Physical Therapy Cardiopulmonary Tests and Measures
Angina Pain Scale
Ankle-Brachial Index
Arterial Blood Pressure
Auscultation of Heart Sounds
Auscultations of Lung Sounds
Capillary Refill Time
Body Mass Index
Dyspnea Scales
Electrocardiogram (ECG)
Exercise Stress testing
Homan's sign for deep vein thromb
Angina Pain Scale
A # of pain scales are used to grade the severity of ANGINA PECTORIS.
1 ? MILD, BARLEY NOTICEABLE
2 ? MODERATE, BOTHERSOME
3 ? MODERATELY SEVERE, VERY UNCONFORTABLE
4 ? MOSTE SEVERE OR INTENSE PAIN EVER
Ankle-Brachial Index
(ABI) %= ankle systolic pressure divided by arm systolic pressure. ABI of 90% or less indicates presence of PVD.
? 1.30 Indicates RIGID arteries ? needs US to check for PAD
1.0-1.30 = Normal ? NO blockage
0.8-0.99 = MILD BLOCKAGE ? Beginning of PAD
0.4-0.
Blood Pressure
Non-invasive measurement of arterial BP w/ a PNEUMATIC CUFF and Sphygomomanometer.
**Vital Signs** important indicator of health. Deviations from normal pressure provide info regarding cardiovascular conditions.
BP procedure
Use appropriate sphygmomanometer cuff for size of body part.
BLADDER INSIDE CUFF SHOULD ENCIRCLE 80% OF ARM IN ADULTS AND 100% OF ARM IN CHILDREN YOUNGER THAN 12
*Occlude Brachial artery w. sphyg. (warpped around arm).
*Inflate Sphy to to above anticipate
Korotkoff phases
Phase 1 ? SBP ?1st appearance of CLEAR TAPPING SOUND corresponding to APPEARANCE OF PALPABLE PULSE
Phase 2 ? Sound becomes SOFTER and LONGER
Phase 3 ? Sound becomes CRISPER and LOUDER
Phase 4 ? Sound becomes MUFFLED and SOFTER
Phase 5 ? DBP ? Last audible
Adult Normal blood pressure
Normal - < 120 mm Hg SBP and < 80 DBP
Hypotension = lower than 90 SBP/ 60 DBP
Pre-HTN = 120-139 mm Hg SBP /80-89 mm Hg DBP
Stage I HTN = 140-59 mm Hg SBP/ 90-99 mm Hg DBP (Thiazide diuretic for most patients)
Stage II HTN = ?160 mm Hg SBP/100 mm Hg DPB (t
BP for Children 3-17
Normal BP = SBP and DBP <90%
Pre-HTN = SBP or DBP ? 90% ?95%
Stage 1 HTN = SBP and/or DBP ? 95% ? 99% + 5mm HG
Stage 2 HTN =
Placement of Stethoscope
Directly on Pt.s skin
Aortic Area: 2nd intercostal space at R sternal border
Pulmonic Area: 2nd intercostal space@ L Sternal border
Mitral Area: 5th intercostal space, Medial to L midclavicular line
Tricuspid area: 4th intercostal space @ L sternal border
S1
the "lub" sound when ventricular pressure rises and closes the mitral and tricuspid valves - (SYSTOLE)
This is the first sound heard as the AV valves close & is heard loudest at apex of heart. Heard at the left 5th intercostal space,
S2
the "dub" sound when ventricular pressure falls (after emptying) below the pressure in the aorta and pulmonary artery allowing the aortic and pulmonic valves to close - (DIASTOLE),
the second heart sound that occurs with closure of the semilunar valves an
S3
VENTRICULAR GALLOP
this heart sound is normal in children but abnormal in adults, an abnormal heart sound detected early in diastole as resistance is met to blood entering either ventricle; most often due to volume overload associated with heart failure
S4
ATRIAL GALLOP,
the fourth heart sound in the cardiac cycle. It occurs late in diastole on contraction of the atria. Rarely heard in normal subjects, it indicates an abnormally increased resistance to ventricular filling, as in hypertensive cardiovascular
Systolic murmur
Abnormal heart sound during the first heart sound or "lub". Can be caused by narrowed semi-lunar valve, regurgitation of the bicuspid and tricuspid valves or a VSD or ASD leading to excessive blood being ejected from the right ventricle.
