John Peter Lovingski R.

Esporlas BS PT 3-1
CARDIOVASCULAR REHABILITATION BLOOD TEST (CARDIAC ENZYME)
GENERAL INFORMATION
a. Age
b. Race
- African-American
c. Gender
- Male LABORATORY TEST
d. Body Mass
- Obese 1. Blood Test (Cardiac Enzymes)
3 MAJOR RISK FACTORS 2. Electrolytes
- Smoking 3. CBC
- Hypertension 4. Liver and Kidney Test
- Hyperlipidemia 5. Lipid and Like Values
1. PAST MEDICAL HISTORY - LDL (Low Density Lipoprotein)
- Pulmonary Disorder - HDL (High Density Lipoprotein)
- Neuromuscular Disorder - ICL
- Past oncologic disorder treated with - Triglycerides
radiation therapy
- Obesity
- Pre-mature birth
- Auto-immune dysfunction
- Vascular Dysfunction
- Endocrine or Metabolic Disorder
2. FAMILY HISTORY
- DM
- Hypertension
3. PERSONAL SOCIAL ENVIRONMENTAL
HISTORY
a. Smoking
b. Occupational exposure to irritants or PATIENT COMPLAINT
allergens (eg, carbon monoxide, - Most Common Sign and Symptoms
chemicals) a. Angina
c. Residing in locations with high levels of - Often described as heart pain
air pollution - If an elephant is sitting upon my chest
d. Sedentary Lifestyle - If someone is squeezing my chest
e. Personality Type - Substernal burning/pain
- Type A Personality: Time urgency with - Chest pressure
high stress - Chest tightness
- Type D Personality: Suppression of - Classical Representation for Substernal
Emotions Pain is accompanied by Levine Sign
f. Diet - Due to: Myocardial Ischemia
- Low mineral intake
- Low Anti-oxidant intake
- Low Essentialy Fatty Acid Intake
 DYSPNEA

DYSPNEA SCLAE
GRADING DESCRIPTION
0 No Dyspnea
1 Mild, Noticeable
2 Mild, some difficulty
3 Moderate Difficulty, but can
continue
4 Severe Difficulty, cannot continue
VITAL SIGN: BLOOD PRESSURE
Stages SBP DBP
Pre- 120-130 80-89
Hypertension
Stage 1 130-140 90-100
Stage 2 140-160 100-110
ANGINAL SCALE Stage 3 >160 >110
GRADING DESCRIPTION KOROTKOFF SOUNDS
0 No Angina Phase I First clear, faint, repetitive, clear
1 Light, barely noticeable tapping sound which gradually
2 Moderate, bothersome increase in intensity for at least
3 Severe, very uncomfortable: pre- two consecutive beats
infarction pain Phase II Murmur or Swishing Sound
4 Most pain ever experienced; Phase III Sharper sounds, which become
infarction pain crisper to regain
Phase IV Abrupt muffling of sounds,
become soft and blowing in
quality
Phase V Last sound heard
PULSE (L) Ventricular Ventricular
Failure Failure
- Normal Value: 60-100 bpm
Dyspnea Increased
- Preferred Site: Radial Pulse
Paroxysm Fatigue
- Most Accurate Site: Apical Pulse al Dependent
- Rate: Bradycardia/Tachycardia Nocturnal Edema
- Quality Dyspnea (usually
a. Paradoxical Pulse/ Pulsus Paradoxus Orthopnea beginning in
- Decrease amplitude of the pressure wave Cough the ankles)
detected during quiet inspiration with a Pulmonary Pitting
return to full amplitude on expiration Edema Edema
- Commonly seen in patient with COPD Cerebral (After 5-10
b. Pulsus Alterans (Alternating Pulse) Hypoxia lbs of edema
- Marked by a fluctuation in amplitude Fatigue accummulat
between beats (a weak and a strong), and e
muscular Edema in
with minimal change in overall rhythm.
cramping the sacral
GRADING PULSE QUALITY or area or the
weakness back of the
Nocturia thighs
Right upper
quadrant
pain
Cyanosis of
nail beds
- Body Habitus or Somatotype: Can also
provide information about cardiovascular
risk
- Pear-shaped body: 3 Times more likely to
develop cardiovascular disease.
ANTHROPOMETRIC MEASUREMENT
1. BODY WEIGHT

VITAL SIGNS: RESPIRATORY RATE

- Normal: 12-20 cpm
- Appearance: Skin Color and Body Traits
- Sign of Poor Cardiovascular Function
a. Pale and Cyanotic Skin
b. (+) Diagonal Ear Lobe Crease
c. Cyanosis: When O2 saturation is Ideal Body weight should be made in reference
<85% to body type
d. Diaporesis: Excessive Sweating
e. Presence of Edema in the extremity - Small Body Frame: Calculated Ideal Body
Wt. x 0.9
 - Large Body Frame: Calculated Ideal Body b. Rotate the head slightly to the
Wt. x 1.10 opposite side
c. Press the External Jugular Vein above
and parallel to the clavicle
approximately 10-20 seconds
d. Measure the highest visible pulsation
2. FINGER PRESSURE
e. (N) Level: Less than 3-5 cm
7. AUSCULTATION
- Position: (L) Side-lying, sitting and
standing
- Sounds that are important to recognize
- 1st and 2nd Heart sounds
- 3rd and 4th Heart Sounds
- Loud 2nd Heart Sounds
3. GIRTH MEASUREMENT
Area Landmarks
Aortic Area 2nd ICS, Sternal Border
Pulmonic Area 2nd ICS, (L) Sternal Border
Mitral Area 5th ICS, Sternal Border
Tricuspid Area 5th ICS, midclavicular line
near the nipple
Appropriate Site: Mid-calf/Middle Forearm Using of stethoscope:
4. SKIN FOLD CALIPERS 1. Diaphragm
- For high-frequency sounds and should be
used with firm pressure.
2. Bell
- For Low-frequency sounds and should be
used
- If Firm: Transform into diaphragm
5. BMI/BODY MASS INDEX - Alternating light and firm can
differentiate normal from abnormal heart

Grading of BMI
- Underweight: Below 18.5
- Normal: 18.5-24.9
- Overweight: 25.0-29.0
- Obese: <30
6. JUGULAR VEIN DISTENTION
- Simply the filling of the jugular vein(s)
with excessive fluid such that they
become visibly distended
- Due to: Sided Heart Failure
- Procedure:
a. Patient Placed semi-supine at 45
degrees
 RATE PRESSURE PRODUCT (RPP)
Exercise Tolerance Test (ETT) - HR x SBP
- Purpose: To examine the ability of the
cardiovascular system to accommodate to
increasing metabolic demand
2 Major Goals
- Detect presence of ischemia
- Determine functional aerobic capacity
The patient exercises through stages of
increasing workloads, expressed in units
of oxygen.
MET@Rest= 3.5mL/kg/min.
AEROBIC CAPACITY AND ENDURANCE
- 6MWT
- <300m: Poor Long-Term Survival
ANKLE BRACHIAL INDEX

Formula:

BP: COxTPR
PP: SBP-DBP
CO: SVxHR
MAP:

ICU GOAL: >60 mmHg