The pericardium is a sac that surrounds the heart. There are two main surgeries performed on the pericardium: pericardial fenestration and pericardiectomy. Pericardial fenestration involves making a hole in the pericardium to drain fluid, while pericardiectomy removes part or all of the pericardium. Physiotherapy plays an important role in chest care, mobility, and cardiac rehabilitation after pericardium surgery. Exercises and breathing techniques are used to clear the lungs and strengthen the patient during their recovery.
The 6-minute walk test (6MWT) is an easy to perform and practical test that has been used in the assessment of patients with a variety of cardiopulmonary diseases including pulmonary arterial hypertension (PAH). It simply measures the distance that a patient can walk on a flat, hard surface in a period of 6 minutes.
The 6-minute walk test (6MWT) is an easy to perform and practical test that has been used in the assessment of patients with a variety of cardiopulmonary diseases including pulmonary arterial hypertension (PAH). It simply measures the distance that a patient can walk on a flat, hard surface in a period of 6 minutes.
Cardiac Rehabilitation has been defined as:
Coordinated, multifaceted interventions designed to optimize a cardiac patient’s physical, psychological, and social functioning so that they may, by their own efforts, resume and maintain as normal a place as possible in the community
A treadmill exercise stress test is used to determine the effects of exercise on the heart. Exercise allows doctors to detect abnormal heart rhythms (arrhythmias) and diagnose the presence or absence of coronary artery disease.
This test involves walking in place on a treadmill while monitoring the electrical activity of your heart. Throughout the test, the speed and incline of the treadmill increase. The results show how well your heart responds to the stress of different levels of exercise.
Description
A technologist will explain the test to you, take a brief medical history, and answer any questions you may have. Your blood pressure, heart rate, and electrocardiogram (ECG) will be monitored before, during, and after the test.
You will be asked to sign a consent form. This form is required before the test can proceed.
You will be asked to remove all upper body clothing, and to put on a gown with the opening to the front.
Adhesive electrodes will be put onto your chest to capture an ECG. The sites where the electrodes are placed will be cleaned with alcohol and shaved if necessary. A mild abrasion may also be used to ensure a good quality ECG recording.
Your resting blood pressure, heart rate, and ECG will be recorded.
You will be asked to walk on a treadmill. The walk starts off slowly, then the speed and incline increases at set times. It is very important that you walk as long as possible because the test is effort-dependent.
You will be monitored throughout the test. If a problem occurs, the technologist will stop the test right away. It is very important for you to tell the technologist if you experience any symptoms, such as chest pain, dizziness, unusual shortness of breath, or extreme fatigue.
Following the test, you will be asked to lie down. Your blood pressure, heart rate, and ECG will be monitored for three to five minutes after exercise.
The data will be reviewed by a cardiologist after the test is completed. A report will be sent to the doctor(s) involved in your care.
A study to assess the effectiveness of structured teaching program on knowledge regarding care of patients after cardiac surgery among staff nurses at Shree Narayana, Hospital, Raipur, chhattisgarh.
Cardiac Rehabilitation has been defined as:
Coordinated, multifaceted interventions designed to optimize a cardiac patient’s physical, psychological, and social functioning so that they may, by their own efforts, resume and maintain as normal a place as possible in the community
A treadmill exercise stress test is used to determine the effects of exercise on the heart. Exercise allows doctors to detect abnormal heart rhythms (arrhythmias) and diagnose the presence or absence of coronary artery disease.
This test involves walking in place on a treadmill while monitoring the electrical activity of your heart. Throughout the test, the speed and incline of the treadmill increase. The results show how well your heart responds to the stress of different levels of exercise.
Description
A technologist will explain the test to you, take a brief medical history, and answer any questions you may have. Your blood pressure, heart rate, and electrocardiogram (ECG) will be monitored before, during, and after the test.
You will be asked to sign a consent form. This form is required before the test can proceed.
You will be asked to remove all upper body clothing, and to put on a gown with the opening to the front.
Adhesive electrodes will be put onto your chest to capture an ECG. The sites where the electrodes are placed will be cleaned with alcohol and shaved if necessary. A mild abrasion may also be used to ensure a good quality ECG recording.
Your resting blood pressure, heart rate, and ECG will be recorded.
You will be asked to walk on a treadmill. The walk starts off slowly, then the speed and incline increases at set times. It is very important that you walk as long as possible because the test is effort-dependent.
