Physical Therapy For
Cardiovascular
Disorders
DR. Mohamed Seyam PhD. PT.
Assistant Professor Of Physical Therapy For
Cardiovascular /Respiratory Disorder
Course Code : RHPT 482
Credit hours ( 2+1+0)
Objectives
What is the main purpose for this course?
This course provides the student with the required information
about the techniques of application to treat various acute &
chronic cardiac conditions.
Planning and managing the appropriate way of application of
treatment for various cardiovascular disorders.
This course also serves to integrate the knowledge gained by the students
in clinical cardiac conditions with the skills gained in exercise therapy,
electrotherapy and massage, thus enabling them to apply these in clinical
situations-of dysfunction due to pathology.
COURSE TOPICS
1- Normal Cardiac Anatomy & Physiology
03
04
2- Assessment of Cardiovascular disorders
06
08
3- Electrocardiogram(ECG)
03
04
4- Exercise Tolerance Test(ETT)
03
04
5- Cardiac Rehabilitation
06
08
6- Aerobic Exercise Prescription, Home Exercise Program
03
04
7- Coronary Artery Disease and Myocardial Infarction
06
08
8- Congenital Heart Disease
03
03
9- Peripheral Vascular Diseases
06
08
Schedule of Assessment Tasks for Students During the Semester 482 RHPT
Assessment task
percent
First Quiz
5%
First Midterm exam
15%
Second Quiz
5%
Topics covered
Week Due
Normal Cardiac Anatomy & Physiology
3rd week
Electrocardiogram(ECG)
Cardiac Rehabilitation
Aerobic Exercise Prescription, Home Exercise Program
6th week
10th week
12th week
9th week
Midterm clinical exam
20%
Assessment of Cardiovascular disorders
Second Midterm exam
15%
Final clinical exam
10%
Coronary Artery Disease and Myocardial Infarction
Congenital Heart Disease
Peripheral Vascular Diseases
Exercise Tolerance Test(ETT)
15th week
Final exam
30%
All Topics
16th week
Learning Resources
1. Essentials of Cardio Pulmonary Physical Therapy; Hillegass and Sadowsky, 3rd edition.
2. Cardio Pulmonary Physical Therapy-A Guide to practice; Scot Irwin, Jan Stephen Teclin, 3rd
edition.
3. Cardiovascular and Pulmonary Physical Therapy: Evidence and Practice ; Donna
Frownfelter, Elizabeth Dean PhD
4. List Electronic Materials
www.apta.org
www.physio-med.com
www.medsourceusa.com
www.books.google.co.in
www.amazon.co.uk
www.en.wikipedia.org/wiki
Course Learning Outcomes
a3.1 Recall anatomy and physiology of Cardiovascular system. Signs &
symptoms of normal and abnormal cardiovascular system.
a3.2 Identify the different types of investigative procedures used in
diagnosis of cardiovascular disorders.
a3.3 Outline the Physical Therapy assessment of patient with
cardiovascular problem and different treatment protocols for patients with
cardiac disorders.
b3.1 The student will interpret results of, patient/client examination and
other investigative procedures, for appropriate physical therapy diagnosis
and prognosis
b3.2 Develop an effective and safe evidence-based
physiotherapy intervention plan prioritized in order to address
assessment findings, while aiming to achieve the individual's
treatment goals.
c2.1 Demonstrate an understanding of the presentation and
management of a wide range of cardiovascular problems while
being respectful and sensitive to individual client needs.
d2.1 Demonstrate the appropriate level of approach to
interrelate with families and other health care professionals.
e1.1 Perform safely the application of different cardiovascular
physical therapy techniques in cardiac disorders.
‫مقدمة عن المقرر‬
‫‪‬الخطوط األساسية للمقرر( بما في ذلك المعلومات والمهارات التي صمم المقرر لتطويرها ) ‪.‬‬
‫‪‬متطلبات النجاح في المقرر ( الواجبات التي يتم التقييم بناء عليها ‪ ،‬ومحكات التقييم ) ‪.‬‬
‫‪‬مصادر المساعدة في المقرر ( الساعات المكتبية لعضو هيئة التدريس ‪ ،‬والمراجع )‪.‬‬
The cardiovascular system
It is consists of
the heart, which pumps blood throughout the body and
the blood vessels, which are a closed network of tubes that transport the
blood.
There are three types of blood vessels:
Arteries, which transport blood away from the heart;
Veins, which transport blood toward the heart;
Capillaries, which connect the arteries and veins, are the smallest of the
blood vessels, and are where oxygen, nutrients, and wastes are exchanged
within the tissues.
BLOOD VESSELS WALLS
The walls of the blood vessels
consist of three layers or tunics:
1) tunica externa (adventitia)-the
outer connective tissue layer.
2) tunica media-the middle smooth
muscle layer (may also contain
varying amounts of elastic fibers
in medium and large arteries).
3) tunica intima-the inner
endothelial lining of the blood
vessels.
Heart
It is the pump which pushes blood into the
circulation. It is formed of 2 sides,
a. Right side: Right atrium and right ventricle.
b. Left side: Left atrium and left ventricle.
