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In this Chapter

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  • Rationale for diagnosis of cardiac and pulmonary pathologies by physical therapists

  • Diagnostic relevance of the clinical examination for cardiac and pulmonary pathologies

  • Interpretation of common examination findings with respect to pathology affecting the cardiovascular and pulmonary systems

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Introduction

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Physical therapy is becoming a more common route of first entry into the health care delivery system. This development necessitates that physical therapists quickly and accurately recognize the pathology underlying patients' clinical presentations, especially those pathologies that require referral to other health care providers. Of particular importance is the appreciation of cardiovascular and pulmonary disorders that may present in patients who are being seen for unrelated musculoskeletal or neuromuscular dysfunction.

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Most patients who experience acute cardiovascular or pulmonary symptoms do not initially seek the services of a physical therapist. Patients may mention these symptoms to a physical therapist or manifest signs of compromised cardiovascular or pulmonary function during the course of treatment for another disorder. In such situations, the physical therapist should establish the patient's cardiovascular and pulmonary status quickly by means of a thorough line of questioning, evaluation of current signs and symptoms, and application of appropriate definitive assessment tools.

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During this process, the physical therapist must decide on the appropriate course of action to ensure the health and safety of the patient in a timely manner. Depending on the patient's medical stability, this can include expeditious referral to the patient's primary care physician, direct contact with the primary care provider while the patient is still in the presence of the physical therapist, administration of basic cardiopulmonary life support techniques, or activation of the emergency medical services system.

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This chapter is not intended to present a comprehensive cardiovascular and pulmonary examination sequence; rather, it provides an overview of how observation and fundamental evaluation tools contribute to the diagnostic process with respect to cardiovascular and pulmonary pathology.

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General Observation is an Important Initial Basis for Diagnosing Cardiovascular and Pulmonary Pathologies

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Patients with various cardiovascular and pulmonary diseases commonly adopt recognizable body positions that should prompt the therapist to examine further the pathological reasons behind these preferences. Individuals with chronic obstructive pulmonary disease often assume the "professorial position," which consists of leaning forward with hands or elbows resting on knees or another stationary object. This strategy helps to stabilize the shoulder girdle so that the accessory muscles of ventilation can function more optimally in elevating the clavicle and upper ribs. Patients with chronic obstructive pulmonary disease may also avoid tasks that require the arms to be held at or above shoulder level because of the altered ventilatory mechanics and increased energy cost associated with overhead activities.1

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The effects of gravity on the distribution of pulmonary edema secondary to chronic congestive heart failure may lead some patients to assume a semi-Fowler's position (the head of the bed ...

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