CARDIOVASCULAR ASSESSMENT
DR. MOHAMED SEYAM PHD. PT.
Assistant Professor Of Physical Therapy For
Cardiovascular/Respiratory Disorder
CHEST X-RAY
on the basis of standard posteroanterior PA chest x-ray
it is possible to determine
1. the size of the heart,
2. its various chambers, and
3. the major blood vessels
The size of the heart
The size of the heart is usually determined by measuring
transverse diameter of the heart relative to the transverse
thoracic diameter
from a posteroanterior (PA) chest film taken at full
inspiration.
Normally, the ratio is usually between 0.45 and 0.50.
Posteroanterior view.
Lateral view
Schematic illustration of the parts of the heart
Chest radiographs depict
1. the pulmonary vasculature, especially on the right, and
can reveal
2. increased pulmonary blood flow,
3. pulmonary hypertension, and
4. pulmonary (vascular) congestion
Auscultation
The technique for listening to heart sounds consists of the
following steps:
The patient should be lying in the supine position, with
bare chest exposed, in a quiet, comfortable room and
should breathe quietly through the nose.
The entire chest is auscultated, using the diaphragm of
the stethoscope and paying particular attention to the
high-pitched sounds; the bell of the stethoscope is then
used to accentuate lower frequency sounds.
The clinician listens to five main topographic area
1. The aortic area is located near the 2nd intercostal space just to
2.
3.
4.
5.
the right of the sternum.
The pulmonic area is found at the 2nd intercostal space to the
left of the sternum.
The 3th left intercostal space can reveal murmurs of either aortic
or pulmonary origin.
The tricuspid area is located at the lower left sternal border
around the 4th or 5th intercostal space.
The mitral area is found at the apex of the heart, usually in the
5th left intercostal space, medial to the mid clavicular line.
Heart sounds
(S1) (first heart sound) Associated with mitral and tricuspid closure
and corresponds with the onset of ventricular systole
(S2) Associated with aortic and pulmonary valve closure and
corresponds with the start of ventricular diastole
(S3) Associated with early rapid diastolic filling of the ventricles
(S4) Associated with ventricular filling due to atrial contraction
The most significant change is the onset of a third heart sound
(S3) as a result of activity.
Heart murmurs are vibrations of longer duration than the heart
sounds and often represent turbulent flow across abnormal valves
caused by congenital or acquired cardiac defects
Ambulatory/Holter Monitoring
It permits the recording of a patient’s ECG while he
carries on his usual daily activities.
It can be performed either as a continuous 24- to 48hour recording of one or more ECG leads or as an
intermittent event monitor, worn for several days to
weeks at a time, that the patient activates when he/she
experiences a significant arrhythmia, allowing
occasional events to be captured.
Uses of Ambulatory/Holter Monitoring
It is useful for the diagnosis of cardiac arrhythmias
and myocardial ischemia as correlated with patient
symptoms
the evaluation of efficacy of antiarrhythmic drug therapy,
and the assessment of artificial pacemaker function.
the therapist may be able to anticipate the rhythm changes
that may occur during activity and can inform the physician
about any changes in the patient’s status and the
effectiveness of treatment.
Arterial Blood Gases (ABG)
Parameter
1) Partial pressure of oxygen(PO2,
2)
3)
4)
5)
6)
PaO2)
Partial pressure of carbon dioxide
(PCO2, PaCO2)
Hydrogen ion concentration (PH)
Arterial oxygen saturation (SaO2)
Bicarbonate level (HCO3- )
Base excess/deficit (BE)
Normal Value (Range)
1) 97 mm Hg (>80)
2) 40 mm Hg (35-45)
3) 7.40 (7.35-7.45)
4) >95%
5) 24 mmol/L (22–26)
6)
0 (- 2 to + 2)
Respiratory Acidosis
pH,
CO2 ,
Ventilation
o Causes
1) CNS depression
2) Lung diseases like COPD/ARDS, Pneumothorax,
3) Diaphragmatic paralysis, Restrictive lung disease.
