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Examination of
Circulatory System

General considerations
Heart
Cardiac diseases
Developmental defects
Abnormalties in heart rate
Heart failure
Inflammatory and other disease
conditions of heart
Examination of heart
Palpation
Percussion
Auscultation
Blood vessels
Arteries
Veins
Capillaries
Circulatory function test
Blood pressure
Electrocardiography
Phonocardiography
Examination of pericardial fluid
Exertion test
Determination of blood volume
GENERAL CONSIDERATIONS
The circulatory system includes heart and
blood vessels. Though at some places the
lymph vessels are also included in the circulatory system but the affections of lymph

vessels are described in a separate chapter

of lymphatic system. The heart is the chief
organ in circulatory system, which maintains
circulation of blood throughout the body for
proper exchange of oxygen, carbon dioxide,
electrolytes, nutrients and waste products
between blood and body tissues.
HEART
In all animals, the heart is situated in the
thorax. The base of heart in cattle is situated
at the level of 3rd to 6th rib while apex is
just opposite to the joint formed by 6th costal
cartilage with sternum which is about 2 cm
away from diaphragm. On left side of thorax,
the heart is in contact with thoracic wall from
3rd rib to 4th intercostal space. In horses, the
heart is asymmetrical as left side has more
than half portion. The base of heart is situated
at the level of junction of middle and dorsal
thirds of the dorsoventral diameter of thorax.
The base of heart extends upto the level of
second to 6th intercostal space. The apex of
heart is about 1 cm above the last segment
and 2-3 cm anterior to diaphragm. The left
side of heart is in contact with lower third
of the thoracic wall from 3rd to 6th rib.
In pigs, the heart has a blunt apex and
situated just anterior to diaphragm. The heart
is in contact with thoracic wall from second

86 Textbook of Veterinary Clinical and Laboratory Diagnosis

intercostal space to 5th rib on left side. In
dogs, the heart is situated obliquely. The base
of heart is present at the level of 3rd rib while
the blunt apex is near the diaphragm on left
side. The heart is in contact with left thoracic
wall at the level of 3rd to 6th rib.
Cardiac Diseases
Developmental Defects
1. Persistence of foramen ovale: Normally after
birth, the foramen ovale between right and
left atrium is closed. But sometimes, it
remains open and gives rise to hypertrophy of right ventricle, embolism and
cyanosis in calves.
2. Persistence of interventricular foramen: The
interventricular opening is responsible for
increased blood pressure in ventricles,
pulmonary artery and hypertrophy of
right ventricle which is manifested by a
systolic murmur.
3. Patent ductus arteriosus: The opening of
pulmonary artery in aorta is present in
fetal life, normally its closure occur after
birth. Sometimes it remains open and may
cause hypertrophy of the right ventricle,
characterized by cyanosis in calves.
4. Ectopia cordis: Heart is found outside the
thoracic cavity either in neck region or in
abdominal cavity, the condition is called
as ectopia cordis.
5. Acardia: Acardia is the absence of heart in
the animal.
6. Diplocardia: In this condition, two hearts
are present in an animal.
Abnormalities in Heart Rate
1. Tachycardia: Tachycardia is the increased
heart rate of an animal. The heart rate of
animals is influenced by age, temperature,
excitation and due to diseases. Tachycardia
is of two types:

a. Simple tachycardia: It occurs due to

excitement, pain, fever, temporary
hypertension, increased venous
pressure and due to administration of
adrenergic drugs.
b. Paroxysmal tachycardia: It is a rare
condition in animals; It occurs as
sudden period of increased heart rates
of shorter duration. The heart sounds
are also abnormal indicating a reduced
blood volume. This condition is
observed in myocardial diseases.
2. Bradycardia: Bradycardia is the diseased
heart rate of an animal; It is of two types:
a. Simple bradycardia: The heart rate is
decreased due to stimulation of vagus
nerve, increase in blood pressure, hydrocephalus and other space occupying
lesion in brain, postparturient hypocalcemia, neonatal hypoglycemia of piglets,
jaundice and traumatic reticulopericarditis. In athletic animals such as race
horses, it occurs when animal is at rest.
b. Heart block bradycardia: The decreased
heart rate due to heart block occurs in
animals. The interference in impulse is
responsible for heart contractions which
are observed in myocarditis.
Heart Failure
In this condition, the heart is unable to
maintain the proper blood supply leading to
death of animal. It occurs due to coronary
vascular diseases like atherosclerosis resulting
in myocardial infarction. Anoxia, poisoning,
myocardial necrosis, shock, cardiac tamponade or occlusion of pulmonary artery are
some conditions, which ends in cardiac
failure. Acute heart failure leads to brain death
within minutes. The right ventricle is dialated
and characterized by rounded bulging of
ventricle.
Chronic heart failure is also known as
congestive heart failure which occurs as a

