This document provides an overview of how physical therapists can assess the cardiovascular and pulmonary systems through various measures and sounds. It discusses how to measure body mass index, blood pressure, heart rate, ventilatory rate, and heart and lung sounds. The roles of physical therapists in evaluating common conditions related to these systems, such as hypertension, heart failure, and respiratory diseases, are also reviewed. Guidelines are provided for how physical therapists should respond to a patient experiencing chest pain or discomfort based on their cardiovascular or pulmonary status.

1. REVIEW OF CARDIOVASCULAR
AND PULMONARY SYSTEMS
AND VITAL SIGNS
QURATULAIN MUGHAL
BATCH IV
IIRS, IUKC
DPT
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2. TABLE OF CONTENTS
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 Importance
 Basic Physiologic Measures ( How & When?)
 BMI
 Blood Pressure (BP)
 Heart Rate (HR)
 Ventilatory Rate
 Heart And Lung Sounds
 PT’s Role

3. Importance Of Cardiovascular And
Pulmonary Systems
 They may accurately reflect the patient’s
general health and wellness.
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4. Basic Physiologic Measures Of
Cardiovascular And Pulmonary
Systems
 BMI
 Blood pressure (BP)
 Heart rate (HR)
 Ventilatory rate
 Heart and lung sounds
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5. 5

6. Body Mass Index
 How to Measure Body Mass Index
 When to Measure Body Mass Index
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7. Calculation of BMI
• BMI gives comparative weight for height information that
is “significantly correlated
with total body fat”
• Nonmetric formula = weight (lb)/height (inches)2 × 704.5
• Metric formula = weight (kg)/height (m)2
FOR EXAMPLE:
•Subject is female—weight 183 lb, height 5 feet 4 inches,
waist 32 inches
• BMI = [183/642] × 704.5 = 31.5
• Using table, subject is at high risk for disease
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8. 8

9. Do BMI For:
• Hypertension
• Dyslipidemia (abnormalities of blood lipids)*
• Type 2 diabetes*
• Coronary heart disease*
• Stroke
• Gallbladder disease
• Osteoarthritis
• Sleep apnea and respiratory problems
• Endometrial, breast, prostate, and colon cancer
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10. Role of the Physical Therapist
 Back pain.
 Hip pain
 Knee pain
 Ankle impairments
 Joint degeneration
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11. Blood Pressure
 The force driving the blood through the vascular tree.
 Pressure is usually measured in the systemic arteries.
 B.P is usually divided into:
1. SBP
2. DBP
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12. How to Measure Blood Pressure?12

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14. 14

15. 15

16. When Blood Pressure Should
Be Assessed
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Signs of hypotension
include the following:
• Lightheadedness
• Syncope
• Mental or visual blurring
• Sense of weakness or
“rubbery” legs
Signs of hypertension include the
following:
• Headache (usually occipital and
present in the morning)
• Vertigo (dizziness)
• Flushed face
• Spontaneous epistaxis
(nosebleed)
• Blurred vision
• Nocturnal urinary frequency
1. RESTING:
2. ACTIVITY

