Cardiac Exmination

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CARDIOLOGY

Daniel F. Hogan, DVM, Diplomate ACVIM (Cardiology), Purdue University

Cardiac Examination & History

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n today’s world of high-tech cardiology diagnostic techniques, such as echocardiography, the physical examination and historical clinical information may seem obsolete. However, this could not be further from the truth. In fact, an accurate cardiacdiagnosis (or at least short differential list) is usually made while the clinician is still in the examining room, based on the results of the physical examination of the patient and questioning of the owner. In addition, high-tech equipment is often not available in all practices, or access to specialists trained in the use of such equipment is limited. Furthermore, an accurate physical examination andclinical history allow a clinician to focus the diagnostic workup so that superfluous diagnostic tests can be avoided. This reduces the amount of potentially distracting test results as well as financial burden on the client.

STEP BY STEP CARDIAC EXAMINATION & HISTORY

There are a few key points to a good clinical history, including body language and listening skills. Closed body language(such as crossed arms) and lack of eye contact can immediately put off clients and will negatively affect the history they can provide. Active listening lets clients know you feel what they are saying is important. Asking questions generated from their previous answer is a very good way to demonstrate active listening. It is also very important to introduce yourself to your patient.

1Interviewing

There are no unique aspects to history for cardiovascular disease compared with other diseases. As for any dis-

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Pertinent History

ease, you should determine why the client brought the animal to see you, whether the problem has gotten better or worse, what treatment (if any) has been used, and whether any clinical response (better or worse) to that treatment has occurred. Becausemany of these animals receive multiple medications, it is strongly suggested to list each medication, the dose, and the frequency of administration (Table 1). This information is important if new medications will be added or doses changed. Additional questions that may be related to the cardiovascular system include the presence and frequency of coughing, difficulty breathing, and abdominaldistension. A history of collapse, especially exercise-induced, could be very important but is uncommonly reported.
c o n t i n u e s

Table 1. Drug History
Drug Name:___________________________________________________________ Dose of Drug:__________________________________________________________ Dosing Frequency: ______________________________________________________ ❏ Improvement ❏ No Change ❏Worsening

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CONTINUED

Thephysical examination should be done systematically so that the process is consistent between patients and important clinical variables are not overlooked. The initial physical exam can be accomplished while acquiring the history and includes observing the animal with respect to demeanor, respiratory effort, and overall condition. Once the history has been taken, the “hands on” physical exam can begin.3

Physical Examination

Arterial Pulses
A good first step is palpation of the femoral arterial pulse for strength, symmetry, and synchrony to the apical heartbeat. The strength of the arterial pulse is an indication of left ventricular function. Common causes of reduced pulse strength (quality) include reduced cardiac output from systolic dysfunction (ie, dilated cardiomyopathy),...