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Transcript
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=39n4XWv7fl Q • - 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 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. • • • • 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=kY5gKdF WT3k 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=iGlxCtU4 Ejw Examples of ECG • Try to find out what is missing • Atrial fibrilation • http://www.youtube.com/watch?v=K_uccmtC qZI 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 Wc 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