Diastolic murmur
Abnormal heart sound during the second heart sound or "dub". Can be caused by narrowed bicuspid or tricuspid valve or regurgitation of the semi-lunar valves.
Body Mass Index
Or BMI, is using your height and weight to determine if you are underweight (Below 18.5), Normal (18.5 - 24.9), Overweight (25.0 - 29.9), Obese (30.0 and Above)
BMI=Weight(kg) � Height(m squared)
BMI=Weight(kg) � Height(in �) x 703
<18.5 Underweight
18.5-
Dyspnea
Non-painful ? uncomfortable awareness of breathing that is inappropriate to the level of exertion, also called shortness of breath.
Caused by ?'d O?, Hypoventilaiton, hyperventilation, ?'d work of breathing d/t ?'s in respiratory mechanics or anxiety
Dyspnea Scales
0 No breathlessness
.5 VV Slight
1 V Slight = noticeable to participant, but not to observer
2 Slight Breathlessness = some difficulty, participant can continue to exercise
3 Moderate difficulty,= participant can continue to exercise
4 Somewhat Severe = d
Capillary Refill Time
Time it take blood to resume flowing in the base of the nail beds
Normal = > 2 seconds after compression and release of the nail bed
Abnormal = < 2 Seconds (arterial occlusion, hypovolemic shock, hypothermia)
Normal Breath Sounds
BRONCHIAL/TRACHEAL = Big tubes. Loud sounds = heardover the proximal airways such as the trachea. You hear the air. Usually over the sternum and between the scapula. **A PAUSE** occurs between the inspiratory and expiratory phases
VESICULAR = High Pitched
Abnormal Breath Sounds
Adventitious breath sounds = Abnormal breathing sounds heard during inhalation or expiration
CRACKLE (formerly RALES)
PLEURAL FRICTION RUB
RHONCHI
STRIDOR
WHEEZE
Crackle (used to be called Rales)
Discontinuous, High-Pitched POPPING sound ? heard more w/ INSPIRATION. Assoc. w/ Restrictive or Obstructive Respiratory disorders
PLEURAL FRICTION RUB
DRY, CRACKLING sound heard during EXP/INSP
Inflamed pleura
RHONCHI
Continuous LOW PITCHED sound described as having a SNORING or GURGLING quality
STRIDOR
Continuous HIGH PITCHED "Wheeze" heard w/ INSP or EXP.
WHEEZE
Continous MUSICAL SQUEAK or WHISTLING Various PITCHES occuring on expiration n sometimes on inspiration When air moves thru a narrowed or partially obstrcuted airway.
ECG
Graphic representation of the Hearts Electrical activity recorded from electrodes on the surface of the body. Provides insight into the Electrical behavior of the heart and its modificaiton by physiologic, pharmacologic and pathologic events
12 Leads? pro
Waveforms and Intervals
...
P Wave
Atrial Depolarization
PR Interval
From beginning of P wave to the beginning of the QRS complex (the time neccessary for atrial depolarization plus time for the impulse to travel through the AV node to ventricles)
QRS comples
- Ventricle depolarization and
- Atria repolarization
QT Interval
Ventricular depolarization and repolarization, ventricles contract and relax
ST Segment
Time during which ventricles are contracting and emptying, Isoelectric, ventricles depolarizaed
T Wave
ventricle repolarization
Sinus Node Rhythms
...