17. Common Conditions Related
to BP and the PT’s Role
Orthostatic Hypotension
Congestive Heart Failure: Jugular
Venous Pressure, Palpation, and
Engorgement
Hypertension and Prehypertension
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18. Hypertension and Prehypertension
HTN can produce serious consequences,
including the following:
• Stroke
• Myocardial infarction
• CHF
• Peripheral vascular disease
• Renal failure
• Blindness
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19. Stages Of Hypertension
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20. Cascade of events associated
with mean arterial BP
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21. Pulse Palpation For HR, Rhythm,
And Patency Of Blood Vessels
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22. Pulse Palpation
 How to Measure the Pulse
 Common Errors in
Palpating the Pulse
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23. Pulse Assessment Scales For
Pulse Strength
PULSE 0-4 SCALE*
0 Absent pulse
1 Markedly reduced pulse
2 Slightly reduced pulse
3 Normal pulse
4 Bounding pulse
PULSE 0-3 SCALE†
0 Absent
1 Weak, thready
2 Normal
3 Full, bounding
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24. Rhythm Of Pulse Classified
Into
1. Regular—similar rate and volume.
2. Regularly irregular—the periodic nature
of the irregularity comes at a specific such
as bigeminy or trigeminy.
3. Irregularly irregular—no specific
pattern, and rate and volume vary, such
as atrial fibrillation or multiple premature
ventricular contractions not in a row or
sequence.
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25. Factors Affecting Pulse
Rate
• Age—increased in infants and decreased in adults >65
years
• Gender—male < female
• Environmental, core temperature, hydration
• Physical activity
• Emotional status
• Medications (beta-receptor blocker, calcium channel
blocker, or beta-receptor
stimulators), chemicals (caffeine), hormones (thyroid
hormones)
• Pain
• Pathology—anemia, congestive heart failure, autonomic
dysfunction (e.g., diabetes,
spinal cord injury, fever)
• Physical condition
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26. Causes Of Dysrhythmias Or
Ectopic Pacemakers
• Ischemia/hypoxia of the myocardium
• Sympathetic discharge—anxiety, exercise
• Acidosis
• Alterations in electrolytes (primary ↓ K+ <3.2 mEq/dL)
• Excessive stretch of the myocardium (e.g., congestive heart
failure)
• Pharmacologic agents
• Sympathomimetics—caffeine
• Antiarrhythmic drugs
• Digitalis
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27. Potential Errors In Pulse
Assessment
FALSE-POSITIVE ERRORS
• Anorexia
• Examiner error (e.g., examiner’s digital pulse)
FALSE-NEGATIVE ERRORS
• Obesity
• Edema
• Scar tissue
• Thickened skin
• Examiner error (e.g., palpation in wrong area)
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28. When Heart Rate Should Be
Assessed
 RESTING HEART RATE
 HEART RATE DURING ACTIVITY
 EMERGENCY SITUATIONS
 VALIDITY OF MEASUREMENT
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29. Common Conditions Related to HR
and Rhythm and the PT’s Role
 Dysrhythmias
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30. Ventilatory Rate and Rhythm
• Apnea—no breathing
• Tachypnea—rate greater than 20 breaths/min in an adult
Bradypnea—rate less than 12 breaths/min in an adult
• Hyperpnea—normal rate but increased volume
• Hypopnea—normal rate but decreased volume
• Hyperventilation—increased rate and volume
• Hypoventilation—decreased rate and volume
• Cheyne-Stokes—hyperventilation followed by
hypoventilation,
then apnea, with the cycle repeating
• Orthopnea—difficulty breathing while horizontal, with easing
of breathing with more vertical positioning
• Dyspnea—labored or difficult breathing
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31. How to Measure Ventilation
 Validity of measurement
 Resting values (normal and abnormal)
 Activity values
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32. Normal Resting Respiratory Rates
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33. Values that May Contraindicate
Activity or Require Termination of Activity
Level 0: on a single breath
Level 1: requires two breaths
Level 2: requires three breaths
Level 3: requires four breaths
Level 4: unable to count
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34. Guidelines for Patients with
Onset of Chest Pain or
Discomfort
• Stop any activity and place patient in comfortable position
(sitting or lying).
• Monitor vital signs.
• Ask whether patient has been diagnosed with heart disease.
• If yes, then:
• Ask whether this symptom is usual or different.
• Ask whether patient has medication (e.g., nitroglycerin).
• Allow administration of three tablets in a 10-minute period, and
if symptoms do not resolve, get patient to emergency
department or seek medical attention.
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35. • If no, then:
• Ask patient to describe discomfort.
• Ask what precipitated discomfort.
• Ask whether discomfort is getting worse or better.
• If signs and symptoms improve and do not appear to be
musculoskeletal (movement or revealed by palpation) in
origin, have patient see his or her physician.
• If signs and symptoms are worsening, get patient to the
emergency department.
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36. • Assess for common changes in vital signs with chest
discomfort from coronary artery disease:
• Pulse may change from normal sinus rhythm to
dysrhythmia (ischemia of heart cells leads to
overexcitability and ectopic pacemakers), causing pulse
to change in rhythm.
• Pulse rate may increase (anxiety and pain) or
decrease (damage to pacemaker cells).
• Blood pressure may increase (anxiety and pain) or
decrease (damage to myocardium).
• Ventilatory rate usually increases (anxiety and pain)
with tidal volume declining (anxiety and pain).
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37. • Auscultate heart for changes in rate, rhythm, or
sound (S3).
• Ask whether patient has been diagnosed with lung
disease.
• If yes, then:
• Ask whether this symptom is usual or different.
• Ask whether patient has medication (inhaler).
• Allow use of inhaler and see whether symptoms
resolve. If symptoms do not
resolve and are worsening, get patient to
emergency department or seek medical
Attention.
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38. • If no, then:
• Ask patient to describe the discomfort.
• Ask what precipitated the discomfort.
• Ask whether discomfort is getting worse or better.
• If signs and symptoms are improving and do not
appear to be musculoskeletal
(movement or revealed by palpation) in origin, have
patient see his or her physician.
• If signs and symptoms are worsening, get patient to
emergency department.
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39. • Assess for common changes in vital signs with
chest discomfort from lung disease.
• Ventilatory rate usually increases when tidal volume
increases.
• Pulse rate usually increases.
• Blood pressure may increase (anxiety and pain) or
decrease (lack of normal blood
flow through lungs or retention of CO2, which is a
potent vasodilator).
• Auscultate lung for changes in ventilatory sounds
(crackles, wheezes, lack of
normal ventilation).
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40. Borg Dyspnea Scale
0 Nothing at all
0.5 Very, very slight (just noticeable)
1 Very slight
2 Slight (light)
3 Moderate
4 Somewhat severe
5 Severe
67
Very severe
89
10 Very, very severe (almost maximal)
* Maximal
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41. If a pt has no known lung
pathology & an Sao2of < 90%,
the PT needs to do the
following:
• Stop performing any physical activity.
• Check that the device is on properly.
• Retake the measurement with the patient being still.
• Notify medical personnel, if the measurement is valid.
• Continue to monitor the patient.
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42. Auscultation of the Heart and Lungs
 Using a Stethoscope
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43. Normal Heart Sounds
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44. Anatomic location of heart valves
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45. Abnormal Heart Sounds
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46. Normal Lung Sounds
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47. Abnormal “Adventitious” Lung
Sounds
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48. Method Of Auscultating The
Chest
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49. Classic Cardiac Symptoms and
Signs of Decompensation
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50. REFERENCE
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51. THANK YOU
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