Examination of Circulatory System 87

result of the decreased cardiac out put in
comparison to venus return of blood. It is
usually divided into following two types.
1. Left sided heart failure: It occurs due to
necrosis of myocardium, disease of aortic
and mitral valve, hypertension and some
congenital defects are also responsible for
left sided heart failure. In this condition,
the lungs are severely affected due to presence of more blood in pulmonary veins.
The increased pressure in pulmonary veins
resulting in severe congestion of lungs.
The presence of heart failure cells in
the lungs are characteristic feature of this
type of cardiac failure. The heart failure
cells are the alveolar macrophages
containing hemosiderin.
2. Right sided heart failure: The right sided
heart failure occurs due to occlusion of
pulmonary artery which occurs in
pneumonia and other lung diseases. The
secondary lesions develop in other body
organs rather than lungs. Increased venous
pressure may be responsible for edema of
subcutis, jugular pulse and ascites.
Inflammatory and other Disease Conditions
of Heart
1. Endocarditis: Endocarditis is the inflammation of endocardium, the inner wall
of heart.
2. Myocarditis: Myocarditis is the inflammation of myocardium, the middle layer
of the heart wall.
3. Pericarditis: Pericarditis is the inflammation of pericardium, the covering of
heart.
4. Hydropericardium: Hydropericardium is
the accumulation of fluid in the pericardial sac.
5. Pneumopericardium: Pneumopericardium
is the accumulation of gases in the
pericardial sac.

6. Hemopericardium: Hemopericardium is
the presence of blood in pericardial sac.
The accumulation of blood in pericardial
sac, sometimes, may cause cardiac
failure; it is known as cardiac tamponade.
7. Pyopericardium: Pyopericardium is the
accumulation of pus in pericardial sac.
It occurs in traumatic pericarditis due
to presence of pyogenic organisms.
8. Brisket disease: At high altitudes, slow
cardiac failure occurs in animals especially in cattle, sheep and horses. In this
condition, the edema of lower parts of
body occurs particularly in brisket
region in high altitude native animals.
This disease occurs as 0.5 to 2% while
in animals imported from planes, it is
as high as 40%. The brisket disease
usually ends with death of animal.
9. Traumatic pericarditis: Since the cattle and
buffaloes are not able to distinguish the
metallic things in feed, they can eat the
sharp metallic objects like needles, nails,
wires, etc. with feed. Such metallic
objects lodge in reticulum and with
movements of stomach compartments,
these may penetrate the wall of reticulum
and passes through diaphragm into
pericardial sac causing pericarditis. This
condition is manifested by anorexia,
arched back condition, stiff gait, rapid
pulse, cardiac dullness, pneumopericardium, loud heart sounds, pulse in
jugular vein and edema of neck, throat
and brisket region.
10. Mulberry heart disease: Mulberry heart
disease occurs in pigs due to suspected
dietary deficiency and characterized by
sudden death due to cardiac failure,
hydropericardium and linear hemorrhages on heart giving the appearance
of mulberries. The other symptoms and

88 Textbook of Veterinary Clinical and Laboratory Diagnosis

lesions are edema and emphysema of
lungs, hydrothorax and ascites.
11. Manchester wasting disease of cattle: This
condition is also known as calcific arteriosclerosis, caused by hypercalcemia
and characterized by chronic wasting,
stiffness of legs and back, deposition of
calcium in heart muscles, arteries, lungs
and kidneys. Clinically, it is characterized by hypercalcemia, hydropericardium and insufficiency of cardiac valves
due to calcification.
Examination of Heart
The examination of heart can be performed
through palpation, percussion, auscultation,
electrocardiography and phonocardiography.
Palpation
The palpation can be performed by putting
the palm of hand over cardiac area of chest
wall and cardiac impulse is observed by placing
one fingertip on the chest wall. The heart can
be palpated with its enlargement, which occurs
due to insufficiency of valves, anemia, ascites,
hepatomegaly and distention of stomach due
to presence of gas or food. The displacement
of heart can be observed through palpation,
which may occur in effusive pericarditis,
pleurisy, hydropericardium, hydrothorax,
neoplasms and hydatidosis. During palpation
of cardiac area, the rhythm of cardiac cycle
is also observed and the thrill can be detected
in cases of stenosis or insufficiency of valves
or in some developmental defects.
Percussion
On percussion, heart gives a complete nonresonant sound including absolute cardiac
dullness because of absence of air in heart.
The increase in the area of cardiac dullness
as observed in cardiac hypertrophy, pericarditis, hydro and hemopericardium, pneumo-