You will be monitored throughout the test. If a problem occurs, the technologist will stop the test right away. It is very important for you to tell the technologist if you experience any symptoms, such as chest pain, dizziness, unusual shortness of breath, or extreme fatigue.
Following the test, you will be asked to lie down. Your blood pressure, heart rate, and ECG will be monitored for three to five minutes after exercise.
The data will be reviewed by a cardiologist after the test is completed. A report will be sent to the doctor(s) involved in your care.
A study to assess the effectiveness of structured teaching program on knowledge regarding care of patients after cardiac surgery among staff nurses at Shree Narayana, Hospital, Raipur, chhattisgarh.
Different Types of Heart Surgery Every Patient Should Know AboutMax Healthcare
The term bypass indicates a new route that is surgically created within the heart to ensure flow of oxygen and blood to the heart. A bypass needs to be treated when the heart is blocked because of coronary artery disease (angina).
Beating Heart Bypass Surgery – Things you should knowMohammad Shakil
Coronary Artery Bypass Grafting (CABG), commonly referred Bypass Surgery, is a surgical procedure that redirects blood flow around a blockage or narrowed section in the major arteries supplying blood and oxygen to the heart.
The Norwood procedure is the first of three surgeries required to treat single-ventricle conditions such as hypoplastic left heart syndrome (HLHS). Because the left side of the heart can’t be fixed, the series of surgeries rebuilds other parts of the heart.
The Norwood procedure is performed in the baby’s first or second week of life.to redirect the blood flow.
Three goals for the Norwood procedure:
1, Build a new aorta.
2, Direct blood from the right ventricle through the new aorta and on to the rest of the body.
3, Direct the right ventricle to pump blood to the lungs until the next surgery.
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
The Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
What is the purpose of the Sabbath Law in the Torah. It is interesting to compare how the context of the law shifts from Exodus to Deuteronomy. Who gets to rest, and why?
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
1. Surgery on
Pericardium
Submitted to- Dr. Jamal Moiz
Submitted by- Hamda Furqan
BPT 4th year
Subject: Physiotherapy in
cardiopulmonary conditions (BPT 402)
1
2. Pericardium
• The pericardium is a thin sac that surrounds the
heart. It protects and lubricates the heart and
keeps it in place within the chest.
• Pericardium layers
• The pericardium has two layers:
• Fibrous pericardium is the outer layer. It’s
made from thick connective tissue and is attached
to the diaphragm. It holds the heart in place in the
chest cavity and protects from infections.
• Serous pericardium is the inner layer. It’s
further divided into two more layers: the visceral
and parietal layers. The serous pericardium helps
to lubricate the heart.
2
3. Surgeries on Pericardium
• Pericardium operations are a type of heart surgery. They are necessary if the
pericardium, or heart sac, becomes thickened or filled with fluid.
• In general, there are two operations available:
Pericardial fenestration-the opening of the pericardium and
Pericardiectomy: the removal of the pericardium
Indications:
• Constrictive pericarditis: pericardium becomes stiff and calcified
• Pericardial effusion: If fluid builds up in the pericardium due to inflammation
in this area (pericarditis), cancer or an injury/haemorrhage, this is called
pericardial effusion.
• Pericardial tamponade: Accumulation of fluid in the pericardial space causing
increase in pressure with subsequent cardiac compression
3
4. Thoracoscopic pericardial fenestration
• In the case of thoracoscopic pericardial fenestration, an endoscope is used to help make
a hole in the pericardium, so that the fluid can be drained or removed.
• Before pericardial fenestration, an attempt will firstly be made to drain the fluid by
puncturing the pericardium and inserting a thin tube.
• If this is insufficient, or the fluid keeps accumulating, pericardial window surgery is
required.
• This operation is performed under general anaesthetic and involves all the usual
preparations required for a general anaesthetic.
Procedure:
• A thoracoscope is inserted into the chest cavity through an incision below the fifth rib
on the patient’s left-hand side.
• The incision is around 10 cm long. Guided by camera imaging, a hole (window) is cut
into the pericardium so that the fluid can drain into the chest cavity.
4
5. • There it is absorbed by the membrane around the lungs (pleura). After pericardial
fenestration, a drainage tube is usually inserted to aid the removal of fluid. The
operation takes around one hour.
• The drainage tube is removed after two or three days and the patient is usually
hospitalised for four or five days.
