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
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
Causes
1) CNS depression
2) Lung diseases like COPD, Pneumothorax,
Respiratory Alkalosis
pH,
CO2,
Causes
1) Intra cerebral hemorrhage (Head injury)
2) Cirrhosis of the liver
Ventilation
Metabolic Acidosis
pH,
 Causes
1. Lactic acidosis
2. Keto acidosis
3. Chronic diarrhea
HCO3
Metabolic Alkalosis
pH,
 Causes
1) Vomiting
2) Diuretics
HCO3
EXERCISE ASSESSMENT
Exercise stress testing
Timed walk tests (e.g., the 6- or 12-minute walk test)
Shuttle test
BODY COMPOSITION ASSESSMENT
Health risk is 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:
Body Composition Measures
1. Underwater, or hydrostatic, weighing is considered the
“gold standard” for determining percentage body fat
2. Dual-energy x-ray absorptiometry (DEXA)
3. Skinfold assessment .
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)
1) Underweight
1) <19
2) Normal weight
2) 19 – 25
3) Overweight
3) 25 – 30
4) Obesity, class I
4) 30 – 35
5) Obesity, class II
5) 35 – 40
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.
The reading should be obtained at the end of a normal
expiration
1. Very low risk:
WC less than (70 cm) for females and less than (80 cm) for males
2. Low risk:
WC (70 to 90 cm) for females and (80 to 99 cm) for males
3. High risk:
WC (90 to 109 cm) for females and (100 to 120 cm) for males
4. Very high risk:
WC more than (110 cm) for females and more 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.
a high health risk of WHR is associated with a
more than 0.8 for males
more than 0.7 for females.