Physical therapy evaluation for cardiovascular disorders
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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

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Physical therapy evaluation for cardiovascular disorders

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Physical therapy evaluation for cardiovascular disorders

Physical therapy evaluation for cardiovascular disorders

Ahmad Osailan


Cornerstone of cardiac assessment

Cornerstone of cardiac assessment

  • Review of history

  • Physical examination

  • Diagnostic tests

  • Functional capacity assessment


Review history

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

Physical examination

  • 1) General examination:

  • - Cyanosis

  • - Pale face

  • - Dyspnea during conversation or with minimal activity

  • - Nutritional status: Malnutrition, obesity, overweight

  • - Skeletal deformities

  • - Tremor


Physical examination1

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 examination2

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 semilunarValves

  • 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

Diagnostic Tests

  • Types of Diagnostic Tests for cardiac disease:

  • Electrocardiogram (ECG)

  • Echocardiogram

  • Chest X- ray

  • Angiography


Diagnostic tests1

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

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 test1

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 heartchambers

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


Diagnostic tests2

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 tests3

Diagnostic Tests

  • Electrocardiograph


Diagnostic tests4

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

Examples of ECG

  • Try to find out what is missing

  • Atrialfibrilation

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


Examples of ecg1

Examples of ECG

  • Try to find out what is missing

  • Premature ventricular contraction PVC

  • http://www.youtube.com/watch?v=s7cJyoaM-Yg


Examples of ecg2

Examples of ECG

Premature atrial contraction PAC

http://www.youtube.com/watch?v=HrhLtDdxAWc


Examples of ecg3

Examples of ECG

  • Ventricular ectopic tachycardia

  • http://www.youtube.com/watch?v=i-_clh3oFwE


Functional capacity assessment

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


Physical therapy evaluation for cardiovascular disorders

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 assessment1

Functional capacity assessment

Through :

Cardiopulmonary exercise testing (stress test)

Incremental Shuttle Walking Test.

Chester step test

6 MWT


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