CASE PRESENTATION

Anahata Kaur
12102591
Demographic data :-

Name :-Mrs ABC

Age- 65 years
Gender :- female
Address :- model town ext. , ldh
Occupation: Housewife
D.O.E – 07/03/2022
Chief complaints:-
 Breathlessness – 3-4 days
 Pain in chest – 1 days
 Headache – 3 days
History of present condition:-
 The patient was apparently well when she started felling
breathlessness 3 days ago , later she also experienced
continuous chest pain . She was also felling difficulty in
climbing stairs as she lives on second floor and there is
no lift in her building . She is also felling heaviness in
her chest while doing ADL’S like bathing , dressing up ,
cooking , combing , watering plants etc.
Past history :-
 B/L Osteoarthritis – 7 years
 Diabetes – 12 years

 Hypertension -15 years

 Cholelithiasis – 10 years

Surgical History :-
 B/Lknee replacement – 5 years
 Cholecystectomy – 10 years
Medications :-
Dopamine – 2 years
 Glipzide
 Atenol
 Pindolo

Personal History:-
 Food habit – non vegetarian , deep fried food 3 times a
week .
 Alcohol – occasionally

 Smoker – non- smoker

 Cardinal sign and symptoms :-
Cough :-
 Onset :- sudden and continuous

 Duration – 2 weeks

 Nature :- dry

Sputum :- not present

 Breathlessness :-

 Exercise tolerance – not able to climb stairs , walk for

more than 3-4 minutes.
Shortness of breath at rest
Other symptoms :-
 Sudden weight loss

 Vomiting and nausea

OBJECTIVE ASSESSMENT :
 Height– 5’6”
 Weight –68kgs

Vital signs :-
Temperature – 98.4
Pulse – 78 beats / min
Respiratory rate – 20 breathes / min
Blood pressure -105 /155 mmhg
 Level of consciousness :-
 GCS – 15/15

 Body type:- ectomorphic

 Posture and positioning :- sitting

 Examination:-
 Chest X-ray – shows pleural effussion.

 ECG :-

 ECO :-
Diagnosis :-
CAD (coronary artery disease )

Procedure done :-
 CABG – coronary artery bypass grafting
Phases of Cardiac Rehabilitation ;-
Cardiac rehabilitation consists of 3 phases.
Phase I: Clinical phase :-
 Begins in the IPD ,soon after a cardiovascular surgery. It begins
by assessing the patient's physical ability and motivation to
tolerate rehabilitation. Therapist may start by guiding patients
through exercises in the bed or at the bedside, focusing on a
range of motion and limiting hospital deconditioning.
 Focus on activities of daily living (ADLs) and educate the
patient on avoiding excessive stress. Patients are encouraged to
rest properly . The rehabilitation team assesses patient needs
such as assistive devices, patient and family education, as well
as discharge planning.
Phase II: Outpatient cardiac rehab
Initially, patients have an assessment with a focus on
identifying limitations in physical function, restrictions of
participation secondary to comorbidities, and limitations to
activities.
The treatment phase intends to promote independence and
lifestyle changes to prepare patients to return to their lives at
home.
Phase III: Post-cardiac rehab. Maintenance
 This phase involves more independence and self-
monitoring.
 Phase III centers on increasing flexibility, strengthening,
and aerobic conditioning.
Goal:
 Facilitate long term maintenance of lifestyle changes,
monitoring risk factor changes and secondary prevention
  Nutrition – management

 Weight management

 Improve Physical activity 

 Exercise training
Warm-Up
Purpose: Prepare the body for exercise .
Effects: redistributes blood to active tissues
 increases muscle temperature and speed of muscle
action and relaxation
 prepares the mind

 prepares the muscle for the ROM involved for the

conditioning period
 Should include activities (5 minutes) marching on the
spot, bed-walking .
Exercises :-
 Shoulder Shrugs - Bring your shoulders up to your
ears, then relax your shoulders down.
 Shoulder Circles - Sitting upright, roll your shoulders
in a smooth motion up, back and down in a circle.
Repeat in the reverse direction.
 Trunk Twists - Slowly rotate trunk to the right,
looking over your shoulder. Then rotate your trunk to
the left, hold .
 Trunk Side bending Hold your arms relaxed at your
sides and maintain your trunk upright. Lean to your
right side slowly , hold. Then lean to your left side,
hold .
 Chest Stretch - Place hands behind head, while sitting
upright. Move your elbows back, hold. Relax elbows
forward to rest.
 Forward Arm Raise - Sitting with upright posture,
straighten arm with thumb facing up. Raise arm up to
the front over head. Elbow should be next to ear.
Repeat with other other arm.
 Side arm raise :- Hold arm straight out to side with
thumb up. Raise arm up to the side over head, hold.
Repeat with other arm.
 Backward Reach :- With arms relaxed at side, elbows
straight, reach arms straight backwards. Hold and
stretch. Then repeat.
 Hands behind back and reach - Grasp hands together
behind the small of your back. Slowly lift your hands
off your back, hold
Coughing and Breathing Exercises:
 incentive spirometer - 10 times per hour when awake.

 Deep breathing exercises – 10 times per hour when

awake
Cool Down
 10 minutes at the end
 Goal: bring the body back to its resting state

 Active ROM exercises

Necessary because of;

 Increased risk of hypotension

 Older hearts take longer to return to resting levels

 Raised sympathetic activity during exercise increases the risk

of arrhythmias immediately post exercise.
Advice
 Patient use a pillow to hold over your incision when
you cough. This will provide support and decrease
pain.
 Patient is advised not to perform any exercise if
felling uncomfortable .
Home – Based Exercises
 Deep breathing and coughing
Instructions
 Support the incision when coughing or sneezing by hugging your chest.

 Take 5 to 10 deep breaths followed by two double coughs four times a

day for another two weeks after you leave the hospital.
 Walking :-

 Walk at a comfortable pace on a level surface. Do not include any stairs

in your walking program.
 When you can walk for 10 minutes, you may walk outdoors. Exercise
indoors if the weather is extremely cold or hot or if there is high
humidity or poor air quality. Some good indoor places to walk are a
local shopping centre, apartment hallway, or recreation centre.
 ARTICLES
 References :-
 https://www.med.umich.edu/1libr/CVC/CardiacSurgeryBook/C
hapter6.pdf
 https://www.bmc.org/cardiac-surgery/patient-information/exerc
ise-after-cardiac-surgery
 https://www.physio-pedia.com/Cardiac_Rehabilitation

 https://www.uptodate.com/contents/recovery-after-coronary-art
ery-bypass-graft-surgery-cabg-beyond-the-basics