QUARTERLY BEAT / JULY 2023 ///
/// QUARTERLY BEAT / JULY 2023
EMERGENCIES Cardiovascular THE BEAT GOES ON
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understanding of cardiovascular physiology and the categories of cardiovascular emergencies is imperative. The clinical signs associated with Chronic Valvular disease (CVD), Dilated Cardiomyopathy (DCM), Hypertrophic Cardiomyopathy (HCM) with associated Arterial Thromboembolism (ATE), Pericardial Effusion (PE) and Congestive Heart Failure (CHF) will be discussed. Triage Rapid assessment is crucial, and the use of a standardized triage protocol can improve efficiency in effectively performing a rapid primary survey. During this time the patient will be evaluated for Circulation, Airway, Breathing (CAB) and mental status or Level of Consciousness (LOC). The findings from your primary survey will guide your assessment of patient’s status as emergent, urgent vs. non urgent and determine the initial resuscitation methods and or therapeutic interventions. The Importance of the History The presenting patient may be in critical condition and treatment should be initiated before a full history is obtained. History can provide inciteful information that will aid the veterinarian in developing their treatment plan. As part of a complete history the veterinary technician should obtain information on exercise tolerance, appetite, diet, water intake, C/S/V/D, and pertinent past medical history The patient’s signalment can provide important information that can help with diagnosis, as there are certain breeds that are predisposed to specific cardiac disease. Congenital defects are commonly identified in dogs and cats under the age of 3 and frequently younger than 6 months. Acquired cardiac disease such as Myxomatous Mitral Valve Disease (MMVD) is often seen in middle age to older, small to medium sized, breeds.
Is breathing fast and shallow or deep and long?
Stridor vs. stertor?
Posture (orthopnea)
Level of consciousness or mentation
Abdominal distension (ascites)
Body Condition Score (BCS)- is cachexia observed?
Hind limb paresis (cat)
Further evaluation of the patient’s physical exam should include evaluation of mucous membrane color and capillary refill time (CRT), pulse quality, auscultation of the heart and lungs and, if NOT in respiratory distress, obtaining a rectal temperature. Cold extremities are often noticed in cardiac patients due to lack of peripheral perfusion. Abnormalities seen in patients with cardiovascular dysfunction are summarized below. Abnormalities Found on Physical Exam
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MM- cyanotic, grey
Heart Murmur*
Arrhythmia
Bradycardia (cat**) (arrhythmias)
Tachycardia
Crackles on auscultation
Tiffany Gendron, CVT, VTS (ECC) Veterinary CE Coordinator, VETgirl
Dull lung sounds
Changes in pulse quality
Fluid in the abdomen
VETERINARY TECHNICIAN WEBINAR
Hypothermia
Do you get tachycardiac when you see cardiac emergencies? If you missed our Veterinary CE Coordinator, Tiffany Gendron, CVT, VTS (ECC)’s veterinary technician webinar on May 31, 2023 entitled Cardiovascular Emergencies – The Beat Goes On , read the highlights below!
Orthopnea
Abdominal breathing effort
*Cardiac murmurs are classified by the International Small Animal Cardiac Health Council (ISACHC) on a scale of I-VI. **A cardiac murmur is not always auscultable in patients with cardiac disease.
WATCH FULL WEBINAR
Clinical signs commonly associated with cardiac emergencies include: • Collapse • Cough • Cyanosis Webinar Highlights
An Important Tool: The Physical Exam
• Understanding the importance of signalment in recognition of disease • Obtaining vital parameters • Performing diagnostics • Evaluating the response to therapy and monitoring for complications.
Cardiac diseases are often seen in small animal practice, especially in the emergency room. It is important that the veterinary technician possesses the skills and knowledge to aid in diagnosis, treatment, and monitoring of the cardiac patient. This can be accomplished by:
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A thorough physical exam is worth its weight in gold. A generalized observation should be made when beginning your evaluation, this includes a visual inspection before the animal is handled.
• What is the respiratory status? Is the patient tachypneic, dyspneic, orthopneic or all of the above?
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Accurate triage assessment
Obtaining an accurate history
As with any disease process, the knowledge of the staff improves efficiency and efficacy in diagnosis and treatment. An
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VETGIRL BEAT EMAGAZINE | VETGIRLONTHERUN.COM
VETGIRL BEAT EMAGAZINE | VETGIRLONTHERUN.COM
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