CORONARY ARTERY DISEASES DR. MOHAMED SEYAM PHD. PT. Assistant Professor Of Physical Therapy For Cardiovascular/Respiratory Disorder

Classification of Blood Pressure Blood Pressure CategorySystolicDiastolic Optimal<120<80 Normal<130<85 High Normal Hypertension Stage 1 (Mild) Stage 2 (Moderate) Stage 3 (Severe)> 180> 110

MANAGMENTS 1- PHARMACOLOGICAL THERAPY 2- SURGICAL INTERVENTION  Angioplasty  Stents  PTCA (percutaneous transluminal coronary angioplasty)  Coronary artery bypass grafting (CABG) 3- PHYSICAL THERAPY

Coronary angioplasty It is a technique in which a long fine tube (a catheter) is inserted into the femoral artery in the thigh, passed through external and common iliac arteries and into the aorta to the origins of the coronary arteries.

Percutaneous Transluminal Coronary Angioplasty (PTCA) A technique in the treatment of atherosclerotic coronary heart disease and angina pectoris in which some plaques in the arteries of the heart are flattened against the arterial walls, resulting in improved circulation.

PHYSICAL EXERCISE PROGRAMME Modest pre-operative exercise program before surgery for at least two weeks under the supervision of a physiotherapist, Including  Treadmill walking  Stationary bicycle  Light Weights  Gentle stretching exercises  Light aerobic exercises

A-Preoperative education Preoperative information are offered to patients undergoing nonemergency cardiac surgery. which includes breathing exercises, coughing techniques, opening of the sternum, early mobilization, techniques for getting in and out of bed, lower limb exercises and thrombosis preventive exercises.

B- PT during first five postoperative days Breathing exercises: deep breathing exercises and incentive spirometry. Breathing exercises 1-4 times a day during the first two postoperative days. The common suggested frequency is hourly treatment during the first five post operative days. Incentive spirometry was the second most frequently used breathing technique It is suggested to use it from 5-10 breaths / session every hour. Coughing techniques are provided with chest support by the therapist or patient performance with a small pillow.

Early mobilization Vital signs should be followed during sessions. Active-assistive exercises of the lower/upper extremities – ankles and wrists, five repetitions, bed inclined 45°. Active-assistive exercises of upper and lower limbs in sitting position(90°) –flexion- extension of the bilateral shoulder, elbow, wrist, knee, and ankle; adduction- abduction of the hips (two sets of 15 for each) and orthostatic position / walking on spot (5 min) as tolerated. Active exercises, as in step 2, but in three sets of 15 in the sitting position and ambulation within the inpatient ward (5 min). Exercise similar to step 3 in sitting position; ambulation within the inpatient ward(10 min) Exercise similar to step 3 in orthostatic position, ambulation (10 min) and flight of stairs ( four steps).

Sternal precautions the patients should avoid weight bearing between 7 and 12 weeks (mean 9weeks). the patients are allowed to lift between 1 and 5 kg (mean 2.5 kg) while the sternum was healing. range of motion exercises is permissible if there is no evidence of sterna instability as dedicated by the movement of sternum, pain, cracking, or popping. Sternal precautions recommended for the healing period during the first postoperative weeks after cardiac surgery patients are not allowed to: *Use arms to push up from a lying to a sitting position. *Use arms to push up from sitting to standing. *Use stomach muscles to raise themselves from a lying to a sitting position. *Use arms and shoulders, full active movement. *Use arms and shoulders, full active movement with 1-2 kg weights. *Use a walker. *Use crutches.

The Pedometer a small device worn at the waist that counts steps used successfully in obesity studies

PREVENTION 1. Stop Smoking 2. Exercise Regularly 3. Keep Weight Low 4. Eat a Low-Fat Diet 5. Keep Cholesterol Levels Low 6. Keep Blood Pressure Low 7. Control Diabetes 8. Take Daily Aspirin