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INTRODUCTION

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LEARNING OBJECTIVES

  1. Describe the etiology, pathophysiology, symptomatology, and sequelae of coronary heart disease.

  2. Describe the etiology, pathophysiology, symptomatology, and sequelae of congestive heart failure.

  3. Identify and describe the examination procedures used to evaluate patients with heart disease and establish a diagnosis and plan of care.

  4. Describe the role of the physical therapist in assisting the patient in recovery from heart disease in terms of interventions, patient-related instruction, coordination, communication, and documentation.

  5. Identify and describe strategies of intervention during various phases of cardiac rehabilitation.

  6. Analyze and interpret patient data, formulate realistic anticipated goals and expected outcomes, and develop a plan of care when presented with a clinical case study.

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INTRODUCTION AND EPIDEMIOLOGY OF HEART DISEASE

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Cardiovascular disease (CVD) is a term referring to the pathological process of atherosclerosis affecting the entire arterial circulation. Coronary artery disease (CAD), also called coronary heart disease (CHD), refers to the pathological process of atherosclerosis, specifically affecting the coronary arteries. CAD includes the diagnoses of angina pectoris, myocardial infarction (MI), silent myocardial ischemia, and sudden cardiac death.

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The pathophysiological conditions that underlie CVD are atherosclerosis, altered myocardial muscle mechanics, valvular dysfunction, arrhythmias, and hypertension (HTN). Atherosclerosis is a disease in which lipid-laden plaque (lesions) is formed within the intimal layer of the blood vessel wall of moderate and large size arteries; over time the plaque may extend into the lumen causing a decreased lumenal diameter. Atherosclerosis is also a primary contributor to cerebrovascular disease (cerebrovascular accident [CVA]) and peripheral vascular disease (PVD).

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Alteration in myocardial muscle mechanics involving the systolic and/or diastolic properties of the myocardium results in an impairment of left ventricular (LV) function. Heart failure is a clinical diagnosis caused by impaired LV functioning and is referred to as congestive heart failure (CHF) when it is accompanied by signs and symptoms of edema (i.e., congestion). There are many causes of heart failure, including myocardial scarring and remodeling as a result of an MI, cardiomyopathy (involving an enlarged, thickened, and/or hardened heart muscle) from various causes, or impaired valvular function, especially within the mitral and aortic valves.

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Arrhythmias are caused by a disturbance in the electrical activity of the heart, resulting in impaired electrical impulse formation or conduction. Arrhythmias may present as benign or malignant (i.e., life threatening). Examples of malignant arrhythmias are sustained ventricular tachycardia (V-tach) and ventricular fibrillation (V-fib). An example of a common benign arrhythmia in the elderly is atrial fibrillation (A-fib) with a controlled ventricular response involving a ventricular rate between 60 and 100 beats per minute (bpm).

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HTN is the most prevalent CVD in the United States and one of the most powerful contributors to cardiovascular morbidity and mortality. HTN occurs when the systolic blood pressure is consistently greater than 140 mm Hg or the DBP is equal to or greater than 90 mm Hg.

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