4) Musculoskeletal disorders(Myasthenia gravis, Guillain Barre
syndrome)
Respiratory Alkalosis
pH,
CO2,
Causes
1) Intra cerebral hemorrhage (Head injury)
2) Anxiety – decrease lung compliance
3) Cirrhosis of the liver
4) Sepsis
5) Pulmonary Embolism
6) Pneumonia
7) Asthma
Ventilation
Metabolic Acidosis
pH,
HCO3
 Causes
1. Lactic acidosis : is when lactic acid builds ups in the blood
stream faster than it can be removed.
2. Keto acidosis : ( Associated with Diabetes) It occurs when the
body cannot use sugar (glucose) as a fuel source because there is
no insulin or not enough insulin. By products of fat breakdown,
called ketones, build up in the body.
3. Renal failure
4. Chronic diarrhea
Metabolic Alkalosis
pH,
HCO3
 Causes
1) Vomiting
2) Diuretics - Diuretics cause the kidneys to remove
more sodium and water from the body
3) Hypokalemia - A drop in potassium level.
4) Renal Failure
EXERCISE ASSESSMENT
Exercise stress testing
Timed walk tests (e.g., the 6- or 12-minute walk test)
Shuttle test
BODY COMPOSITION ASSESSMENT
Because obesity, especially excessive intraabdominal
(visceral) fat, is associated with increased morbidity and
mortality due to
HTN, CAD, stroke, type 2 DM, and other diseases,
an assessment of body composition or risk status due to
overweight or obesity is often performed by PTs.
Health risk is associated with body fat percentages of
12% to 20% for males and 20% to 30% for females.
The percentage of body fat associated with elevated
health risk varies with age:
For males, health risk is elevated with body fat values of:
 20% to 24% for ages 20–39 years
 22% to 27% for ages 40–59 years
 25% to 29% in ages 60–79 years
For females, health risk is high with body fat values of:
39% or more for ages 20–39 years
40% or more for ages 40–59 years
42% or more in ages 60–79 years
Body Composition Measures
1. Underwater, or hydrostatic, weighing is considered the
“gold standard” for determining percentage body fat and
is based on the difference in density between fat and
lean tissue (muscle, bone, and fluid)
2. Dual-energy x-ray absorptiometry (DEXA)
3. Skinfold assessment relies on the measurement of
skinfold thicknesses at selected body sites using skinfold
calipers and the calculation of percent body fat via
various regression equations.
Body mass index (BMI)
Body mass index (BMI) is the most commonly used
method for assessing risk related to excess body weight.
It is calculated by dividing the individual’s body weight (in
kilograms) by body surface area (in meters squared)
• BMI of 19 to 25 is lowest statistical health risk.
• BMI of 25 or more is greater health risk,
1) Underweight
1) <18.5
2) Normal weight
2) 18.5 – 24.9
3) Overweight
3) 25 – 29.9
4) Obesity, class I
4) 30 – 34.9
5) Obesity, class II
5) 35 – 39.9
6) Obesity, class III
6) > 40
waist circumferences
The recommended procedure for measuring waist
circumference (WC) is to place the measuring tape in a
horizontal plane around the abdomen at the level of the
iliac crest, ensuring that the tape is snug but does not
compress the skin and is parallel to the floor. The reading
should be obtained at the end of a normal expiration
WC of (88 cm) for females and (102 cm) for males is an
indicator of high abdominal fat and is associated with
increased health risk, type 2 DM, HTN, and CAD.
1. Very low risk: WC less than (70 cm) for females and less
than (80 cm) for males
2. Low risk: WC (70 to 80 cm) for females and (80 to 99
cm) for males
3. High risk: WC (90 to 109 cm) for females (100 to 120
cm) for males
4. Very high risk: WC greater than (110 cm) for females
and greater than (120 cm) for males
The waist-to-hip (WHR) ratio
The waist-to-hip (WHR) ratio is an index of abdominal to
lower body fat distribution and is obtained by dividing
waist circumference by hip circumference at the widest
point.
Its use led to the recognition of the importance of central
obesity as a major risk factor for the diseases associated
with obesity.
In general, a WHR less than 0.8 for males and
less than 0.7 for females is associated with a low health
risk.
However, healthful values for WHR vary with age as well
as gender, and thus progressively higher values fall into
the low risk category as an individual ages (e.g., men and
women in their 60 s will have a low risk of chronic disease
if the WHR is less than 0.91 or 0.76, respectively).