thorax: Lack of resonance if the lung has solidified; Detection of fluid line | |
− | + | -Abdomen: Detection of fluid thrill | |
− | |||
− | === | + | ====4. Auscultation==== |
− | + | A method of diagnosis performed by listening to sounds inside the body. Auscultation can be performed with or without a stethoscope. Abdominal, cardiac, pulmonary, and thoracic auscultation can all be performed. | |
− | + | Cardiac auscultation is used to listen to heart sounds & heart murmurs. | |
− | + | ||
− | + | '''Heart Sounds''' | |
− | + | ||
− | + | Cardiac Auscultation Species Differences: | |
− | + | ||
− | + | '''Dog & Cat''' | |
− | + | ||
+ | Normal Heart Sounds: S1 (closure of atrioventricular valves; heard best at left heart apex) & S2(closure of semilunar valves; heard best at left heart base); Lub-Dup sound | ||
+ | |||
+ | Abnormal Heart Sounds: S3 & S4 occur during diastole and should not be audible in dogs and cats. If either one is present, this is called a GALLOP RHYTHM and suggests poor ventricular filling. Du-Lub-Dup sound. | ||
+ | |||
+ | '''Horse''' | ||
+ | |||
+ | Normal Heart Sounds: S1 & S2, S3 & S4; S3 is audible in many horses and marks the end of ventricular filling. | ||
+ | |||
+ | '''Ox''' | ||
+ | |||
+ | Normal Heart Sounds: S1 & S2, S4; Healthy farm animals do not have an audible S3 as in the horse. | ||
+ | |||
+ | |||
+ | '''Heart Murmurs''' | ||
+ | |||
+ | -Heart Murmurs=abnormal heart sounds due to turbulent blood flow. Heart murmurs are characterized based on their timing, location, intensity, radiation, pitch, and shape. | ||
+ | |||
+ | |||
+ | ===Electrocardiography (ECG)=== | ||
+ | |||
+ | -Not needed in the diagnosis of heart failure | ||
− | + | -Can be used to recognize arrhythmias or conduction problems | |
− | |||
− | + | ===Radiology=== | |
− | + | -Cardiac enlargement +/- | |
− | + | '''Right-Sided Heart Failure:''' | |
− | + | -Ascites | |
− | + | -Hepatomegaly | |
− | + | -Pleural Effusion | |
− | + | '''Left-Sided Heart Failure:''' | |
− | + | -Pulmonary edema | |
+ | -Pulmonary venous distension | ||
− | |||
− | + | ===Echocardiography=== | |
− | + | -Used to determine the cause of heart failure | |
− |
Revision as of 13:18, 5 September 2008
|
History & Clinical Signs
-Cough
-Dyspnea
-Tachypnea
-Orthopnea
-Exercise Intolerance
-Syncope
-Lethargy
-Ascites
-Peripheral Edema
-Weight Loss
-Capillary Refill Time: under 3 seconds is normal; over 3 seconds is abnormal
-Mucous Membrane Color:
Pallor=pale skin/mucus membrane; suggests poor peripheral circulation due to vasoconstriction, decreased hemoglobin in the blood (anemia), or shock
Cyanosis=blue skin/mucus membrane discoloration; Suggests adequate hemoglobin, but inadequate oxygenation; Seen with Pleural effusion/pulmonary edema, right to left shunt within the circulation causing deoxygenated blood to mix with oxygenated blood
- Signs of heart failure are directly related to which side is affected.
- The above signs are characteristic of cardiac problems, but can also be the signs of other diseases involving different body systems.
- A good physical exam including signalment, history, observation, palpation, percussion, and auscultation are necessary to identify true cardiac problems.
Physical Exam
1. Observation
-Clinical signs: (listed above)
2. Palpation
-Precordium:(Left side of the chest behind the elbow where heart contractions are easily palpated and auscultated)
Heart Rate, Rhythm, Character
Apex Beat
Palpable Thrill
-Pulse: (Rate, Rhythm, Character)
Dog: Femoral Pulse; Palpate heart
Horse: External Maxillary/Facial Artery; Transverse Facial Artery; Median Artery; Digital Artery; Metatarsal Artery
Cattle: External Maxillary/Facial Artery; Middle Coccygeal Artery; Median Artery
Pulse Deficits (Seen with Arrhythmias)
Jugular Pulses and/or Jugular Venous Distension and/or Enlarged Ventral Abdominal Veins (Indicates High Venous Pressure)
-Abdomen:
Pitting Edema
Ascites
Splenomegaly
Hepatomegaly
Fluid Thrill (Fluid movement causes a palpable vibration)
3. Percussion
A method of diagnosis performed by flicking a body part with fingers and the resulting sound helps determine size, position, and density of the underlying structures.
-Thorax: Lack of resonance if the lung has solidified; Detection of fluid line
-Abdomen: Detection of fluid thrill
4. Auscultation
A method of diagnosis performed by listening to sounds inside the body. Auscultation can be performed with or without a stethoscope. Abdominal, cardiac, pulmonary, and thoracic auscultation can all be performed.
Cardiac auscultation is used to listen to heart sounds & heart murmurs.
Heart Sounds
Cardiac Auscultation Species Differences:
Dog & Cat
Normal Heart Sounds: S1 (closure of atrioventricular valves; heard best at left heart apex) & S2(closure of semilunar valves; heard best at left heart base); Lub-Dup sound
Abnormal Heart Sounds: S3 & S4 occur during diastole and should not be audible in dogs and cats. If either one is present, this is called a GALLOP RHYTHM and suggests poor ventricular filling. Du-Lub-Dup sound.
Horse
Normal Heart Sounds: S1 & S2, S3 & S4; S3 is audible in many horses and marks the end of ventricular filling.
Ox
Normal Heart Sounds: S1 & S2, S4; Healthy farm animals do not have an audible S3 as in the horse.
Heart Murmurs
-Heart Murmurs=abnormal heart sounds due to turbulent blood flow. Heart murmurs are characterized based on their timing, location, intensity, radiation, pitch, and shape.
Electrocardiography (ECG)
-Not needed in the diagnosis of heart failure
-Can be used to recognize arrhythmias or conduction problems
Radiology
-Cardiac enlargement +/-
Right-Sided Heart Failure:
-Ascites
-Hepatomegaly
-Pleural Effusion
Left-Sided Heart Failure:
-Pulmonary edema
-Pulmonary venous distension
Echocardiography
-Used to determine the cause of heart failure