CORONARY ARTERY
DISEASES
DR. MOHAMED SEYAM PHD. PT.
Assistant Professor Of Physical Therapy For Cardiovascular/Respiratory
Disorder
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
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.
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.
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
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.
•
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 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).
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