Scientific Research Journal of India ● Volume: 2, Issue: 3, Year: 2013

RESPIRATORY PHYSIOTHERAPY IN TRIPLE VESSEL DISEASE WITH

POST CORONARY ARTERY BYPASS GRAFTING SURGERY (CABG)

Shanmuga Raju P (MPT)*, Renkha Rao (MCh), Rajendhra Kumar J (MD), SuryaNaryana
Reddy V (MS)

ABSTRACT
We are presenting a case of 47 years of old female with triple vessel disease and coronary artery bypass
graft surgery. Her complaint was chest pain and shortness of breath since last 5 months. Coronary
angiogram revealed triple vessel disease and she underwent three coronary artery graft surgery on 24th
February, 2013. Second day aftter CABG, she developed dyspnoea, reduced chest expansion and decreased
arterial O2 saturation. She was treated with daily session involving positioning, chest percussion, deep
breathing exercise, manual mobilization exercise and passive and active limb movements. We observed that
receiving chest physiotherapy has significant effect in recovery of post CABG patient after 3 weeks of follow
up. Our aim of case study is to describe effects of respiratory physiotherapy in post operative CABG in
triple vessel disease.
Keywords: Triple vessel disease, Coronary artery bypass grafting, respiratory physiotherapy

INTRODUCTION Approximately, one sixth of the world population

(1)
lives in India . Coronary artery bypass graft
India have 29.8 million symptomatic patients
(CABG) surgery is challenging for coronary artery
with coronary artery disease (CAD).

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 ISSN: 2277-1700 ● Website: http://srji.drkrishna.co.in ● URL Forwarded to: http://sites.google.com/site/scientificrji

disease. CABG is associated with an occurrence of eosinophils 03%, monocytes 05%, basophilis 00%
pulmonary complications, defined as any and ESR is 30mm/1hours.
pulmonary abnormality that occurs during the post Biochemistry: Sodium 136 mmol/L, potassium
(2)
operative period . A decrease in pulmonary 4.1 mmol/L, chlorides 106 mmol/L, fasting serum
function is well known after open heart surgery. glucose 103 mg/dL. Urine level is 100ml. Blood
Chest physiotherapy is routinely used in order to group is ‘O’ negative. Chest expansion
prevent or reduce pulmonary complications after measurements were 58 cm at axilla level, 83 cm at
surgery. Post operative treatment includes early nipple level and, 79 cm at xiphoid level.
mobilization, change in position, breathing
(3)
exercises and coughing techniques .

CASE REPORT
A 47 year old female patient was diagnosed to
have triple vessel disease; coronary angiogram
revealed triple vessel coronary artery disease and
was referred to department of cardiothoracic
surgery at Chalmeda AnandRao Institute of
Medical Sciences, Karimanagar on 24th February
Figure: 1 Before CABG and respiratory
2013. Medical history was chest pain and
physiotherapy transthoracic 2D echo cardiogram
shortness of breathlessness since last 5 months.
show decrease Left ventricular systolic function
She was known case of type to II Diabetes
(LV ejection fraction (EF) 20.3 %).
mellitus, but no history of hypertension. Coronary
angiogram showed triple vessel disease with left
ventricular dysfunction. She underwent coronary
artery bypass grafts surgery and three grafts were
placed, one graft was placed to obtuse marginal 1
(OM 1), second graft was placed to left anterior
descending artery and third graft was placed to
right coronary artery. She was hemodynamically
stable on first post operative day but on second
postoperative day, she had aspirated gastric
contents and developed hypoxia due to asphyxia. Figure: 2 After CABG and respiratory

Her blood pressure was 149/81 mm/Hg, pulse physiotherapy transthoracic 2D echocardiogram

106 per/minute, heart rate 123 per/minute, show improve LV systolic function (LV ejection

respiration rate 16 breaths per/minute, and fraction 55.3 %).

temperature was 1000 F. Complete blood picture

show hemoglobin 6.5 gm/cumm, WBC 5,800 DISCUSSION

cells/cumm, neutrophils 78%, lymphocytes 17%, Patient undergoing cardiac surgery (CS), in
most number of cases post operative pulmonary

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 Scientific Research Journal of India ● Volume: 2, Issue: 3, Year: 2013

dysfunction developed with a significant reduction anteroseptal wall and apical part of LV were
in lung volume, respiratory function, and lung hypokinetic and reduced LV systolic function.
(4-5)
compliance and increased work of breathing . Second day after surgical procedure (CABG) she
Atelectasis and hypoxemia are among the main had aspirated gastric contents and developed
pulmonary complications post operatively of hypoxia due to asphyxia. Three week after
(6)
CABG . Respiratory therapy is often used in the respiratory physiotherapy treatment, her chest
prevention and treatment of post operative expansion, arterial O2 saturation and cardiac
complications as retention of secretions, atelectasis function were improved (EF 55%). She was
(7)
and pneumonia . discharge and advised follow-up.
In our case, before CABG, an
electrocardiogram shows Q wave in V1 V2 V3 & CONCLUSION
V4 chest lead are poor progression of R wave in Our case report showing that post operative
chest lead V5 and V6. After CABG ‘Q’ wave are respiratory physiotherapy is an effective
present in V1 and V4 chest lead, no new ST- T management for a patient with coronary bypass
changes. Before surgical procedures transthoracic graft surgery for reducing in pulmonary
2D echocardiogram shown normal valves and complications.
normal size chambers. Anterior wall, lateral wall,

REFERENCES

1. Aggarwal A, Sourabh A, Goel A, Sharma V, Dwivedi S. A retrospective case control study of

modifiable risk factors and cutaneous markers in India patients with young coronary artery disease.
J R Soc Med Cardio 2012, vol:1(38); p: 1-8.
2. O’ Donohue WJ Jr. Postoperative pulmonary complications. When are preventive and therapeutic
measures necessary? Post grad Med 1992, 91(3): 167-170.
3. Westerdahl E, Lindmark B, Almgren SO, Tenling A. Chest physiotherapy after coronary artery
bypass graft surgery- A comparison of three different deep breathing techniques. J Rehab Med
2001; 33: 79-84.
4. Westerdahl E, Lindmark B, Eriksson T, Friberg O, Hedenstierna G, Tenling A. Deep breathing
exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery.
Chest. 2005; 128(5): 3482-8.
5. Feltrim MIZ, Jatene FB, Bernardo WM. Em pacientes de alto risco, submetidosa’ revascularizacao
do miocardio, a fisiotherapia respiratioria pre-operatoria previne as complica coes pulmonares? Rev
Assoc Med Brac.2007; 53(1): 1-12.
6. Renault JA, Costa- Val R, Rossetti MB. Respiratory physiotherapy in pulmonary dysfunction after
cardiac surgery. Rev Bras Cir Cardiovasc.2008; 23(4): 562-9.

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 ISSN: 2277-1700 ● Website: http://srji.drkrishna.co.in ● URL Forwarded to: http://sites.google.com/site/scientificrji

7. Lopes C, Brandao CM de A, Nozawa E, Auler Junior JOC. Benefits of non-invasive ventilation

after extubation in the post operative period of heart surgery. Rev Bras Cir Cardio Vasc 2008; 23
(3): 344-350.

CORRESPONDING AUTHOR:

*Dr. P. Shanmuga Raju, MPT, Asst. Professor & I/C Head, Department of Physical Medicine &
Rehabilitation, Chalmeda Anand Rao Institute of Medical Sciences, Karimngar- 505001, Andhra Pradesh,
INDIA. E-mail: shanmugampt@rediffmail.com

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