Heart Failure, Diagnosis

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