thorax and diaphragmatic hernia. The cardiac

dullness area reduces in emphysema. During
percussion of cardiac area a pain reaction is
suggestive of the presence of acute pericarditis.
Auscultation
Auscultation can be performed in two ways,
i.e. direct or indirect. However, an indirect
method is usually preferred due to absence
of clarity of sounds in direct auscultation.
Normally animal should be in standing
position while applying stethoscope to hear
the heart sounds. The diaphragm of the
stethoscope is put beneath the shoulder by
lifting the left foreleg slightly forward. The
stethoscope is applied in a space between
foreleg and left chest wall at the level of 4th
and 5th intercostal space. Auscultation reveals
the character of heart sounds like rate,
rhythm, intensity and quality. The frequency
of sounds is observed by the number of
vibrations occurring in per unit of time. The
intensity of heart sounds depends on the
amplitude of the vibrations. The quality of
sounds depends on the sound composed of
frequency and amplification of vibrations. The
cardiac sounds are of three types:
1. Transient Cardiac sounds: Transient sounds
are the normal heart sounds which include
sound I, II, III and IV, diastolic gallop and
systolic extra sound which are of shorter
duration.
a. First heart sound is loud, prolonged
and dull. This occurs after a pause.
b. Second sound is short and sharper; this
sound occurs immediately after first
sound. The first and second sounds are
manifested by lub-dupp sound.
c. The third heart sound is weak and
recognized in certain cardiac diseases
which occurs immediately after the
second sound.

Examination of Circulatory System 89

d. The fourth sound of heart is detected
by phonocardiography which is very
complex and have two components.
Abnormal loud heart sounds may occur
in cardiac hypertrophy and anemia. Heart is
over stimulated due to fever, exertion and
nervous diseases, which are responsible for
intensification of heart sounds. The cardiac
hypertrophy of the right side of heart may
lead to increase in volume of heart sounds.
The low volume heart sounds are observed
in cardiac insufficiency, congestive heart
failure, hydrothorax, hydropericardium,
obesity, anasarca, pericarditis and pleurisy.
The intensity of first sound is related to the
contraction of ventricles, in ventricular
hypertrophy it has an increased volume while
in myocardial asthenia it is of decreased
volume. The volume of second sound
depends on systemic and pulmonary arterial
pressure which is loud in bronchitis,
pneumonia and pulmonary emphysema.
Reduplication of heart sounds is observed
normally in cattle, horses and dogs when their
blood pressure becomes higher. In aortic
stenosis, the reduplication of second sound
occurs in animals.
2. Murmur cardiac sounds: Murmur sounds
either replace the first and second sound or
follow them and occurs in the form of hissing,
humming, whirring or in vibrant tone. These
sounds originate from inside the heart due
to endocardial lesions including valvular
vegetations or adhesions.
Cardiac murmurs are observed when blood
flows through a narrow opening. The murmur
sounds of incompetence are softer and hissing
while in stenosis these are harsh and whirring.
Systolic murmurs occur during stenosis of
semilunar valves or atrioventricular valve
insufficiency. The diastolic murmurs are
observed in stenosis of atrio-ventricular valves
or semilunar valve insufficiency.