Normal Sinus Rhythm
Atrial Depolarizaion begins in the SA NODE and spreads normally thru out Electrical conduction sys w/ a HR b/w 60-100 Beats/ min
Regular rhythm of the heart cycle stimulated by the SA node (average rate of 72 beats per minute)
The normal sequence on the E
Bradycardia
Slow heart rate, usually below 60 beats per minute (Adults)
Tachycardia
abnormally rapid heartbeat (over 100 beats per minute) Adults
Arrhythmia
Irregular pattern of heartbeats. quickening/slowing of impulse fomation in the SA NODE ? beat - beat variations
Sinus Arrest
Intermittent failure of either SA node impulse formation or AV node conduction ? Results in the occasional complete absense of P or QRS waves
Exercise Stress Testing
Exercise stress tests are used to assess the patients ability to tolerate increasing intensity of exercise while ECG, BP, HR and symptoms are monitored for evidence of myocardial ischemia, abnormal electrical conduction, or other normal signs and symptoms
Procedure for Exercise Stress Testing
Pt is required to EX at progressively greater increments of work, by varying the speed / grade of treadmill or speed / resistance to Pedaling an UE or cycle Ergometer
*HR, BP, ECG, RPE and S/S are monitored b4, during & after
ABSOLUTE Indications to TERMINATE Stress Test
*? in SBP > 10mm Hg from baseline despite ? in workload w/ other evidence of ISCHEMIA
*MODERATELY SEVERE Angina (3/4)
*? NS Sx (Ataxia, Dizziness)
*Signs of POOR PERFUSION (cyanosis, pallor)
*SUSTAINED Ventricular TACHYCARDIA
*1.0 mm ST ? in Leads W/O Dia
RELATIVE Indicaitons for TERMINATING Stress Test
*? in SBP > 10mm Hg from baseline despite ? in workload WITHOUT other evidence of ISCHEMIA
*> 2 MM ST Segment DEPRESSION
*ARRHYTHMIAS other than SUSTAINED VENTRICULAR *TACHYCARDIA including mulifocal PVC's, Supraventricular Tachycardia, Heart Block or Bra
Interpretation of Exercise Stress Test
(?) Test indicates a ? probability of CAD
An Aerobic Exercise Perscription can be determined from Performance on the Ex test.
Homan's sign for DVT
Test to detect DVT in the LE
Passively dorsiflex the foot a the ankle with the knee straight
(+) = Pain in the calf or popliteal space.
Clinical findings alone are INSENSITIVE and NON-SPECIFIC Cannot be relied on to confirm / exclude Dx of DVT
Palpation of Peripheral Arterial pulses
Assessing heart rate and rhythm as well as blood flow in the extremity
Normal = Stronge / Regular
Irregular = Weak / Difficult to Palpate
High Intensity = Present when SV is ?'d
Procedure for Peripheral arterial Pulses
*Assessing HR and RHYTHM
Palpate over the artery with the tip of the index and the middle finger with enough pressure to feel the pulse but with out obstructing blood.
*Note TIME BETWEEN PULSATIONS
*REGULAR = Time B/W Pulsations is ? EQUAL ? Count the pul
Pulse Points
*CAROTID = The pulse felt along the large carotid artery on either side of the neck.
*BRACHIAL (cubital) = Medial to tendon of biceps brachii
*RADIAL = At the Wrist ? Lateral to FCR tendon
*ULNAR = At Wrist ? b/w Flexor Dig. Superficialis, & FCU tendon
*F
Heart Rate by AGE
Beats/MIn
NEWBORN = 130-140
INFANT ? 2 yrs = 110-130
2 ? 6 yrs = 96-115
6 ? 10 yrs = 70-110
ADULT = 60-80
Volume / Amplitude of Pulse
+3 = Large / Bounding pulse
+ 2 = Normal / Avg Pulse
1 = Small / Reduced Pulse
0= No Pulse felt
Pulmonary Function Test
Measures the volume or flow of air during inhalation or exhalation. Typically involves subject exhaling as hard and fast into a mouthpiece which determines the FVC.
Procedure for PFT
*Upright Posture? Pt EXHALES into the spirometer mouthpiece as hard and as fast as possible for 6 SECONDS until no more air can be expelled
*Repeat 3 Times
*Modern Spirometers Calculate "PREDICTED NORMAL" values (Test value pt. should normally attain base
Interpretation of PFT
OBSTRUCTIVE VENTILATORY IMPAIRMENT
= ?'d EXPIRATORY flows
NARROWED AIRWAYS ? resistance to airflow during breathing.
