CORONARY ARTERY
DISEASES
DR. MOHAMED SEYAM PHD. PT.
Assistant Professor Of Physical Therapy For Cardiovascular/Respiratory
Disorder
UNIT OBJECTIVES
• Discuss
• Define
the anatomy and normal blood flow to the heart.
the role of atherosclerosis in causing coronary artery disease (CAD).
• Identify
the signs, symptoms, laboratory values, and clinical images of
coronary artery disease.
• State
the principles of physical therapy role in CAD.
• Outline
the principles of long-term outpatient treatment of CAD.
• Summarize
prevention measures for CAD.
Classification of Blood Pressure
Blood Pressure Category
Systolic
Diastolic
Optimal
<120
<80
Normal
<130
<85
High Normal
130-139
85-89
Stage 1 (Mild)
140-159
90-99
Stage 2 (Moderate)
160-179
100-109
Stage 3 (Severe)
> 180
> 110
Hypertension
Blood Lipids
High serum cholesterol levels markedly increase a person’s risk for
developing atherosclerosis-induced heart injury. The LDL fraction of
cholesterol is the specific culprit.
•
FASTING BLOOD LIPID LEVELS
•
Type
•
Total cholesterol
<200 mg/dl
>240 mg/dl
•
HDL cholesterol
≥60 mg/dl
<40 mg/dl for men
Optimal Levels
Unhealthy Levels
<50 mg/dl for women
•
LDL cholesterol
<100 mg/dl
>160 mg/dl
•
Triglycerides
<150 mg/dl
>200 mg/dl
MANAGMENTS
1- PHARMACOLOGICAL THERAPY
2- SURGICAL INTERVENTION
Angioplasty
Stents
PTCA (percutaneous transluminal
Coronary
coronary angioplasty)
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.
•
A fine wire is then passed into the coronary artery and is used to cross the stenosis.
•
A fine balloon is then passed over the wire and inflated at the level of the obstruction,
thus widening it.
•
If the coronary artery disease is too severe to be treated by coronary angioplasty,
surgical coronary artery bypass grafting may be necessary.
•
The great saphenous vein in the lower limb is harvested and used as an autologous
graft.
•
It is divided into several pieces, each of which is used to bypass blocked sections of the
coronary arteries.
•
The internal thoracic or radial arteries can also be used for this purpose.
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.
The procedure involves threading a catheter through the vessel to the atherosclerotic
plaque, inflating and deflating a small balloon at the tip of the catheter several times,
and then removing the catheter.
The procedure is performed under radiographic or ultrasonic visualization.
When it is successful, the plaques remain compressed and the symptoms of heart
disease, including the pain of angina, are decreased.
The alternative to this treatment is coronary bypass surgery, which is more expensive
and dangerous and requires longer hospitalization and rehabilitation.
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
Cardiac rehabilitation
• PHASE I hospital activity
• PHASE II immediate post discharge
• PHASE III supervised out patients exercise program
• PHASE IV transition to long term community ex’s
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.
•
How many breaths the patients were instructed to perform at each training session
varied from one to 40 breaths and
•
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 can be useful in patients who are resistant or unable to cooperate fully with maximal
inspiratory effort.
•
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°) –flexionextension of the bilateral shoulder , elbow, wrist, knee, and ankle; adductionabduction 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).
Exercise Regularly
•
Regular exercise at an appropriate level improves the body’s metabolism as well as
conditioning the heart muscles.
•
Physical conditioning from a regular exercise program generally increases the amount of
activity a patient can do before developing chest discomfort.
•
Physical exercise helps in losing weight and in maintaining weight loss.
•
It also makes smoking cessation easier, improves lipid levels, lowers blood pressure, and
increases the patient’s feeling of well-being.
•
Better physical conditioning improves a person’s chances of surviving a myocardial
infarction.
•
Formal cardiac exercise programs are supervised and tailored to the abilities of the patient,
and these programs increase exercise levels appropriately but gradually.
•
In such programs, stress testing is often used as a guide when planning a safe level of
exercise for a patient.
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