Rapid Interpretation of Heart and Lung Sounds

A Guide to Cardiac and Respiratory Auscultation in Dogs and Cats

Bruce W. Keene, Francis W. K. Smith, Larry P. Tilley, Bernie Hansen

• Publisher: Saunders
• Year: 2014
• eBook ISBN: 9780323341233
• Edition: 3
• Topic: Medicine
• Subtopic: Veterinary Medicine

Composed of a website and a companion book, this package demonstrates how to do accurate clinical evaluations of the heart and lungs in the examining room. The website offers step-by-step instructions on how to identify, interpret, and differentiate heart and lung sounds in dogs and cats. Made by using a heart sound simulator as well as recordings from patients, the website also covers heart murmurs and arrhythmias.The book expands on the website content and offers clear, concise illustrations of electrocardiograms (ECGs) and polarcardiograms (PCGs). It also includes pretests and post-tests to ensure thorough understanding of the material, as well as content on properties of sound, the stethoscope, and keys to successful auscultation.- Heart sound simulator allows you to focus on the heart sounds without the distraction of respiratory sounds or artifacts of hair rubbing against the stethoscope.- Wide variety of heart and lung sounds provides you with real-life cases that are as close to clinical practice as possible.- Pretests may be taken prior to reviewing the book and website to measure how much you already know.- Posttests help determine when the material has been mastered and direct the user to remediation in areas where additional study is needed.- Inclusion of clinically-relevant conditions makes it easy for you to apply this information to day-to-day practice.- Key points called out within the text alert you to potential problems, variations on techniques, and other treatment considerations. Lung sounds added Many more heart sounds Section on murmurs and arrhythmia expended Intros for each sound on the companion website have been expanded to provide more information

1

Heart Sounds

Objectives

These objectives are presented to help you to focus on the most important points in the program and to assess your progress. Upon completion of this program, you should be able to:

1. Explain the function of the bell and diaphragm of the stethoscope.

2. Outline the basic physical properties of sound.

3. Draw the hemodynamic events of the cardiac cycle, including their temporal relationship to the heart sounds.

4. Describe the basic characteristics of normal (transient) heart sounds.

5. Explain and draw what is meant by normal, fixed, and paradoxical splitting of the second heart sound.

6. List the important factors that determine the loudness of the first heart sound.

7. List the important factors that determine the loudness of the second heart sound.

8. Describe the characteristics of the third and fourth heart sounds.

9. Recognize a gallop sound and explain the origin of a summation gallop.

10. Explain the significance of an ejection sound and midsystolic click(s).

Pretest 1

1. The first heart sound is caused by __________.

a. closing and tensing of the left AV valve (mitral)

b. closing and tensing of the right AV valve (tricuspid)

c. closing and tensing of both the mitral and tricuspid valves

d. opening of both the mitral and tricuspid valves

2. To determine the timing of cardiac events, it is important to be able to differentiate the first from the second heart sound when performing cardiac auscultation. Which of the following is true?

a. When listening at the cardiac apex, the first heart sound is louder than the second.

b. The first heart sound is lower pitched than the second sound.

c. The first heart sound is longer in duration than the second sound.

d. All of the above are true.

3. Which of the following correctly describes the timing of the heart sounds?

a. The first heart sound occurs just after the onset of mechanical ventricular systole.

b. The second heart sound occurs just after the onset of mechanical ventricular systole.

c. The third heart sound occurs just after the onset of mechanical ventricular systole.

d. None of the above is true.

4. Which of the following correctly describes the origin of a transient heart sound?

a. The second heart sound is caused by the opening of the left and right AV valves.

b. The third heart sound is caused by the closing of the aortic and pulmonic semilunar valves.

c. The second heart sound is caused by the closing of the aortic and pulmonic semilunar valves.

d. The first heart sound is caused by the opening of the aortic and pulmonic semilunar valves just after the onset of ventricular systole.

5. In dogs and cats the presence of a third or fourth heart sound is usually abnormal. These sounds are often caused by __________.

a. rapid expansion of the aorta or pulmonary artery in early systole

b. rapid deceleration of blood entering a stiffer than normal ventricle

c. rapid acceleration of blood exiting a stiffer than normal ventricle

d. rapid deceleration of blood in the aorta at the end of systole

6. A midsystolic click may indicate prolapse of the mitral valve into the left atrium, which sometimes occurs with endocardiosis of the mitral valve in dogs. Which of the following statements is true about midsystolic clicks?

a. They are often a sign of impending heart failure.

b. They may or may not be associated with the onset and murmur of mitral valve regurgitation.

c. They are sometimes confused with S3 or S4, because despite their name, they can also occur during diastole.

d. They are louder in the presence of left atrial enlargement.

7. With regard to the stethoscope chestpiece, which statement is incorrect?

a. The diaphragm screens out some low-frequency sounds.

b. If the bell is pressed too firmly against the chest wall, the skin may stretch and function as a diaphragm.

c. Many heart murmurs and breath sounds sound louder and are easier to hear with the diaphragm than the bell.

d. Gallop sounds (third and fourth heart sounds) are usually heard best with the diaphragm.

8. Choose the correct statement about gallop (third and fourth heart) sounds.

a. They are generally lower pitched than the second heart sound.

b. They occur during the period of ventricular diastole.

c. At high heart rates, the period of diastole shortens, and the third and fourth heart sounds may merge to form a summation gallop sound.

d. All of the above are correct.

9. With respect to the intensity (loudness) of transient heart sounds, choose the correct statement.

a. The intensity of S1 depends on sever...

Table of contents

• Cover image
• Title page
• Disclaimer
• Table of Contents
• Copyright
• Dedication
• Your Complete Learning Experience!
• Preface
• Acknowledgments
• Resource Contents
• 1 Heart Sounds
• 2 Murmurs
• 3 Arrhythmias
• 4 Lung Sounds
• Appendix 1 Canine and Feline Breed Predilections for Heart Disease*
• Appendix 2 Recommended Readings
• Appendix 3 Answers to Pretests and Posttests
• Index