CARDIAC ASSESSMENT
DR. MOHAMED SEYAM PHD. PT.
Assistant Professor Of Physical Therapy For Cardiovascular/Respiratory
Disorder
Cardiovascular Assessment
1.
2.
3.
The medical chart review
Patient/family interview
Physical assessment
1. MEDICAL CHART REVIEW
1.
Diagnosis and date of event
2.
Symptoms on admission and after the patient’s admission
3.
Other significant medical problems in the past medical history
4.
Current medications
5.
Clinical laboratory data
6.
Radiological studies
7.
Surgical procedures
MEDICAL CHART REVIEW
Other therapeutic regimens
Other diagnostic tests
Electrocardiogram and
Vital signs
telemetry monitoring
Pulmonary function test
Arterial blood gases
cardiac catheterization data
Hospital course since admission.
Occupational history
Home environmental
assessment
2. Patient/family interview
• establishing relation with the patient and family,
• discerning their level of understanding of the medical
problem(s), and
• their goals and expectations for rehabilitation.
3. Physical examination
1)
Examine pulse
2)
Examine heart sound
3)
Examine heart rhythm
4)
Blood pressure
5)
Rate and depth of respiration
6)
Oxygen saturation
7)
Examine pain
3. Physical examination
• General
appearance Obesity, cachexia, barrel-shaped chest.
• Vital
signs
• Skin
Cold and clammy , pale, blue,
• Cyanosis
(peripheral or central) if marked arterial hypoxemia
• Head, eyes, ears, nose, and throat (HEENT)
• Chest, lungs Abnormal chest examination
and Abnormal breath
sounds (e.g., decreased, bronchial, or adventitious breath sounds
• Cardiovascular Abnormal
heart sounds (e.g., murmurs in valvular
disease, third and/or fourth heart sounds
• Abnormal
peripheral pulses
• Abdomen
Enlarged liver and spleen, ascites in right heart failure
• Extremities Abnormal
extremity examination (e.g., peripheral edema,
digital clubbing, peripheral cyanosis)
Sign or Symptom of Cardiovascular diseases
1.
Chest pain or discomfort
2.
Claudication due to peripheral arterial disease with mismatch between
peripheral O2 supply and demand
3.
Clubbing of digits due to right-to-left shunting in congenital heart disease
4.
Cough due to acute pulmonary edema, Mitral stenosis(MS)
5.
Cyanosis due to right-to-left shunting in congenital heart disease, significant
decrease cardiac output
• Dizziness
• Dyspnea due to pulmonary venous pressure
• Edema may be unilateral or bilateral; increases when limb is dependent
and decreases with periods of elevation; there may be pain during
ambulation
• Fatigue due to low cardiac output
• Hemoptysis due to acute pulmonary edema.
• Hypotension due to decrease cardiac output, vasodilation
• Jugular venous distension due to increase systemic venous
pressure.
• Nocturia due to chronic heart failure(CHF) with peripheral edema
• Orthopnea when lying flat due to increase pulmonary venous
pressure caused by increase venous return to heart.
• Palpitations due to arrhythmias
•
Paroxysmal nocturnal dyspnea In CHF, sudden onset of SOB that awakens patient
at night because of " pulmonary pressures caused by the gradual reabsorption of
edema fluid from the lower limbs resulting in " venous return to heart, which is not
able to handle " workload
Functional Classification of Heart Disease
Functional Classification, Exercise Tolerance, Description Approximate
 I (6 –10 METs) Patient with cardiac disease but without any resulting
limitations of physical activity; ordinary physical activity does not cause undue
fatigue, palpitations, dyspnea, or anginal pain
 II (4–6 METs) Slight limitations of physical activity; comfortable at rest, but
ordinary physical activity results in fatigue, palpitations, dyspnea, or anginal
pain
 III (2–3 METs) Marked limitation of physical activity; comfortable at rest, but
less than ordinary physical activity causes symptoms, as above
 IV (<2 METs) Unable to carry out any physical activity without discomfort;
symptoms of cardiac insufficiency or of angina may be present even at rest; if
exertion is undertaken, discomfort increase