Physical therapy evaluation for cardiovascular disorders

Ahmad Osailan

Cornerstone of cardiac assessment

• Review of history • Physical examination • Diagnostic tests• Functional capacity assessment

Review history Risk factors:

- Age, Smoking - High blood cholesterol (Dyslipidemia, Hyperglycemia)- High Blood pressure - Diabetes Millitus - obesity and overweight- Life style Activity- Past Medical History: History of MI or angina, dysarrythmias, artificial pacemaker.

Physical examination• 1) General examination: • - Cyanosis • - Pale face• - Dyspnea during conversation or with minimal

activity• - Nutritional status: Malnutrition, obesity,

overweight • - Skeletal deformities• - Tremor

Physical Examination• 2) Vitals: • - Heart rate• - Blood Pressure • - Pulse strength ( carotid A, radial A,) • - Breathing Rate ( tachypnea, Bradypnea)• - Breathing Pattern (shallow, Normal) • 3) Palpation • - Edema ( generalized or local) ( pitting or non

pitting)

Physical Examination

• 4) Auscultation:• Normal sound of the heart: S1 and S2 • ‘ Lubb = S1: sound of closure of AV valves • ‘ Dubb = S2 sound of closure of semilunar Valves• http://www.youtube.com/watch?

v=39n4XWv7flQ• - Presence of mumurs ( abnormal sound of

closure of valves)• - Breathing Sound ( different lubes) wheezing or

cripitions may indicate pulmonary Edema

Diagnostic Tests

• Types of Diagnostic Tests for cardiac disease:• Electrocardiogram (ECG)• Echocardiogram • Chest X- ray• Angiography

Diagnostic tests

• Echocardiogram: • a sonogram of the heart. uses standard two-

dimensional, three-dimensional, and Doppler ultrasound to create images of the heart.

• What we care about in Echo: • Early filling and atrial filling E/F ratio• Report of the Echo • Ejection fraction percentage.

Diagnostic Test

• Chest X-ray: is a projection radiograph of the chest used to diagnose conditions affecting the chest, its contents, and nearby structures.

• What do we care about chest X-ray:• Lubes of the lung• Any presence of pleural effusion • Any hypertrophy or change in size of heart

Diagnostic Test

• Angiography: is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins and the heart chambers

• http://www.youtube.com/watch?v=kY5gKdFWT3k

Diagnostic Tests

• Electrocardiograph: A device used to detect electrical activity of the heart over a period of time.

• The ECG allows observation of the heart electrical activity by visualizing waveform beat origin from SA node down to purkinje fibres.

• Types of ECG:• 12 leads ECG• 5 Leads ECG• 3 Leads ECG

Diagnostic Tests

• Electrocardiograph

Diagnostic Tests

• Components of ECG:• P wave: represent atrial excitation• P R interval: represent AV node delay • QRS complex: marks ventricular Excitation• ST segment: shift in depression represent

ischemic heart disease• T wave: marks repolarization.

• http://www.youtube.com/watch?v=iGlxCtU4Ejw

Examples of ECG

• Try to find out what is missing • Atrial fibrilation • http://www.youtube.com/watch?

v=K_uccmtCqZI

Examples of ECG

• Try to find out what is missing• Premature ventricular contraction PVC• http://www.youtube.com/watch?v=s7cJyoaM-

Yg

Examples of ECG

Premature atrial contraction PAChttp://www.youtube.com/watch?

v=HrhLtDdxAWc

Examples of ECG

• Ventricular ectopic tachycardia• http://www.youtube.com/watch?v=i-

_clh3oFwE

Functional capacity assessment

• It is a fundamental requirement for ADL• Definition: Is the ability to perform aerobic,

oxygen work exercise .• Such activities require high efforts from heart,

lung. • Thus, assessment utilizes mostly oxygen

consumption VO2• Functional capacity is identified by METs

METs

• Metabolic Equivalents:• is defined as the ratio of a person's working

metabolic rate relative to the resting metabolic rate.

• One MET represents the oxygen consumption of a resting adult (3.5 ml/kg/min)

• Functional capacity is defined as :poor (<4 METS),moderate (4–7METS), good (>7–10METS)

Functional capacity assessment

Through :Cardiopulmonary exercise testing (stress test)Incremental Shuttle Walking Test.Chester step test6 MWT