Cardio-Pulmonary Conditions: Basics, Assessment and Evaluation

Objectives:
The course shall enable the candidate to expertise in the knowledge and skill of operating advanced instrumentation at the intensive care area as well as modern investigative procedures such as stress testing in the presence of a physician. Such candidate shall also attend an ability to function as an essential team member of intensive care units, as well as team of experts in the cardio-pulmonary rehabilitation general fitness and health promotion at the hospital set-ups industrial/ geriatric set-ups, health clubs, sports fitness/ training and women’s health. The sub-specialities are

• Adult and paediatric emergency.
• Cardiac rehabilitation and management.
• Pulmonary Rehabilitation.
• Geriatric and Industrial Health.
• Women’s health.
• Sports sciences and health preparations.

Section-I: Cardio-Pulmonary Conditions- Basics

Anatomy

Fundamentals in cardio-respiratory conditions

• Cardio-Vascular System: Mediastinum: Divisions and contents Pericardium: Thoracic Wall: position, shape and parts of the heart; conducting System; blood Supply and nerve supply of the heart, anatomy of arteries, veins, and capillaries.
• Respiratory system: Outline of respiratory passages. Pleura and lungs: position, parts, relations, blood supply and nerve supply; Lungs – emphasize on Bronchopulmonary segments. Diaphragm: Origin, insertion, nerve supply and action, openings in the diaphragm. Intercostal muscles and Accessory muscles of respiration: Origin, insertion, nerve supply and action.

Physiology

Cardiac System:

• Cardiac muscles: Structure. Ionic basis of action potential and pacemaker potential. Properties.
• Conducting system: Components. Cardiac Cycle: Definition. Phases of cardiac cycle. Heart sounds – causes, character.
• Cardiac Output: Definition. Normal value. Determinants. Stroke volume and its regulation. Heart rate and its regulation and their variations.
• Arterial Blood Pressure: Definition. Normal values and its variations. Determinants. Peripheral resistance. Regulation of BP.
• Arterial pulse.
• Shock – Definition. Classification–causes and features
• Regional Circulation: Coronary, Cerebral and Cutaneous circulation.

Respiratory System:

• Function of respiratory system: Pleura, tracheo-bronchial tree, alveolus, respiratory membrane and their nerve supply. Respiratory muscles.
• Mechanics of breathing: Intrapleural and Intrapulmonary pressure changes during respiration.
• Lung compliance: Normal value, pressure-volume curve, factors affecting compliance and its variations. Surfactant – Composition, production, functions.
• Spirometry: Lung volumes and capacities. Timed vital capacity and its clinical significance. Maximum ventilation volume. Respiratory minute volume.
• Dead Space: Types and their definition.
• Pulmonary Circulation. Ventilation-perfusion ratio and its importance.
• Transport of respiratory gases: Diffusion across the respiratory membrane. Oxygen-haemoglobin dissociation curve. Factors affecting it. Haldane and Bohr Effect. Carbon dioxide transport: Different forms, chloride shift.
• Neural Regulation of Respiration. Hering-breuer’s reflex. Voluntary control. Chemical Regulation.
• Physiology of microcirculation and edema
• Hypoxia: Effects of hypoxia. Types of hypoxia. Asphyxia. Cyanosis – types and features.
• Periodic breathing – definition and types.
• Artificial respiration

Cardio-Pulmonary Conditions- Biomechanics, pathomechanics & Applied

Anatomy

• General structure and function
• Rib cage and the muscles associated with the rib cage
• Ventilatory motions: its coordination and integration
• Developmental aspects of structure and function
• Body positioning and various systemic changes
• Changes in normal structure and function I relation to pregnancy, scoliosis and COPD
• Respiratory muscle fatigue and training
• Development of the Cardio Vascular, Pulmonary systems and deviations from the normal development.
• Age related changes in Cardiovascular & Pulmonary System
• Normal and abnormal responses of Cardiovascular & Pulmonary System during Exercise