Mitral murmurs in horse and dogs are

loudest on left side at 5th intercostal space.
Ruminants have mitral murmurs at 4th
intercostal space. Pulmonary murmurs are felt
on left side at 3rd intercostal space in
ruminants, dogs and horses. Aortic valve
murmurs have been reported to occur in dogs
and can be observed at 4th intercostal space.
The tricuspid valve murmurs are louder and
clear on right side at 4th intercostal space.
Organic murmurs are associated with valvular insufficiency or developmental defects,
which are louder and systolic or diastolic
both accompanied by the enlargement of
heart.
Functional murmurs are associated with
primary heart disease and are known to occur
in toxemia, and anemia. These are usually
systolic, faint and audible at the base of the
heart.
3. Pericardial frictional sounds: Pericardial frictional sounds are observed due to inflammatory conditions or adhesions of pericardium
causing roughening of the pericardial surface.
These sounds are not related to the cardiac
cycle. Tinkling sounds in cardiac area are
suggestive of pneumopericardium which are
readily observed in traumatic pericarditis.
Adhesions in pericardium causes friction during heart contraction and thus gives frictional
sounds.
BLOOD VESSELS
Arteries
In arteries, thrombosis may occur due to
inflammatory condition of arteries. The inflammation of artery is called as arteritis.
Arteritis is caused by parasites Strongylus
vulgaris larvae in horse. This parasite
particularly affects the anterior mesenteric
artery, iliac artery, base of aorta, renal artery,
cerebral artery or coronary artery. In cattle,

90 Textbook of Veterinary Clinical and Laboratory Diagnosis

arteritis occurs in bovine malignant catarrh
and onchocerciasis. In horses, the equine viral
arteritis virus causes inflammation of arteries
which is characterized by fever, leukopenia,
conjunctivitis, rhinitis, palpebral edema, respiratory distress, incoordination and edema
of limbs. Arterial thrombus may occur in
lungs and kidneys, which can be examined
at the time of necropsy.
Arteriosclerosis is the hardening of arteries, characterized by thickening of intimal
layer of arteries due to proliferation of
connective tissue and deposition of lipids and
calcium. It leads to increased blood pressure,
thrombosis and embolism. Atherosclerosis
affects the large elastic arteries and occurs
by the deposition of mushy gruel like
substances in the intimal layer of the vessels.
It may generally, occurs in the wall of aorta
or its associated branches. It leads to
embolism.
Veins
The inflammation of vein is known as
phlebitis. The thrombus may form due to
inflammatory condition of veins. It involves
jugular vein and posterior vena cava as observed in strangles in horses. The thrombosis
associated with phlebitis leads to purplish
discolouration of the body.
Varicose veins condition occurs due to
dilatation of vein which becomes tortuous.
The stagnation of blood in dialated veins
causes pain. In animals scrotal plexus in horse
and supramammary veins in cows are mainly
affected. Varicose veins occur due to stenosis,
exertion, ageing and pulmonary emphysema.
Capillaries
Capillaries are the small blood vessels, which
are very prone to break due to bacterial, viral,
parasitic and other infections. The bacterial
toxins and other poisons like bracken fern

may cause break in capillaries which is

characterized by petechial or ecchymotic
hemorrhages on the serus and/or mucous
surface.
CIRCULATORY FUNCTION TESTS
Blood Pressure
The estimation of blood pressure has little
value in animals because it is very difficult
to retain animal in a relax position. However,
in shock, surgical operations and heart
disease, the blood pressure measurement has
prognostic value. The blood pressure can be
measured through direct and indirect
methods:
1. Direct method: In this method, the needle
is inserted in a suitable artery, which is
connected to mercury of manometer. It
gives only mean blood pressure of systolic
and diastolic.
2. Indirect method: In this method, the blood
pressure is measured by using a sphygmomanometer which is having a pneumatic
cuff, that is fixed at the base of tail or in
foreleg in horses and in hind legs in dogs.
After the application of cuff, pressure the
bulb until the lumen of artery and pulse
wave is obliterated. Now apply one finger
or stethoscope at the distal portion of
artery and reduce the pressure slowly
until the pulse wave appears; note the
reading of manometer, this is the systolic
pressure. Keep reduction of air pressure
continue which allows more blood to flow
and tone of sound become low pitched and
finally disappears. Note this point also; as
this is the diastolic pressure.
In normal dogs, the systolic pressure of
coccygeal artery is 85-135 mmHg while that
of median artery it is 145-190 mmHg. The
diastolic pressure is 40-70 mmHg of the
coccygeal artery while it is 105-150 mmHg in

