Transcript Physical therapy evaluation for cardiovascular disorders

Physical therapy evaluation for
cardiovascular disorders
Ahmad Osailan
Cornerstone of cardiac assessment
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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
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1) General examination:
- Cyanosis
- Pale face
- Dyspnea during conversation or with
minimal activity
• - Nutritional status: Malnutrition, obesity,
overweight
• - Skeletal deformities
• - Tremor
Physical Examination
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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
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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=39n4XWv7fl
Q
• - Presence of mumurs ( abnormal sound of
closure of valves)
• - Breathing Sound ( different lubes) wheezing or
cripitions may indicate pulmonary Edema
Diagnostic Tests
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Types of Diagnostic Tests for cardiac disease:
Electrocardiogram (ECG)
Echocardiogram
Chest X- ray
Angiography
Diagnostic tests
• Echocardiogram:
• a sonogram of the heart. uses standard twodimensional, 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.
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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
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http://www.youtube.com/watch?v=kY5gKdF
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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
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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=iGlxCtU4
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Examples of ECG
• Try to find out what is missing
• Atrial fibrilation
• http://www.youtube.com/watch?v=K_uccmtC
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Examples of ECG
• Try to find out what is missing
• Premature ventricular contraction PVC
• http://www.youtube.com/watch?v=s7cJyoaMYg
Examples of ECG
Premature atrial contraction PAC
http://www.youtube.com/watch?v=HrhLtDdxA
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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 test
6 MWT