1. CARDIOPULMONARY SYSTEM
AUSCULTATION AND PHYSICAL DIAGNOSIS

2. PHYSICAL EXAMINATION
Inspection
Palpation
Percussion
Auscultation.

3. INSPECTION
Body condition
Attitude
Posture

4. BODY CONDITION Body condition is classified according to degree of fat
Normal overweight: not ill from heart failure but may manifest pulmonary disease eg. Pulmonary fibrosis, chronic obstructive lung disease lung disease.
Moderate to long standing heart failure often present as thin to cachectic condition.

5. ATTITUDE
The animal will be depressed.

6. POSTURE STANDING:- reluctance to lie down -Thoracic limb abducted
-Neck extended to its ventilation
SWAY BACK with tail in between legs because of muscular weakness or occasionally caused by digitalis toxicity
Muscular weakness (skeletal muscles) as in cardiomyopathy
Exhaustion due to the work of breathing as in heart failure.

7. PALPATION Hands placed in the axilla and slide caudally
Reaction to existing pain
Point of maximum impulse:
Fifth inter-costal on the left
Third inter-costal space on the right

8. PERCUSSION
Thumping on the thorax or abdomen to determine the relative density of underneath structures
Dull sound indicate water filled structures

9. AUSCULTATION
Listening heart and breath sounds with the aid of stethoscope
Heart sounds:
Frequency
Regularity

10. HEART SOUNDS May be normal or abnormal First heart sound
Second heart sound
Third heart sound
Fourth heart sound
Sequence: 4th – 1st - 2nd – 3rd

11. CARDIAC MURMURS Grade I murmur Grade II murmur Grade III murmur
Grade IV murmur
Grade V murmur

12. MUCOUS MEMBRANE
Delayed capillary refill time indicates peripheral vasoconstriction, often as a compensatory response to reduced arterial pressure
Very short refill time (bright red membrane) indicates peripheral vasoconstriction as septic shock or potent arterial vasodilator therapy.

13. MUCOUS MEMBRANE (cont’d)
Pallor indicates:
Anaemia
Low cardiac output with reflex vasoconstriction
E.g. low output heart failure, severe aortic stenosis, cardiac tamponade
But without pulmonary congestion that often cause cyanosis.

14. DIAGNOSTIC TOOLS Electrocardiography Radiography
Ultrasound(Echocardiography)
Phonocardiography

15. CONGESTIVE HEART FAILURE
The capability of the heart to eject blood returning to the heart from venous circulation is compromised
In-balance between ventricular output and venous return
There is accumulation of blood over time
There is severe pulmonary distress due fluid accumulation in the lungs

16. CONGESTIVE HEART FAILURE(cont’d)
Patient is always exhausted
May be cyanotic and dyspnoeic
If right sided, there will anasarca
Commonly observed: ascites, hydropericardium, hydrothorax and distended superficial veins
Left sided results in pulmonary congestion or alveolar oedema

17. DISTURBANCE IN HEART RATE AND RHYTHM
Cardiac arrythmia
Sinus arrest(pause)
Atria fibrillation
Atria flutter
Bradycardia
Tachycardia

18. CONGENITAL ABNORMALITIES
Atrial septal defect
Ventricular septal defect
Persistent right aortic arch
Aortic Stenosis
Tetraology of fallot
Patent ductus ateriosus