Cardiology for Veterinary Technicians and Nurses

H. Edward Durham, H. Edward Durham, Jr.

• Publisher: Wiley-Blackwell
• Year: 2017
• Print ISBN: 9780813813530
• eBook ISBN: 9781119357421
• Edition: 1
• Topic: Medicine
• Subtopic: Veterinary Medicine

Cardiology for Veterinary Technicians and Nurses is a comprehensive resource for veterinary technicians and nurses working with cardiovascular patients in veterinary practice.

• Offers a complete reference to veterinary cardiology targeted at veterinary technicians and nurses, summarizing fundamental knowledge on cardiovascular disease
• Covers dogs, cats, horses, ruminants, and camelids
• Provides information ranging from introductory to advanced for a thorough guide to cardiac conditions
• Presents detailed procedures for common cardiac catheterization techniques, including supplies required
• Includes photographs and illustrations to depict the concepts described

Section II
Diagnostics

3
History and Physical Examination

H. Edward Durham, Jr.

Patient History

In evaluating the cardiac patient, a complete and thorough history, and physical examination are essential. Detailed information about the clinical signs is critical for creating a complete picture of the patient's current condition. The observations made during the history and physical examination will guide all diagnostics throughout the patient's care. Therefore, the importance of a thorough history and physical examination cannot be overemphasized.

In the non-emergency situation, a history is taken with the patient in the examination room. This will allow the patient to acclimatize to the environment and allow for important observations of the patient as part of the physical examination. Good listening skills are critical when taking a medical history. It is important to filter what the client relates into an accurate and complete summary that can be included in the medical record. Often clients will give more information than is truly relevant. It is up to the veterinary professional to extract the salient features. One method is to allow the client tell “their story” uninterrupted. This can give you a good feel for the clinical signs they are seeing at home and the level of anxiety caused by these clinical signs. Usually during this time the client will tell you what they think is the problem. After they have expressed all their concerns, more targeted questions can be asked.

Identified early in the history is the patient's species and breed, age, gender and reproductive status. Congenital heart defects are often first noted in young animals, and certain congenital cardiac defects have breed predispositions and defects, such as patent ductus arteriosus (PDA) which is more common in female patients. Acquired diseases such as valvular insufficiency, or myocardial disease, are noted in middle-aged to geriatric patients. Small breed dogs are more prone to chronic valvular degeneration whereas large breed dogs are more prone to myocardial failure.

It is also relevant to ascertain if the patient has an “occupation”. Is the patient a house pet, or is it a show or breeding animal? Some patients are working animals and the ability to return to work may be part of the therapy goal. This may be especially true in equine cardiology, but may also include service or herding dogs.

The medical history should start with the presenting complaint or the reason the client felt the need to bring the animal to the veterinary cardiologist. The client is the best judge of abnormal behavior. Often there are no overt clinical signs of heart disease, but a murmur or arrhythmia may be auscultated during a routine examination, prompting a visit to the veterinary cardiologist. The client may present the animal for coughing, exercise intolerance or poor performance, rapid breathing or other abnormal breathing patterns such as open mouth breathing in cats. Occasionally there may be a complaint of abdominal distension. Follow-up questions should be targeted to learn specific information and should only be directed at one aspect of the patient's health. Asking question with a “yes” or “no” answer will help direct the client to give limited responses. Questions about previous or concurrent medical conditions are an appropriate place to start. This area of questioning should include a vaccination history, previous illnesses or surgeries, parasite testing and prevention. Inquiring about the patient's diet and other animals in the house with the patient will help establish the home environment. Information such as whether the animal is housed indoors, outdoors, or both should not be forgotten. In addition to asking about the diet, it is important to ask about the patient's appetite and any apparent weight gain or loss. Fluid retention will increase body weight. Ascites may make the patient appear “fat” in the abdomen to the owner. Anorexia can lead to weight loss or cachexia.

Vomiting and diarrhea are not typically signs of heart disease, but may be seen with heart failure or indicate a concurrent disease condition, intolerance to current medication, or may affect the ability of the patient to take oral medications. Questions about the duration and frequency of vomiting and diarrhea should be asked.

During the interview, any medications the patient may be taking should be listed. When collecting the medication history, the veterinary technician should endeavor to learn the name of the medication, the strength of the dose and the frequency of administration. From this, the veterinary cardiologist can determine the dose and if there is room for adjustment. When the medication was started and how easily the patient can be medicated should also be ascertained. All current medications should be listed, including heartworm prevention and the last heartworm test.

Although pain is not typically associated with heart disease or failure, determining if the patient exhibits any signs of pain is part of a complete history. Pain may be perceived as difficulty lying down or rising, or more obvious signs such as limping or crying out when touched may be noted. With cats, limb paresis is a common sign of thromboembolic disease and is extremely painful.

Information about exercise can be useful in assessing overall cardiovascular function. Often the presenting complaint for a patient with cardiac disease may be exercise intolerance, which may manifest as a decreased ability to exercise or a complete lack of desire to be playful. Some clients notice that during a walk, the patient may hav...

Table of contents

• Cover
• Title Page
• Copyright
• Dedication
• List of Contributors
• Foreword
• List of Abbreviations
• Introduction: Why Animals have a Circulatory System
• Section I: Cardiac Anatomy and Physiology
• Section II: Diagnostics
• Section III: Cardiac Diseases
• Section IV: Therapies and Interventions
• Section V: Large Animal Cardiology
• Appendix: Commonly Used Cardiovascular Drugs
• Index
• EULA