Section-II: Cardio-Pulmonary Conditions – Assessment and Evaluation

• Assessment of cardio-pulmonary system, Adult and Pediatric:
  • Medical Chart Review
  • Patient/Family interview
• Vitals:
  • Heart rate measurement
  • Blood pressure measurement
  • Respiratory rate measurement
  • Temperature measurement
• Physical Therapy Examination:
  • Inspection
  • Auscultation
  • Palpation
  • Percussion
• Exercise Assessment:
  • Exercise Stress testing
  • Activity and Endurance Evaluation
  • Walk tests
• Clinical Monitoring:
  • Heart Rate and heart rate response to exercise
  • Heart rhythm
  • ECG monitoring
  • Pace-maker rhythm
  • Blood Pressure and Blood pressure response to exercise
  • Respiratory rate and respiratory response to exercise
  • ABG analyses
  • Pulse Oximetry, oxygen saturation monitoring
  • RPE
  • Other signs and symptoms of exercise intolerance
  • Exercise capacity
• Other assessment tools: Body composition and body composition measures
• Respiratory muscle strength and endurance
• Autonomic dysfunction
• Questionnaires survey and Scales
• Assessment of findings:
  • Chest assessment
  • Activity and endurance evaluation
  • Defining the physiotherapy problem
• Basic interpretation of investigative procedures used in cardio-respiratory conditions:
  • Thoracic imaging
  • Chest X-ray
  • CT scan
  • MRI,
  • Bronchogram
• Pulmonary function test
• Evaluation Of peripheral vascular diseases
• Clinical decision making skills in functional diagnosis in neonate, pediatrics, adults and geriatrics
• Laboratorical investigations
• Differential diagnosis
• ADL analysis
• Evidence based practice

Paper-VI Elective: Physiotherapeutic Interventions in Clinical Cardio-Pulmonary Conditions

Section-I: Clinical Cardio-Pulmonary Conditions
Causes, clinical features, pathophysiology, general investigation, Medical and surgical management of the below mentioned conditions

• Respiratory Conditions:
  • Obstructive lung disease: Asthma, Chronic bronchitis, emphysema, Bronchiectasis, Cystic fibrosis, etc.
  • Restrictive lung disease: Atelectesis, pneumonia, Pleural effusion, Pneumothorax, ARDS,
  • Suppurative lung diseases like lung abscess, etc.
  • Occupational lung diseases-occupational asthma, inhalation injuries, etc.
  • Chest trauma
  • Chest wall deformities
  • Lung cancers
  • Pediatric/Neonatal Pulmonary diseases
  • Sleep apnea
  • Respiratory failure
• Cardio Vascular Conditions:
  • Pediatric Cardio-vascular disorder: Fallot’s tetralogy, Co-arctation of aorta, Patent ductus arteriosus, Arterial septal defect, ventricular septal defect, Transposition of great vessels.
  • Acquired heart diseases: Coronary Artery Diseases, Cardiac arrhythmias, Valvular heart diseases, Cardiomyopaties,
  • Myocardial infarction
  • Hypertension and diabetes
  • Diseases of the myocardium
  • Pericardial diseases
  • Tumors of the heart
  • Peripheral vascular diseases: Definition, Etiology, Clinical features, signs and symptoms, complications, management and treatment of following diseases : Arteriosclerosis, Atherosclerosis, Aneurysm, Buerger’s disease, Raynaud’s Disease, Thrombophlebitis, Deep Vein Thrombosis, Pulmonary Embolism, Varicose Veins.
  • Cardiac arrest

Section-II: Physiotherapy Interventions in Cardio-Pulmonary Conditions
Student should be able to plan appropriate treatment regime based on the knowledge of various subjects learned during the two year programme for the below mentioned conditions. Additionally emphasis should be on special techniques/ approaches like Suctioning, Chest PNF, Inhalation and Humidification therapy, FET’s. Student should update himself/ herself with latest advancement in the therapeutic approaches.

