Cardiopulmonary Examination

Cardiopulmonary System Overview

  • Focus on clinical application for entry-level physical therapists.

  • Emphasize safe and effective patient care using current evidence-based practice.

Examination Components

  • Evaluation, Differential Diagnosis, Prognosis, Interventions.

Cardiovascular System Key Points

  • Heart Anatomy: Main structures include atria, ventricles, valves (tricuspid, mitral, aortic, pulmonary).

  • Heart Rate by Age:

    • Newborn: 120-140 bpm

    • 1-12 months: 80-140 bpm

    • 1-3 years: 80-130 bpm

    • 3-5 years: 80-120 bpm

    • 6-12 years: 70-110 bpm

    • 13-17 years: 55-105 bpm

    • >18 years: 60-100 bpm

  • Heart Sounds:

    • S1: AV valves closure

    • S2: Semilunar valves closure

    • S3: Early diastole (CHF, athletes)

    • S4: Late diastole (MI, hypertension)

Blood Pressure Guidelines

  • Normal: <120/80 mmHg

  • Elevated: 120-129/<80 mmHg

  • Stage 1 Hypertension: 130-139/80-89 mmHg

  • Stage 2 Hypertension: ≥140/≥90 mmHg

Exercise Physiology

  • HR and SBP increase linearly; DBP shows limited changes.

  • Tidal volume and respiratory rate increase during exertion.

  • Abnormal Responses: Angina, dyspnea, dizziness, cyanosis, excessive fatigue, and EKG changes.

Angina Types

  • Unstable: Occurs at rest, immediate intervention needed.

  • Stable: Predictable workload.

  • Prinzmetal: Occurs at rest, responds to treatment.

Myocardial Infarction (MI) Signs/Symptoms

  • Chest pressure, pain radiating to arm/jaw.

  • Symptoms may vary in women (fatigue, anxiety).

Congestive Heart Failure (CHF)

  • Caused by hypertension, CAD, valve abnormalities.

  • Symptoms: fatigue, edema, dyspnea, S3 heart sound.

Deep Vein Thrombosis (DVT)

  • Signs include unilateral swelling and pain, may be asymptomatic.

Respiratory System Overview

  • Muscles of Inspiration: Diaphragm, external intercostals; Accessory: SCM, pectoralis minor.

  • Respiratory Rates by Age: 0-1 years: 30-60; 1-3 years: 24-40; etc.

  • Adventitious Sounds: Crackles (CHF), wheezes (asthma), rhonchi (bronchitis).

Breathing Techniques

  • Pursed-lip breathing: Helps prevent airway collapse.

  • Huffing: Mobilizes secretions.

EKG Basics

  • Normal Rate: 60-100 bpm; Bradycardia <60 bpm; Tachycardia >100 bpm.

  • ST Segment Changes: Depression indicates ischemia; elevates in STEMI.

  • AV Blocks: Different types indicate varying pathology.

Contraindications for EKG

  • Absolute: sustained V-tach, ST-elevation.

  • Relative: ST changes, supraventricular tachycardia, bradyarrhythmias.