Examination of Circulatory System 91

median artery. The systolic blood pressure
of carotid artery in cattle is 120-190 mmHg
while diastolic pressure is 70-130 mmHg.
Electrocardiography
Electrocardiography provides an accurate
diagnosis about the heart disease. In this
method, the amplifiers and sensitive electronic measuring devices associated with a
direct writing or recording apparatus are
used. The electrocardiography reveals the
differences in electrical potential generated
by waves of polarization or depolarization.
However, the use of this method in
veterinary medicine is limited.
Phonocardiography
Phonocardiography records the heart sounds
in a graphic manner known as phonocardiogram. The apparatus includes a microphone,
as audioamplifier and a recording galvanometer. The use of phonocardiography is
limited in veterinary medicine.
Examination of Pericardial Fluid
The examination of pericardial fluid is indicated in cardiac dullness to findout the
cause. The area of intercostal space is properly
saved and antiseptics are applied as for doing
any surgery. A needle with stylate is then
inserted anteromedial at the caudal side of
the area of cardiac dullness as detected by
percussion. Collect the pericardial fluid for
examinations like cultural examination and
microscopic for cells.
Exertion Test
Animals are, normally, examined under
resting stage. But, the animals suspected for
disturbance in circulatory system should also
be examined after brief exercise. This can be
achieved by running the animal for about

100 meter; more pronounced symptoms after

exertion indicates the disease in circulatory
system. For this pulse rate, heart rate,
endocardial and pericardial murmurs, venous
pulse, cyanosis and fatigue signs should be
noted before and after exertion.
Determination of Blood Volume
The blood volume is measured by intravenous administration of dye (bromosulfophthalein, 0.2 ml of 1% aqueous solution per
kg body weight) and determination of dye
after 10 minute in the blood sample. The dye
content is measured in plasma as described
in kidney function tests at page 120. The
blood volume is calculated as per the
following equation:
Plasma volume =
Amount of dye injected in mg

Dye concentration (mg/ml of blood)

Blood volume =
Plasma volume (ml) x 100

(100 - hematocrit value of blood in percent)

The determination of hematocrit should be
done as detailed at page number 149.
Normally the blood volume of a neonatal
calf is about 115 ml/kg body weight, which
falls with advancing of age and reaches to
50-85 ml/kg body weight in adult cattle. The
plasma volume of the adult animal is 3545 ml/kg body weight. The change in blood
volume may occur due to hemorrhages,
diarrhea, vomiting and/or in shock.
QUESTIONS
Q 1. Indicate whether the following statements are True or False.
1. _________ Persistence foramen ovale, a developmental defect results in hypertrophy
of the left ventricle of heart.

92 Textbook of Veterinary Clinical and Laboratory Diagnosis

2. ________ Increased heart beat or pressure
is known as bradycardia.
3. _______ In case of transposition of aorta, the
aorta arises from the right auricle.
4. ________ Inflammation of vein is called
phlebitis.
5. _________ Chronic heart failure is also called
as congestive heart failure which occurs
as a result of decreased cardiac output
in comparison to venous return of blood.
Q 2. Fill in the spaces below with most
appropriate word/words.
1. Decreased heart rate of an animal is
known as _________.
2. When heart is found outside the thoracic
cavity and in the neck or cervical region
the condition is called _______.
3. When clotted blood surrounds the heart,
the condition is named ________.
4. Systolic murmers occur during stenosis
of semilunar valve or _________ valve
insufficiency.
5. _________ records the heart sounds in a
graphic manner.
Q 3. Select the most appropriate answer
from the four choices given in each
question.
1. Arteriosclerosis is seen in:
A. Aorta
B. Arteries

C. Vein
D. Large sized blood vessel
2. Patent formen ovale is present in:
A. Left ventricle
B. Right ventricle
C. Left auricle
D. Between left and right auricle
3. Heart failure cells in lungs as a results
of cardiac failure are:
A. Hemosiderin containing macrophages
B. Hemosiderin containing neutrophils
C. Hemosiderin containing eosinophils
D. Hemosiderin containing monocytes
4. Mitral murmurs in horse and dogs are
loudest on left side at:
A. Ist intercostal space
B. 3rd intercostal space
C. 5th intercostal space
D. 8th intercostal space
5. Systolic murmurs occur during stenosis
of:
A. Aortic valve
B. Pulmonary valve
C. AV valve
D. Aortic and pulmonary valve
Q
1.
2.
3.
4.
5.

4. Define the following terms.

Atherosclerosis
Cardiac decompensation
Systolic blood pressure
Diastolic blood pressure
Electrocardiography