Cardiovascular and Pulmonary Conditions

Study Notes

General health conditions to recognize include fatigue, malaise, numbness/ paresthesia, fever/chills/sweats, nausea/vomiting, and weakness.
Dizziness or lightheadedness, unexplained weight changes, and issues with mentation/cognition should also be noted.
Cardiovascular system issues to recognize include: dyspnea, orthopnea (discomfort breathing when lying down), chest pain, peripheral edema (swelling in lower extremities), and palpitations. Pain and sweating can also accompany these conditions.
Pulmonary system issues to recognize include: dyspnea, onset of cough, stridor (high-pitched breathing sound), change in cough, sputum production, wheezing, and hemoptysis (coughing up blood). Diagnosing clubbing of the nails is also important.

90% of MSK physiotherapists do not routinely screen heart rate (HR) and blood pressure (BP) during exercise.
Lack of perceived importance, limited time, lack of clinic policy, and not important for the patient's population are some reasons for omission of this screening.
Frequency of HR checks is often infrequent, with 80% checking less than half the time, and only 6% always checking
Frequency of BP checks varies greatly, with 43% never checking and 83% checking less than half the time, and only 4.4% always checking.
In 2019 physical therapy survey, only 10-15% of PTs in direct access are screening for HR and BP.
69% of MSK PT's encounter patients with moderate to high risk factors for cardiovascular disease twice per week.
55% of MSK patients are unaware of having high blood pressure.
30% of MSK patients demonstrate "masked hypertension"–high blood pressure not always detected during screening.
41% of these patients demonstrate an exaggerated response to exercise and/or physical activity.
High blood pressure is a major risk factor for cardiovascular and pulmonary problems.

Hypoxia signs: Pulse oximetry, nails showing hypoxia, peripheral circulation issues, aerobic capacity tests, and blood pressure response to exercise.
Signs/Symptoms of hypoxia
Signs/symptoms of hypoxia
Physical inactivity/low fitness
Unhealthy diet
Family history
Male sex
Obstructive sleep apnea
Psychological stress
Blood Pressure: Positive correlation between increased systolic BP and CVD, and increased diastolic BP and CVD. Recommendations for outpatient MSK PT: 1 stethoscope per therapist, 1 BP cuff per 2 therapists, 1 child BP cuff if patient < 12, and BP cuffs for obesity and thigh.
Optimal BP: AHA normal: 120/80 mmHg.
Blood pressure categories: Normal (<120/<80), Elevated (120-129 /<80), Stage 1 Hypertension (130-139 /80-89), Stage 2 Hypertension (140 or higher/ 90 or higher), and Hypertensive crisis (>180/>120).
Blood pressure response to exercise: Cornerstone of PT practice to prescribe tailored exercise programs.
Heart rate & Rhythm: Apical pulse, Respiratory rate, pattern, and quality.
Breathing patterns: Apnea, Bradypnea (12 breaths/minute), Dyspnea, Eupnea, Orthopnea, Tachypnea, Kussmaul.
Breath sounds - normal/abnormal
Lung sounds: Wheeze, Rhonchi, Crackles/Rales, Stridor, Pleural friction rub.
Causes: Asthma, CF, Pneumonia, Infections, foreign objects, toxins, inflammation.
Symptoms of hypoxia: Restlessness, rapid breathing, shortness of breath, skin color changes, confusion, anxiety
Signs and symptoms of hypoxia.