• The results are generally very good. Pericardial fenestration removes the fluid and the
‘hole’ in the pericardium does not negatively impact on the heart. However, the
underlying illness that caused the build-up of fluid may require further treatment.
Complications
• This is a low-risk operation and generally does not result in complications.
• As with all surgery, the operation may lead to infections, post-operative
haemorrhaging or blood clots in rare cases.
Follow-up:
• In the initial period after pericardial fenestration, ultrasound examinations are
necessary to investigate how the pericardium is progressing and to ensure there is no
new fluid build-up. 5
6. Pericardiectomy
• Pericardiectomy is the surgical removal of a portion or all of the pericardium. It is
also called pericardial stripping.
• The most common reason for performing a pericardiectomy is constrictive
pericarditis, a condition in which the pericardium has become stiff and calcified.
The stiff pericardium prevents the heart from stretching as it normally does when
it beats. This causes the heart chambers to fill incompletely with blood, and blood
backs up behind the heart. The heart swells, and symptoms of heart failure
develop.
• Pericardiectomy also can be used to treat recurrent pericarditis, in patients with
intractable recurrent symptoms and complications of the anti-inflammatory
medications including steroids.
6
7. Preparation:
• The patient should not eat or drink anything after midnight before the day of the
surgery.
• The doctor may want some extra tests before the surgery. These might include:
Chest X-ray
ECG or EKG to check the heart rhythm
Blood tests to assess general health
Echocardiogram, to view heart anatomy and blood flow through the heart
CT scan or MRI if the doctor needs more information about the heart
• Heart catheterization to measure the pressures inside the heart
• Hair on and around the area of the operation may be removed ahead of time.
7
8. Procedure:
• The procedure is performed under general anesthesia
• There are different types of procedures that may be done.
• The chest cavity is opened using a small incision between the ribs, known as a
thoracotomy. Then the surgeon removes part or all of the pericardium, depending on how
thick and calloused it has become. The pericardium does not need to be replaced. The
heart can move freely in the chest cavity without it. The operation can usually be
performed without the use of a life-support machine.
• In some cases, the surgeon will make a vertical incision along the sternum. This incision
will be several inches long. To access the heart, the surgeon will separate the sternum.
• The doctor will surgically remove a large portion of the pericardium or the entire
pericardium.
• The doctor will do other repairs to the heart if needed.
• The muscle and the skin incisions will be closed and a bandage will be applied.
8
9. Risks/complications:
• Abnormal heart rhythms, which can cause death in rare instances
• Blood clot, which can lead to stroke or other problems
• Complications from anesthesia
• Death
• Excess bleeding
• Fluid buildup around the lungs
• Heart attack
• Infection
• Low cardiac output syndrome
• Pneumonia
• Risks may vary according to the age, general health, and the cause. They may also
vary depending on the anatomy of the heart, fluid, and pericardium.
9
10. In general, after the pericardiectomy:
• The patient may be groggy and disoriented upon waking.
• The patient’s vital signs, such as heart rate, blood pressure, breathing, and oxygen
levels, will be closely monitored.
• The patient may have a tube draining the fluid from the chest.
• The drained fluid may be sent to a lab for analysis.
• The patient may feel some soreness, but shouldn’t feel severe pain. Pain medicines
are available if needed.
• The heart symptoms will likely get better very soon after surgery.
• The patient will probably be able to have liquids the day after surgery. The patient
can have regular foods as soon as he can handle them.
10
11. When discharging from the hospital following instructions are given to
the patient:
• You will probably have your stitches or staples removed in a follow-up
appointment in 7 to 10 days. Be sure to keep all follow-up
appointments.
• You should be able to resume normal activities relatively soon, but you
may be a little more tired for a while after the surgery.
• Ask the doctor if you have any exercise limitations. Avoid heavy
lifting.
• Call the doctor if you have fever, increased draining from the wound,
increased chest pain, or any severe symptoms.
• Follow all the instructions your healthcare provider gives you for
medicines, exercise, diet, and wound care.
11
12. Physiotherapy Management
There are 3 main areas of physiotherapy involvement:
• 1. Chest care
• 2. General mobility
• 3. Rehabilitation
Chest Care:
Chest care Chest problems do occur after cardiac surgery even if the patient have no
history of chest problems or smoking.
