University of the West of England
Faculty of Health and Life Sciences
BSc (Hons) Physiotherapy
Cardiovascular and Respiratory Syllabus
Summary of the cardiovascular and respiratory teaching and
learning throughout the programme
We take a broad approach to the cardiovascular and respiratory education
underpinning the subject specific considerations with wider physiotherapy principles,
most notably rehabilitation and a holistic functional approach.
We endeavour to cover a breadth of issues related to this subject from acute care of
the critically ill through "ward care" and out into the community. Key areas of study over the
three years incorporate:
 cardiovascular and respiratory anatomy and physiology,
 medical and surgical conditions and their management,
 recognition and care of the critically ill patient
 specific rehabilitation programmes and principles
 exercise physiology
 the provision of exercise testing and prescription to address cardiovascular and
respiratory "fitness"
 literature evaluation and critique to assess evidence based practice in
cardiovascular respiratory care
 review of current professional issues and changes that may affect
cardiorespiratory care in the near future
 on call preparation
Although cardiac, pulmonary and amputee rehabilitation are specifically addressed,
there is a strong emphasis on the importance of rehabilitation generally with all
patient groups along side the "chest physiotherapy and management".
Lectures, seminars, practical session, and workshops are all used, enco mpassing a
variety of teaching tools such as case studies, problem solving, videos,
demonstration and practice of techniques and demonstration and use of relevant equipment..
Below are the learning outcomes and session outlines for the various modules
throughout the course. In reality we are unable to fully encompass or indeed fully
assess competency of all the learning outcomes during the contact time in university.
Therefore there is an expectation for the students to address any "untaught" learning
outcomes through self study and whilst on clinical placement. Similarly an important
part of the assessment of their learning and competency, particularly their practical
skills, needs to be assessed whilst on clinical placement. We are very grateful for the
support of our clinical colleagues in this vital role.
Year 1 Cardiovascular
Cardiovascular Physiology
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Describe the gross and minute structure of the heart
Describe the structure and function of the conducting system of the heart
Relate the events of the cardiac cycle to the normal heart sounds and ECG
Define cardiac output and explain the factors that affect it
Explain the factors affecting venous return
Compare the structure and function of the various types of blood vessels
Define blood flow and peripheral resistance and explain the factors that affect them
Define the term arterial blood pressure and give average values for the normal adult
Explain the relationship between blood pressure, peripheral resistance and cardiac
output.
Explain the factors responsible for regulating blood pressure
Cardiovascular disease
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Classify and briefly define the types of vascular disorders (arterial and venous)
Explain how the pathological changes of atherosclerosis affect the normal structure of
the arteries
Identify the signs and symptoms of arterial disease using the Lower Limb and the
Heart as examples of regions affected
Identify the signs and symptoms of venous obstruction, and deep vein thrombosis
using the lower limb as an example of the region affected
Explain how the pathological changes of arterial and venous diseases give rise to the
signs and symptoms
List the predisposing factors relating to atherosclerosis, and deep vein thrombosis
Outline the role of the physiotherapist in the prevention of vascular disease (with
particular reference to atherosclerosis and deep vein thrombosis)
Compare the physiotherapy management of patients with arterial and venous
pathology
State the surgical procedures that may be used to treat lower limb peripheral vascular
disease
Define the terms Heart Failure and Circulatory Failure (Medical Shock)
Explain the Signs and symptoms of:
