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
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