Physical examination of dogs and cats

Physical evaluation of the animal with suspected heart disease includes observation (e.g., attitude, posture, body condition, level of anxiety, respiratory pattern) and a general physical examination. The cardiovascular examination itself consists of evaluating the peripheral circulation (mucous membranes), systemic veins (especially the jugular veins), systemic arterial pulses (usually the femoral arteries), and the precordium (left and right chest wall over the heart) :palpating or percussing for abnormal fluid accumulation (e.g., ascites, subcutaneous edema, pleural effusion); and auscultating the heart and lungs. Proficiency in the cardiovascular examination requires practice. But these skills are important for accurate patient assessment and monitoring.

Respiratory difficulty (dyspnea) usually causes the animal to appear anxious. Increased respiratory effort, flared nostrils, and often a rapid rate of breathing are evident. Increased depth of respiration (hyperpnea) frequently results from hypoxemia, hypercarbia, or acidosis. Pulmonary edema (as well as other pulmonary infiltrates) increases lung stiffness; rapid and shallow breathing (tachypnea) results as an attempt to minimize the work of breathing. An increased respiratory rate is an early indicator of pulmonary edema in the absence of primary lung disease. Large-volume pleural effusion or other pleural space disease (e.g., pneumothorax) generally causes exaggerated respiratory motions as an effort to expand the collapsed lungs. It is important to note whether the respiratory difficulty is exaggerated during a particular phase of respiration. Prolonged, labored inspiration is usually associated with lower airway obstruction or pulmonary infiltrative disease (including edema).

Animals with severely compromised ventilation may may refuse to lie down; they stand or sit with elbows abducted to allow maximal rib expansion, and they resist being positioned in lateral or dorsal recumbency (orthopnea). Cats with dypnea often crouch in a sternal position with elbows abducted. Open-mouth breathing is usually a sign of severe respiratory distress in cats. The increased respiratory rate associated with excitement, fever, fear or pain can usually be differentiated from dyspnea by careful observation and physical examination.

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