Left Sided Heart Failure (LVF)
Right Sided Heart Failure (RVF)
Circulatory Failure
Classify the causes of Circulatory Failure
Define the terms Ischaemic Heart Disease and Myocardial Infarction
Explain how Myocardial Infarction may affect Cardiac Function
Outline of contact teaching sessions
Lecture 1 Introduction to Cardiovascular disease
Lecture 2 Physiology of Blood Pressure
Seminar 1 Problem solving case study - Peripheral vascular disease
Seminar 2 Problem solving case study – DVT
Seminar 3 Problem solving case study - Shock
Seminar 4 Problem solving case study - Heart failure
Self study supported with workbook to cover learning outcomes
Year 1 Respiratory
Aims and learning outcomes. By the end of this module the students should be able to:
Structure of Lungs
 Describe the gross structure of the thoracic cage
 Explain the functions of the thoracic cage
 List and Describe the arrangement of the thoracic contents
 Describe the gross structure of the lungs
 Explain the functions of the lungs
 Outline the gross structure of the upper respiratory tract
 Explain the function of the upper respiratory tract
 Describe the arrangement of the lower respiratory tract
 Explain how the histological structure of the following relate to their function:
 Trachea; Bronchi; Bronchioles; Respiratory Bronchioles; Alveoli
 Explain how the histological structure of the pleura relates to its function
 Explain how the changes in thoracic dimensions result in movement of air in
and out of the lungs
Physiology
 Define the following terms giving values for each:
 Tidal Volume; Functional Residual Capacity; Inspiratory Reserve Volume; Expiratory
Reserve Volume; Inspiratory Capacity; Residual Volume; Total Lung Capacity; Vital
Capacity; FEV 1; Dead Space; Minute Volume
 Discuss the factors which determine Vital capacity
 List the partial pressures of Oxygen and Carbon Dioxide in:
 Atmospheric Air; Alveolar Air; Mixed Expired Air; Arterial Blood; Venous Blood
 Explain why the differences in pressure occur in the above situations
 Explain how 02 and C02 diffuse across the respiratory membrane
 Explain how 02 and C02 are transported in the blood to the tissue cells
 List the factors which affect the rate and depth of respiration and
 Explain how these factors affect the respiratory centre
 Outline the cough reflex
 Explain the following terms (in relation to lung function)
Compliance; Elasticity; Airway Resistance; Shunt; Laminar Flow; Turbulent flow;
Surface tension; Ventilation and Perfusion Ratios; Airway Closure; Equal Pressure
Points; Alveolar interdependence; Collateral ventilation
Pathology - For each of the following conditions:
Respiratory tract infections; Pneumonia; Asthma; Chronic Bronchitis; Emphysema;
Bronchiectasis; Cystic Fibrosis; Abdominal surgery
 List the causes, incidence and distribution
 Describe the pathological changes (in outline)
 Explain how the pathological changes give rise to the signs and symptoms
 Outline the medical management
 Discuss the psychosocial implications
 Discuss the role of the physiotherapist in the management of the condition
 Define the following terms:
Consolidation; Atelectasis; Restrictive Lung Disease; Obstructive Lung Disease;
Dyspnoea; Hypoxia; Orthopnoea; Hypercapnia; Collateral ventilation
Respiratory Assessment and Analysis
Carry out a basic subjective and objective assessment and interpret key findings
Demonstrate how you would ascultate a patient for breath sounds and interpret key findings.
Plan and implement Physiotherapy treatment
 Demonstrate and explain the effects, uses and contraindications of the following
physiotherapy techniques:
Active Cycle of Breathing Techniques; Postural Drainage and positioning; Clapping,
shaking and Vibrations; Control of Breathlessness; Mobilisation of the patient
 Suggest the relative value of these techniques in the management of the conditions
specified.
 Recognise the following equipment used in respiratory care - nebulisers, humidifiers,
inhalers, PEP, incentive spirometry, oximetry and oxygen therapy delivery devises.
Outline of contact teaching sessions
Introduction and the role of the physiotherapist in respiratory care
Physiology Overview
Lung Volumes
Arterial Blood Gases and Respiratory Failure
Breathlessness and mechanics
Cystic Fibrosis
Post op Physiotherapy
Seminars.
