coronary artery disease

1. BPT 403
Physiotherapy in cardiopulmonary conditions
program : BPT IV year
Name : Nusrat Majid
Roll no. : 17Bpt028
Enrollment no. : 17-7411
Assignment submitted to : Dr. Jamal Moiz
Centre Of Physiotherapy and Rehabilitation Sciences
JAMIA MILLIA ISLAMIA
New Delhi
Date: 14- 01- 2021 signature

2. Coronary Artery Disease(CAD)
 A narrowing of the coronary arteries that prevents
adequate blood supply to the heart muscle is
called coronary artery disease
 Usually caused by atherosclerosis, it may progress
to the point where the heart muscle is damaged
due to lack of blood supply. Such damage may
result in infarction, arrhythmias, and heart failure.
 CAD is also known as atherosclerotic heart
disease, coronary atherosclerosis, coronary
arteriosclerosis, coronary heart disease.

3. Risk factors
Modifiable risk factors :
 High blood cholesterol level
 Cigarette smoking, tobacco use
 Stress
 Lack of estrogen in women
 Physical inactivity
 obesity

4. Non-modifiable risk factors
 Family history of coronary heart disease
 Increasing age(highest among middle aged men)
 Gender(occurs three times more often in men than in
premenopausal women after 65 men and women
equilizes)
 Race (higher incidence of heart disease in African
Americans than in Caucasians)
 Diabetes
 High blood pressure

5. Pathophysiology:
due to causes (e.g. high fatty diet, hereditary
or other)
lipids/cholesterol formation on the endothelium
layer of artery.
formation of fatty streak
proliferation
formation of fibrous plaque
partial or complete blockage in the
coronary artery

6. Symptoms
Cardiovascular:
 Angina pectoris
 Ischemia
 Low cardiac output
 Bradycardia(decreased pulse rate)
 Hypertension
 Myocardial infarction
 Diaphoresis(excessive sweating)
 ECG changes- St segment and T wave changes, also show
tachycardia, bradycardia, or dysrhythmias.
 Dyaarrithmias
Respiratory :
 Dyspnea - shortness of breath
 Pulmonary edema

7. Chest heaviness
 Fatigue
 Genitourinary - decreased urinary output may indicate
cardiogenic shock.
Gastrointestinal – nausea and vomiting
Skin- cool, clammy, diaphoretic, and pale appearance
Diagnosis
 electrocardiogram (EKG)
Echocardiograms
Stress tests nuclear
Cardiac imaging
Angiography

10. Complications :
 Chest pain(angina)
 Heart attack
 Heart failure
 Abnormal heart rhythm(arrhythmia)
Prevention :
 Quit smoking
 Control conditions such as high blood pressure, high
cholesterol, and diabetes.
 Stay physically active
 Eat a low fat , low salt diet that’s rich in fruits,
vegetables and wholegrains
 Maintain a healthy weight
 Reduce and manage stress

11. Medical management
various drugs can be used to treat coronary artery
disease, including:
 Vasodilators : nitrates
 Beta – blockers : propranolol 20- 40mg
 Calcium channel blocker : nifedipine, verapamil
 Anticoagulant drugs : heparin
 Opiate analgesic
 Thrombolytic drugs: streptokinase, urokinase
 Antihypertensive medicines: methyldopa , sodium
nitroprusside, amlodipine
Surgical management
Angioplasty and stent placement
Coronary artery bypass grafting

12. Physiotherapy management
Goals of cardiac rehabilitation program :
This program aims at returning the patients with
cardiac disease to their optimal physical, psychological,
social, emotional, vocational, and economic status.
Short term objectives:
 Physical reconditioning
 Education on the disease process and
 Psychological support during the early recovery
phase.
Long term objectives:
 Managing risk factors and
 Teaching healthy lifestyle that improves prognosis
and physical conditioning for an early return to
occupational activities.

13. Phases of cardiac rehabilitation
It consists of three phases
Phase I : clinical phase
 This phase begins in the inpatient setting soon after a cardiac event of
completion of the intervention.
 It begins by assessing the patients physical ability and motivation to
tolerate rehabilitation.
 Therapists and nurses start by guiding patients through non- strenuous
exercise in the bed or at the bed side, focusing on a range of motion and
limiting hospital deconditioning .
 The rehabilitation team may also focus on activities of daily living(ADL’S)
and educate the patient on avoiding excessive stress.
 Patients are encouraged to remain relatively rested until completion
treatment of comorbid conditions, or post- operative complications.
 The rehabilitation team assesses patient needs such as assistive devices,
patient and family education , as well as discharge planning.

14. Phase II : out patient cardiac rehab
 once the patient is stable and cleared by cardiology,
outpatient cardiac rehabilitation may begin.
 Phase II typically lasts three to six weeks though some
may last upto twelve weeks.
 Initially, patients have an assessment with a focus on
identifying limitations in physical function, restrictions
of participation secondary to comorbidities, and
limitations to activities.
 A more rigorous patient centered therapy plan is
designed, comprising three modalities : informative
/advice, tailored training program , and a relaxation
program .
 The treatment phase to intends to promote
independence and lifestyle changes to prepare patients
to return to their lives at home.

15. Phase III: post- cardiac rehab. Maintenance
 This phase involves more independence and self –
monitoring .
 Phase III centers on increasing flexibility,
strengthening, and aerobic conditioning.