coronary artery disease

coronary artery disease

1. BPT 403 Physiotherapy in cardiopulmonary conditions program : BPT IV year Name : N usrat Majid Roll no. : 17Bpt028 Enrollment no. : 17-7411 Assignment submitted to : Dr. Jamal Moiz C entre O f P hysiotherapy and Rehabilitation Sciences JAMIA MILLIA ISLAMIA New Delhi Date: 14- 01- 2021 signature

2. Coronary Artery Disease(CAD) A narrowing of the coronary arteries that prevents adequate blood supply to the heart muscle is called coronary artery disease Usually caused by atherosclerosis, it may progress to the point where the heart muscle is damaged due to lack of blood supply. Such damage may result in infarction, arrhythmias, and heart failure. CAD is also known as atherosclerotic heart disease, coronary atherosclerosis, coronary arteriosclerosis, coronary heart disease.

3. Risk factors Modifiable risk factors : High blood cholesterol level Cigarette smoking, tobacco use Stress Lack of estrogen in women Physical inactivity obesity

4. Non-modifiable risk factors Family history of coronary heart disease Increasing age(highest among middle aged men) Gender(occurs three times more often in men than in premenopausal women after 65 men and women equilizes ) Race (higher incidence of heart disease in A frican A mericans than in Caucasians) Diabetes High blood pressure

5. Pathophysiology : due to causes (e.g. high fatty diet, hereditary or other) lipids/cholesterol formation on the endothelium layer of artery. formation of fatty streak proliferation formation of fibrous plaque partial or complete blockage in the coronary artery

6. Symptoms Cardiovascular: A ngina pectoris Ischemia Low cardiac output Bradycardia(decreased pulse rate) Hypertension Myocardial infarction Diaphoresis(excessive sweating) ECG changes- St segment and T wave changes, also show tachycardia, bradycardia, or dysrhythmias. Dyaarrithmias Respiratory : Dyspnea - shortness of breath Pulmonary edema

7. Chest heaviness Fatigue Genitourinary - decreased urinary output may indicate cardiogenic shock. Gastrointestinal – nausea and vomiting Skin - cool, clammy, diaphoretic, and pale appearance Diagnosis electrocardiogram (EKG) Echocardiograms Stress tests nuclear Cardiac imaging Angiography

8. Complications : Chest pain(angina) Heart attack Heart failure Abnormal heart rhythm(arrhythmia) Prevention : Quit smoking Control conditions such as high blood pressure, high cholesterol, and diabetes. Stay physically active Eat a low fat , low salt diet that’s rich in fruits, vegetables and wholegrains Maintain a healthy weight Reduce and manage stress

9. Medical management various drugs can be used to treat coronary artery disease, including: Vasodilators : nitrates Beta – blockers : propranolol 20- 40mg Calcium channel blocker : nifedipine, verapamil Anticoagulant drugs : heparin Opiate analgesic Thrombolytic drugs: streptokinase, urokinase Antihypertensive medicines: methyldopa , sodium nitroprusside, amlodipine Surgical management Angioplasty and stent placement Coronary artery bypass grafting

10. Physiotherapy management G oals of cardiac rehabilitation program : T his program aims at returning the patients with cardiac disease to their optimal physical, psychological, social, emotional, vocational, and economic status. Short term objectives: Physical reconditioning Education on the disease process and Psychological support during the early recovery phase. Long term objectives: Managing risk factors and Teaching healthy lifestyle that improves prognosis and physical conditioning for an early return to occupational activities.

11. Phases of cardiac rehabilitation It consists of three phases Phase I : clinical phase T his phase begins in the inpatient setting soon after a cardiac event of completion of the intervention. It begins b y assessing the patients physical ability and motivation to tolerate rehabilitation. Therapists and nurses start by guiding patients through non- strenuous exercise in the bed or at the bed side, focusing on a range of motion and limiting hospital deconditioning . The rehabilitation team may also focus on activities of daily living(ADL’S) and educate the patient on avoiding excessive stress. Patients are encouraged to remain relatively rested until completion treatment of comorbid conditions, or post- operative complications. The rehabilitation team assesses patient needs such as assistive devices, patient and family education , as well as discharge planning.

12. Phase II : out patient cardiac rehab once the patient is stable and cleared by cardiology, outpatient cardiac rehabilitation may begin. Phase II typically lasts three to six weeks though some may last upto 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. A more rigorous patient centered therapy plan is designed, comprising three modalities : informative /advice, tailored training program , and a relaxation program . The treatment phase to intends to promote independence and lifestyle changes to prepare patients to return to their lives at home.

13. Phase III: post- cardiac rehab. Maintenance This phase involves more independence and self –monitoring . Phase III centers on increasing flexibility, strengthening, and aerobic conditioning.