• Cardio respiratory physiotherapy management principles, pre and post surgical intervention including critical care.
• Cardio-Respiratory physiotherapeutic techniques in adult and pediatric:
  • To improve lung volumes
  • To decrease work of breathing
  • To clear secretions
  • To Increase exercise tolerance
  • To improve ventilation and gas exchange
  • To Improve ADL demands
• Physiotherapy management in Obstructive and Restrictive lung diseases.
• Post operative management of Respiratory conditions
• Pulmonary rehabilitation
• Adjuncts to chest PT
• Post operative management of cardiac conditions
• PT management in acquired and congenital heart diseases
• Cardiac rehabilitation
• CPR
• PT management in Peripheral vascular diseases
• Cardiac transplantation
• Lung transplantation
• Respiratory and cardiology pharmacology in brief.
• Surgical interventions in brief: Cardio-Respiratory and Peripheral Vascular Disorder.

ICU Management

• Intensive Care unit: concept and set up, equipments for advanced methods of resuscitation, monitoring and patient management
• Artificial airways, ventilators, pulse oximetry, O2 therapy
• PT management in ICU
• Transfer and turning of patient
• Common complications in ICU
• PICU and NICU management

Recommended Books:

• Cardiopulmonary Physical Therapy – Irwin & Tecklin (Mosby).
• Cardiopulmonary Rehabilitation – Barbara.
• Cardiopulmonary Rehabilitation: Basic Theory and Application (Contemporary Perspectives in Rehabilitation) by Brannon, Foley, Saul and Starr (Sep 15, 1997)
• Chest Physiotherapy in Intensive Care Unit – Mackezie, Williams & Wilkins, Baltimore.
• Cardiopulmonary symptoms in Physiotherapy – Cohen M, Churchill, Livingstone.
• A Manual of Neonatal Intensive Care – Robert NRC, Edward Arnold.
• Cardiopulmonary Equipments – David Eubanks & Bone.
• Clinical application of Ventilator support – Kinby, Churchill Livingstone.
• Cardiac Rehabilitation – Amundsen, Churchill Livingstone.
• Mechanical Ventilation by Irwin R.S. Beamers
• ECG by Schamroth
• Interpretation of Pulmonary Function Tests: A Practical Guide by Hyatt, Robert E.; Scanlon, Paul D
• Principles of Exercise Testing and Interpretation: Including Pathophysiology and Clinical Applications by Kalman Wasserman
• Egan’s Fundamentals of Respiratory care by Robert Wilkins
• Harrison’s Textbook of medicine
• API’s Text book of Medicine
• Advancing the Frontiers of Cardioplumonary Rehabilitation by Jean Jobin, Francois Maltais, Paul Poirier and Clermont Simard (May 20, 2002)
• Cardiopulmonary Physical Therapy: A Guide to Practice by Scot Irwin MS PT DPT and Jan S. Tecklin MS PT (Apr 9, 2004)
• Physiotherapy for Respiratory and Cardiac Problems: Adults and Paediatrics by Ammani S Prasad and Jennifer A. Pryor (2008)
• Cardiopulmonary Physical Therapy: A Clinical Manual by Joanne Watchie.
• Cardiopulmonary Physical Therapy: A Clinical Manual by Sadowsky.
• Cardiovascular and Pulmonary Physical Therapy : An Evidence-based Approach by William DeTurk and Lawrence Cahalin (Mar 12, 2004)
• Cardiovascular and Pulmonary Physical Therapy: Evidence and Practice by Donna Frownfelter PT DPT MA CCS RRT FCCP and Elizabeth Dean PhD PT (Dec 5, 2005)
• Essentials of Cardiopulmonary Physical Therapy by Ellen Hillegass EdD PT CCS FAACVPR and H. Steven Sadowsky MS RRT PT CCS (May 11, 2001)
• Cardiopulmonary Physiotherapy by M. Jones and F Moffatt (Jan 2003)
• Clinical Management Notes and Case Histories in Cardiopulmonary Physical Therapy by W. Darlene Reid BMR(PT) PhD and Frank Chung BSc(PT) MSc (Jun 23, 2004)
• Advances in Cardiopulmonary Rehabilitation by Jean Jobin, Francois Maltais, Pierre LeBlanc and Clermont Simard (May 15, 2000)