Reasons for chest problems after the operation include:
• The anaesthetic gases – increase the amount of phlegm produced – make the
phlegm sticky and difficult to cough up – make the patient sleepy after operation –
make you take small rather than big breaths – make your cough less effective
• Previous chest problems or history of smoking – can lead to increased amounts of
phlegm being produced after the operation.
12
13. • The incision – the discomfort from the wound may mean the patient is reluctant to take deep breaths or
cough effectively.
• Posture – if sitting or lying in a slumped position in the bed or chair, the will be unable to take a full
deep breath. So, ask the patient to always sit in an upright position, not slumped
• Decreased activity – in the early stages after the operation the patient spend more time in bed than
usual, and do not take such deep breaths as they would when walking, so phlegm can accumulate.
Therefore to speed the recovery and prevent chest infections, it is vital
that the patient practice the breathing exercises and coughing
• Ask the patient to complete 3 sets of 4 deep breaths every 30 minutes
• Cough and clear your chest as necessary
Coughing
Effective coughing is extremely important to clear any phlegm
present on the chest.
• When coughing, ensure that the patient is sitting upright and that he/she
support the wound with the cough pillow provided
• Ask the patient to take a deep breath in and Cough strongly from your tummy not your throat
• Afterwards do some relaxed breathing
13
14. Cardiac Rehabilitation
Comprehensive cardiac rehabilitation program should contain specific core components.
These components should optimize cardiovascular risk reduction, reduce disability,
encourage active and healthy lifestyle changes, and help maintain those healthy habits after
rehabilitation is complete. Cardiac rehabilitation programs should focus on:
• Patient assessment nutritional counselling
• Weight management
• B.P management
• Lipid management
• Diabetes management
• Tobacco cessation
• Psychosocial management
• Physical activity counselling
• Exercise training
14
15. Phase 1: Inpatient phase
• Involves immediate inpatient exercise rehabilitation that emphasizes:
a) Patient education (informal discussions with nurses and physicians) and
b) Counselling.
Exercise therapy
• Musculoskeletal ROM activities. b) ADLs (sitting, standing, and walking).
• Purpose:
a) Counter the deconditioning effects of prolonged bed rest,
b) Prepare patient for a return to normal daily activities.
• EXERCISE PRESCRIPTION FOR PHASE I
• 1. ROM EXERCISES:
• Shoulder flexion, abduction and internal & external rotation
• Elbow flexion
15
16. Ambulation
• Ambulatory activities in phase 1 should be low in intensity (approx. 1.5-3 METS)
and initially include self care activities (eating, sitting), which are gradually
progressed to slow walking, ROM exercises and activities of daily living.
• Later stair climbing can also be introduced.
• EXERCISE INTENSITY: • Exercise performed in phase 1 typically do not exceed 2-
3 METS.
• The use of Borg Rating of Perceived Exertion Scale is encouraged after first few days
in the hospital.
Phase II: Outpatient cardiac rehabilitation
• Once a patient is stable and cleared by cardiology, outpatient cardiac rehabilitation
may begin.
• Phase II typically lasts three to six weeks though some may last up to up to 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.
16
17. • A more rigorous patient-centered therapy plan is designed, comprising three
modalities: information/advice, tailored training program, and a relaxation program.
The treatment phase intends to promote independence and lifestyle changes to prepare
patients to return to their lives.
Exercises include: breathing exercises: During the first two weeks after the patient is
discharged home, it is important to continue with the breathing exercises,
Shoulder exercises: shoulder shrugs
Trunk exercises
A. Alternate side bending in standing
B. Thoracic rotation
Leg exercises:
A.Alternate knee bends
B. Half squats
C. Step ups
Perform 2 sets of 10 reps each
17
18. Phase III: Post-cardiac rehab. Maintenance
• This phase involves more independence and self-monitoring. Phase III centers on increasing
flexibility, strengthening, and aerobic conditioning.
• Goal: facilitate long term maintenance of lifestyle changes, monitoring risk factor changes
and secondary prevention.
• Educational sessions
• Support groups
• Telephone follow up
• Review in clinics
• Outreach programmes
• Exercise program organised by qualified phase IV gym instructor
• Links with GP and primary health care team
• Ongoing involvement of partners/spouses/family
at home.
18
19. References:
• Hirslanden: Pericardium: operations and procedures
• Cleveland clinic: Pericardiectomy
• Hopkinsmedicine: Pericardiectomy
• Physiopedia
• NHS: Physiotherapy following cardiac surgery
19