Gross Anatomy of the Respiratory Tract
Pleural mechanics and disorders including chest drains
Lung Function Tests
Obstructive disease and management case studies
Subjective Assessment Practice
Observation(ribs and mechanics) and Palpation
Postural Drainage
Control of Breathlessness/Positioning
Auscultation
ACBT
Manual techniques
Post op Treatment Principles/Case Studies
Asthma case study
Pneumonia case study
Oxygen/inhalers/nebulisers/PEP
Year 2 October to November
Care and Rehabilitation of the Critically Ill
Aims and learning outcomes
At the end of this part of the module the student should be able to:
Critical Care
 Explain the signs and symptoms of Circulatory shock, Respiratory failure
 Classify the causes of Circulatory and Respiratory failure
 Identify devices used to monitor and observe the cardiovascular and respiratory
systems
 Identify signs of cardiovascular instability
 Explain the significance of the following measurements:
CVP; ECG; BP; Heart rate; PAWP; V02max; ICP; Fluid and electrolyte balance;
Sa02; Pa02; PaC02; pH; Conscious level - coma scale
 Identify abnormal measurements in above values and discuss their significance
 Explain the implications of variations in above measurements when selecting and
using physiotherapy techniques
 Classify the types of patient found on the intensive care unit
 Discuss the effects and dangers of physiotherapy techniques used in the intensive
care unit
 Discuss the factors to be considered when selecting physiotherapy techniques with:
Unconscious patients; Patients with respiratory failure; Patients with cardiovascular
instability; Patients with multiple systems failure; Patients with severe respiratory
disease; patients following neurosurgery; Patients following major trauma; Patients
with chest trauma
 Explain the principles of care with the above patients on the intensive care unit
 Outline the principles of care and use of the following devices
Positive pressure breathing equipment e.g. IPPB, CPAP; Endotracheal tubes;
Tracheostomy tubes; Oxygen equipment; Nebulisers and Humidifiers; Manual
hyperinflation; Suction;
Chest drains; Tubes; CVP lines
 Discuss the role of the physiotherapist on the intensive care unit
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Discuss the psychosocial implications for critically ill patients and their families
Thoracic Surgery
 Explain how the pathological changes of lung cancer and bronchiectasis may lead to
the need for lung surgery
 Outline the following surgical procedures:
Pneumonectomy, Lobectomy, Pleurectomy, Pleurodesis, Oesophagectomy
 Explain the possible complications of thoracic surgery
 Explain how physiotherapy modalities are modified in the pre and postoperative
management of patients undergoing the above procedures
 Discuss the role of the physiotherapist in the management of patients undergoing
thoracic surgery
Cardiac Surgery
 Outline the following surgical procedures:
Coronary artery by pass graft; Valve replacements
 Explain the possible complications of cardiac surgery
 Explain how physiotherapy modalities are modified in the pre and postoperative
treatment of patients undergoing the above surgical procedures
 Discuss the role of the physiotherapist in the management of patients undergoing
cardiac surgery
Raised Intracranial Pressure
 Explain the dilemma facing physiotherapists in the management of patients with raised
intracranial pressure (e.g. post TBI, or post neurosurgery)
 Explain how physiotherapy modalities are modified in the management of this group of
patients
 Discuss the role of the physiotherapist in the management of patients with raised
intracranial pressure
Outline of contact teaching sessions
Lectures
Care and Rehabilitation of the Critically Ill - Introduction
Respiratory Failure and its Management
Assessment of the ITU patient
Ventilation Modes, Positive pressure
Thoracic Surgery
Cardiac Surgery
Acute management of raised intracranial pressure
Seminars
Monitoring.
"Mrs Bowels" - surgical case study
Chest xrays (2 x 1hr).
Endo tracheal tubes and tracheostomies, oral and nasal airways.
Mr Pypless and charts. (extubation case study)
Suction (including closed system) and manual hyperinflation.
Chest drain management.
IPPB and CPAP.
NIPPV and comparison of IPPB/CPAP/NIPPV.
Developing Problem Lists and Management/ Treatment Plans from ITU Case Studies.