The tricuspid valve: It connects between the right
atrium and right ventricle.
The mitral valve: It connects between the left atrium
and left ventricle.
Shape of the heart: It is pyramidal shaped
resting on one of its sides.
- The apex: It projects downward, forward and to the
left.
- It is formed by the left ventricles.
- The base (posterior surface) of the heart:
- It is quadrilateral and directed posteriorly.
- It consists of the left atrium and small
portion of the right atrium
♥ 2 Atria:
■
■
Chambers of the Heart
♥ 2 Ventricles:
Thin-walled chambers.
Receive blood returning to
heart.
■
■
■
Thicker, muscular walls.
Pump blood from heart.
Each has same capacity
& pumps same volume of
blood in same time.
Valves of the Heart
♥ 2 Atrioventricular (AV)
valves:
■ One way valves.
■ Allow bl to flow from
atria into ventricles.
■ Tricuspid (Rt) & Mitral (Lt).
♥ 2 Semilunar valves :
■ One way valves.
■ At origin of pulmonary artery
& aorta.
■ Pulmonary (Rt) & Aortic (Lt).
■ Open during ventricular
contraction.
Heart Walls: 3 Distinct Layers
1. Endocardium:
the innermost layer of the heart.
2. Myocardium:
the thickest main layer,
consists of cardiac muscle.
3. Pericardium (epicardium):
it is a fibroserous sac surrounding the
heart and the roots of the great vessels.
And outer covering or external membrane
around the heart.
Pericardium
It is a fibroserous sac surrounding the heart and the
roots of the great vessels.
It consists of two components:
1. Fibrous pericardium: It is a tough connective
tissue outer layer.
2. Serous pericardium: It is thin and consists of two
layers:
-Parietal layer: It lines the inner surface of the fibrous pericardium
- Visceral layer: It form the layer covering the
heart and greet vessels.
- Pericardial cavity: It is narrow space
created
between the two layers of serous pericardium
containing a small amount of fluid.
Types of
circulation
1. Pulmonary circulation
2. Systemic circulation
Fetal Circulation
•No circulation to lungs
•Foramen ovale
•Ductus arteriosum
•Circulation must go to placenta
•Umbilical aa., vv.
Arterial Supply Of The Heart
A. Right coronary artery: It originates from the right aortic sinus of the ascending aorta
It gives the following branches:
1) Right posterior descending artery branch (RPDA).
2) Sinu-atrial nodal branch.
3) Right marginal branch.
4) Atrial branch.
B. Left coronary artery: It originates from the left aortic sinus of the ascending aorta.
It gives the following branches:
1) Left anterior descending artery branch (LADA).
2) Circumflex branch.
3) Left marginal artery.
Regulation of the Heart
• Intrinsic regulation: Results from normal
functional characteristics, not on neural or
hormonal regulation
– Starling’s law of the heart
• Extrinsic regulation: Involves neural and hormonal
control
– Parasympathetic stimulation
• Supplied by vagus nerve, decreases heart rate,
acetylcholine secreted
– Sympathetic stimulation
• Supplied by cardiac nerves, increases heart rate
and force of contraction, epinephrine and
norepinephrine released
Autoregulation of the Heart
Stroke volume is autoregulated by ventricular filling (Frank-Starling law).
More in
SV
More out
Heart Surface Anatomy
Surface anatomy of the heart is presented by
4 points.
A. Point at the lower border of the left 2nd
costal cartilage.
A
B
B. Point at the upper border of the right 3rd
costal cartilage.
C. Point at the 5th intercostal space near the
midclavicular line represents the apex.
D. Point at the right 6th costal cartilage.
- The upper border: It extends from A-B.
- The right border: It extends from B-D.
- The left border: It extends from A-C.
- The lower border: It extends from C-D.
D
C
Heart : Conducting Tissues
1.
2.
3.
4.
5.
6.
7.
Sinoatrial (SA) node.
Internodal pathways.
Atrioventricular (AV) node.
Bundle of His.
Rt & Lt bundle branches.
Purkinje fibers.
This rhythmic sequence of
events occurs an average of
72 times per minutes
Heart : Conducting Tissues
■ SA- node and to a lesser extent
AV- node contain small round cells
called ‘P cells’ which are probably
the actual pacemaker cells.
■ At AV- node, very small no. of
intercalated discs & gap junctions 
delay transmission of impulse.
SA node located in the right atrial wall, just inferior to the
entrance of the superior vena cava.
The electrical impulses from SA node spread through the
entire right and left atrial muscle mass, triggering contraction of
the right and left atrium.
The impulses from S-A node travel to atrioventricular (A-V)
node.
 A-V node is located in lower end of the interatrial septum
near the tricuspid valve.
Heart Sounds
• First heart sound or “lubb”
– Atrioventricular valves and surrounding
fluid vibrations as valves close at
beginning of ventricular systole
• Second heart sound or “dupp”
– Results from closure of aortic and
pulmonary semilunar valves at beginning
of ventricular diastole, lasts longer
• Third heart sound (occasional)
– Caused by turbulent blood flow into
ventricles and detected near end of first
one-third of diastole