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Atherosclerosis - Physiotherapy Assessment and Management
- 2. Layers of Artery Tunica Intima Tunica Media Tunica Adventitia
- 3. Definition :- It is a progressive occlusive arterial disease involving large and medium-sized arteries. It is characterized by an abnormal mass of lipid material(atheroma) in the intima layer of artery. Age – over 50 years(common); under 30 years (rare) Males > females Common vessels affected – Aorta, the Coronary, the Cerebral, Renal and Femoral
- 4. Etiology/Predisposing Factor :- Diet - rich in animal fat Diabetes – people with DM are more prone Hyperlipidemia – directly proportional to atherosclerosis Smoking – reduce level of HDL Hypertension – cause mechanical injury to arterial wall Other – age, sex, genetic factors, obesity etc. Low Density Lipoprotein(LDL) – maximum association with atherosclerosis Very Low Density Lipoprotein(VLDL) – less marked effect than LDL High Density Lipoprotein(HDL) – protective against atherosclerosis (good cholesterol)
- 5. Pathology :- Response – to – Injury Hypothesis :- most widely accepted Endothelial Injury Accumulation of Lipoprotein Platelet Adhesion Smooth Muscle Cells Proliferation Lipid Accumulation
- 6. Clinical Presentations :- Depends on the site of affected artery Coronary Artery – leads to ischaemia of cardiac muscles Cerebral Artery – ischaemia of the brain Vertebral Artery – dizziness, faintness, impaired vision Iliac, Femoral, Popliteal Artery – intermittent claudication, resting pain, cold limbs, sensory changes, skin changes, loss of pulses.
- 7. PT Assessment :- Demographic data – name, age, gender, height, weight. Presenting complains H/O present illness – duration, onset, frequency of presenting complaints H/O past illness – any history of hypertension, diabetes, infection Medical history – medicines related to present symptoms, other drugs like oral contraceptives, anti-hypertensive Family history – familial predisposition related to diabetes, hypertension. Personal history – cigarette smoking, alcohol intake, physical inactivity Occupational and Environmental history – stressful life
- 8. Observation :- Attitude of limb Behavior of the patient Any discoloration along the veins Observe skin – Thin shiny skin, skin color, redness Any muscle wasting in thigh, calf or foot Any deformity if present Look for loss or diminished hair over toes, dorsum of foot Changes in nail – whether nails are brittle and there are transverse ridges on the nail Look for any ulcer is present or not Look at the pressure areas – heel, malleoli, ball of the foot, tip of the toes
- 9. Palpation :- Skin temperature - distal to obstruction limbs are cold to touch. Oedema - Is it pitting or non-pitting oedema Lymph nodes - Palpate the superficial inguinal lymph nodes Palpate - tenderness adjacent to gangrenous areas Palpate - any local crepitus is presents Examination :- Vitals – temperature, BP, RR, Pulse Ankle Brachial Pressure Index – it is calculated as the ratio of ankle to brachial systolic pressure. Examine the ROM - movement of the distal joints MMT - power of ankle dorsiflexors and plantar flexor, knee flexor and extensor, hip flexor/extensor, hip abductor/adductors.
- 10. Neurological Examination - examine the superficial and deep sensation of the affected area. examine the tone of the distal limb muscles. Examination of Capillary Refilling – Patient is asked to sit up and hang his leg below the bed. a normal leg will maintain the pink color. An ischaemic leg will show change of color from pallor to pink and red purple color. Press the nail bed or the pulp of the tip of the finger and then release. Look for the rapidity of capillary refilling. Time <2secs = normal Time >5secs = abnormal Examination(cond.) Auscultation :- Auscultate heart, abdominal aorta, iliac arteries and femoral arteries
- 11. Investigations :- Chest X-ray ECG Blood Tests Arterial pulse Doppler test Angiography
- 12. Management :- Preventive Measures :- Healthy Diet – more fruits, vegetables, whole grains Regular Exercise - at least 30 to 40 minutes 4 to 5 days a week Stop Smoking Maintaining Proper Weight Stress Management – relaxation techniques, deep breathing, meditation Control Diabetes
- 13. Management :- Symptomatic Treatment – Pain relief (analgesics) Anti-hypertensive Prostaglandin (ulcer) Anti-platelets – Clopidogrel 75mg Statin Therapy – Reduce chance of stroke Endarterectomy Bypass Procedure Angioplasty and stent placement Medical Mx :- Surgical Mx :-
- 14. Management :- Physiotherapy Measures :- Exercise Program – 30 to 35 mins, 3-5 times/week for 6 months(supervised) Buerger’s Exercise Patient with Claudication – supervised treadmill training for 30 to 50 mins, 3 times/week for 12 weeks at least. Lower Extremity Strengthening Exercises – improve treadmill walking Ulcer Management – UST, UVR, ice, Laser therapy, proper care and hygiene. Home Based Exercise - walking with intervals. Lifestyle Modifications - Stop smoking, Avoid cold, Keep the skin clean and free from infection or pressure, Avoid sitting with the legs crossed, Avoid wearing tight shoes, socks, garters or belts, Shoes should be inspected for stones or nails and trauma of all kinds to the legs avoided.
- 15. Strengthening using Thera band Knee Isometric Buerger’s Exercise Avoid Cross sitting No tight shoe Stop Smoking
- 16. References : Harsh Mohan’s Textbook of Pathology Tidy’s Physiotherapy (12th edition) – Ann Thomas, Alison Skinner, Joan Piercy Cash’s Textbook of Chest, Heart and Vascular Disorders for Physiotherapist (4th Edition) – Edited by Patricia A. Downie physio-pedia.com – Peripheral Arterial Disease
- 17. “ ” THANK YOU