Year 2 January to April
Cardiorespiratory Rehabilitation
Aims and learning outcomes
Exercise Physiology
 Explain the acute effects of exercise on the cardiovascular and respiratory systems
 Explain the term VO2max and its significance
 Explain the purpose of incremental exercise tests
 Explain the effects of endurance type exercise on cardiovascular and pulmonary
function
 Explore the health benefits of physical activity
 Identify key components of training programmes to improve cardiovascular
endurance
Amputee Rehabilitation
 Explain how Peripheral Vascular Disease may lead to the need for amputation
 State the indications for surgery
 Describe the possible levels for Lower Limb amputations
 Explain the particular management problems for patients with:
Single above knee amputation; Single below knee amputation
 Indicate the types of prosthesis available
 Formulate a list of appropriate assessment procedures for each of the following
stages:
Preoperative; Postoperative; Post-prosthetic
 Explain the aims of physiotherapy for each of the above stages
Pathology
For each of the following conditions:
Fibrosing Alveolitis; Lung Abscess; Tuberculosis; Pulmonary Embolism; Lung tumours;
Cor Pulmonale
 Give a brief definition
 Outline the implications for Physiotherapy management
Pulmonary Rehabilitation
 Outline the principles of use of oxygen therapy, nebulisers and medication in
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managing patients with COPD
Explain the effects of exercise on breathlessness in patients with COPD
Outline an exercise programme and education topics suitable for pulmonary
rehabilitation
Identfiy outcome measures appropriate for evaluating pulmonary rehabilitation
Cardiac Rehabilitation
 Explain the recommendations for exercise and activity in Phase I, II, III and IV of
Cardiac Rehabilitation
 Discuss the risks and benefits of exercise in patients with cardiac disease
Demonstrate and teach suggested exercises suitable for patients in phase 111 cardiac
rehabilitation.
Outline of contact teaching sessions
Lecture 1 Exercise physiology – acute effects
Lecture 2 Endurance training principles
Lecture 3 Endurance training principles (cont)
Lecture 4 Amputee rehabilitation
Lecture 5 Cardiac rehabilitation
Lecture 6 Pulmonary rehabilitation
Lecture 7 Oxygen, nebulisers and medication in COPD
Practical workshop 1 Amputee rehabilitation
Practical workshop 2 Fitness testing
Practical workshop 3 Cardiac rehabilitation
Seminar 1 Pathology presentations
Seminar 2 Exam question practice
Year 3 November and December
Appraising Physiotherapy in Practice
Outline of teaching
This part of the curriculum is designed to get the students to critically evaluate the
evidence base, literature and the current professional issues which may affect their
practice in the future.
Lectures
Current issues in respiratory care
Evaluation of physiotherapy in respiratory care
ARDS
Chest trauma
Paediatric critical care
Seminars
Review of evaluation of research papers
Current issues in cardiorespiratory care (acute care and community care / professional
issues)
On call preparation
Weaning – theory with equipment e.g. NIPPV, cough assist
Summary.
We aim to build up a fundamental knowledge and understanding of cardiorespiratory
anatomy, physiology, pathology and management in year 1.
We develop this further during year 2 with specific issues around critical care and
rehabilitation principles and programmes. More complex issues are introduced and
explored.
In year 3, we believe students are more able to critically appraise that which they have
learnt in years 1 and 2. Therefore, the emphasis of their cardiorespiratory education is
directed more towards evaluation of the evidence base and also their own personal
learning. This change in emphasis is in order to put into context that which they have
learnt both in the university and on placement with the ultimate aim of developing
them towards competent reflective autonomous professionals.
We endeavour to keep the curriculum current and appropriate to cover the majority of
the issues that may be needed by physiotherapist working in the varied setting of
today's healthcare provision. Inevitably due to the constraints of the packed
undergraduate curriculum, there is some selection of material which we need to make
in order to cover what we regard as the most salient issues. We do review this
regularly but would always value any feedback from our clinical colleagues, either on
this or any other aspect of the undergraduate cardiorespiratory physiotherapy
education.
We all contribute to various parts of the education and can be contacted via UWE.
Many thanks
Jacqueline Mullan, (0117 3288859), Sandy Thomas 0117 3288626), and Anne Konsta (0117
3288414)