1. Physical therapy evaluation for cardiovascular disorders Ahmad Osailan

2. Cornerstone of cardiac assessment Review of history Physical examination Diagnostic tests Functional capacity assessment

3. 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.

4. Physical examination 1) General examination: - Cyanosis - Pale face - Dyspnea during conversation or with minimal activity - Nutritional status: Malnutrition, obesity, overweight - Skeletal deformities - Tremor

5. 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)

6. 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

7. Diagnostic Tests Types of Diagnostic Tests for cardiac disease: Electrocardiogram (ECG) Echocardiogram Chest X- ray Angiography

8. 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.

10. 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

12. 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

14. 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

15. Diagnostic Tests Electrocardiograph

16. 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

17. Examples of ECG Try to find out what is missing Atrial fibrilation http://www.youtube.com/watch?v=K_uccmtC qZI

18. Examples of ECG Try to find out what is missing Premature ventricular contraction PVC http://www.youtube.com/watch?v=s7cJyoaM- Yg

19. Examples of ECG Premature atrial contraction PAC http://www.youtube.com/watch?v=HrhLtDdxA Wc

20. Examples of ECG Ventricular ectopic tachycardia http://www.youtube.com/watch?v=i- _clh3oFwE

21. 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

22. 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 ( 7– 10METS)

23. Functional capacity assessment Through : Cardiopulmonary exercise testing (stress test) Incremental Shuttle Walking Test. Chester step test 6 MWT