Examples = Asthma, Bronchiectasis, COPD, and Cystic fibrosis.
RESTRICTIVE VENTILATORY IMPAIRMENT = Condition where the ability to expand t
Pulse Oximetry
Non-invasive method of estimating the % of O? Saturation of HEMOGLOBIN in the bld using an oximeter with a specialized probe attached to the skin at a site of arterial pulsation, commonly the finger
SpO? ? Indication of partial pressure of O? in Atrial BL
Interpretation of Pulse Oximtry (SpO?)
NORMAL = greater than or equal to 95%
CRITICAL = less than 75%
SIGNIFICANCE = Elevated-Increased inspired o2;
hypervenilation -Decreased-hypovenilation;
inadequate 02 is inspired User-contributed
If SpO? < 90% in Acutely ill pts or < 85% in pts w/ Chronic
RPE
Used during EXERCISE EVALUATION
2 scales = LINEAR (6-20)
NON-LINEAR/RATIO (0-10) ? Used to measure during AEROBIC EX / EXERSION during STRENGTHENING
Used for EX TESTING / PERSCRIPTION and determining INTENSITY esp. when max HR IS NOT known;
Can rate work
RPE Origional Scale
6/7 = Very Very Light
8/9 = Very Light
10/11 = Fairly Light
12/13 = Somewhat Hard
14/15 = Hard
16/17/18 = Very Hard
19/20 = V V Hard
RPE Revised Scale
0 = Nothing
0.5 = Very Very Weak
1 = Very Weak
2 = Weak
3 = Moderate
4 = Somewhat Strong
5 = Strong
6/7/8 = Very Strong
9/10 = Maximal ? Very Very Strong
Interpretations for RPE
13-14 represents about 70% of Maximal HR during Ex on a treadmill / Cycle ergometer
11-13 Upper limits of Prescribed Training HR in EARLY CARDIAC REHABILITATION
RPE can substitute for HR in Prescribing the INTENSITY of EX when ?
*Ability to monitor HR is
Respiratory Rate / Rhythm / Pattern
Complete Assessment of Respiration ? Consideres 4 parameters
Rate ? # of BREATHS /min
Rhythm ? regularity of Insp/Exp
Depth ? Volume of air exchanged w/in each breath
Character ? Effort / Sounds produced during breathing
Interpretation (RR rates for Normal Adults)
Newborn ?30 55
17 years ?12 20
3 years ? 20 30
10 years ?16 20
6 years ?16 22
1 year ? 25 40
Normal Respiratory Rhythm
Inspiration ? � as long as Expiration
I:E ratio ? 1:2
COPD = I:E ? 1:3 or 1:4
Depth of Respiration
Deep or Shallow
Character of Respiration
Normal = Quiet / Effortless
Labored Breathing = Use of Accessory mm
Wheezes/Crackles = Abnormal ? ?'s in Airways
Common Breathing Patterns
...
Apnea
Absence of Spontaneous Breathing
Biot's
Irregular Breathing ? Breaths vary in Depth and RATE. W / periods of APNEA
Assoc w/ ICP or Damage to MEDULLA
Bradypnea
Slower than Normal RR ? < 12 breaths/min in Adults
Assoc w/ Neurologic / Electrolyte disturbance / infection / ? Level of Cardiorespiratory fitness
Cheyne-Stokes
? Rate / Depth of Breathing ? PERIODS OF APNEA
CNS Damage
Eupnea
Normal Rate and Depth of Breathing
Hyperpnea
?'d Rate / Depth of Breathing
Hypopnea
?'d Rate / Depth of Breathing
Tachypnea
Faster than Normal RR ? > 20 breaths / min (Adults)
6 Min Walk Test
6MWT ? Used to measure FUNCTIONAL STATUS and to DOCUMENT OUTCOMES for Pt.s w/ Heart and Lung Disorders (also for healthy adults)
*Pt. walks on Measured "track" at least 100 ft (30 Meters) length
*Take Meds b4 if needed
*May use O? if needed
*Can use Assis
Interpretation of 6MWT
Record Distance walked and # of Rests taken