Prevention Practice for Cardiopulmonary

Conditions

Arham Shamsi
 Intro
 Cardio pulmonary may be Primary or
Secondary complications resulting from
ineffective Prevention Strategies.
 Heart Diseases, Hypertension, Hyperlipidemia,
Arteriosclerosis, CAD, CHF, PVD, Bronchitis,
Asthma and Emphysema are All conditions
that impair Cardiovascular and Pulmonary
System.
 Changes in Cardiopulmonary System Across
Life
 Cardiopulmonary System Begin to Work as early as 4
Months in Utero and continue to function through out
life span.
 Begins Beaten at 4 Months gestational Age.
 Defect in Heart Structure Arterial or Ventricular
septal Defect can reduce the efficiency of heart and
can Potentially Limits Function in Early Life.
 Typically Respiratory rates and pulse rates Decline As
Child matures in to Adult hood. While BP Rises.
 .
 Aerobic Capacity Begin to Decline Ages, After 25.
Usually Drop between 5% to 10% per Decade
between the ages of 20 to 80 years.

 Decline in VOmax2 can attributed to a decreased in

Maximum Heart Rate with aging and Decreased
Muscle Mass and Decreased Muscle Demands
Requiring Less O2.
 ..
 The Metabolizing Tissue that Contribute to VOmax2
Measurement is Almost Exclusively is Muscle Tissue.
 It Appears That Improving Lung Functional Capacity
and Reserves are Key to Slow down the rate of
VOmax2 Decline.
 Absence of Physical Activity leads to increased risk
of Cardiopulmonary Pathology and Generalized
Deconditioning over life span.
 Screening for Cardiopulmonary Conditions

 Should Be Screened through Client’s Observation

and testing of Vital Signs.
 Positive Finding Warranted Special Attention.
 If an Individual has General Health Problems and is
Not being seen regularly by a Physician , A referral is
Warranted.
 If another Individual has chronic Medical Condition
that is stable under medical care consultation for
prevention program is appropriate.
 .
 If an Individual is in Good General Health and
has NO health Complains, A prevention
Program Should Begin IMMEDIATELY,
through Health Education and Advise on
Appropriate Physical Activity
SCREENING FOR CARDIOPULMONARY
CONDITIONS
SCREENING RESOURCES POSITIVE FINDING
INFORMATION NEEDED
FAMILY SCREENING H/O congenital ,Genetic Heart or Pulmonary
HISTORY FORM
1. Hyper/
conditions.
Hypotension
2. Heart Disease
3. Pulmonary
Disease
4. Life Style
Behaviors
PRIOR HISTORY SCREENING As Above
OF INDIVIDUALS FORM
H/O Cardiac or
Pulmonary Illness
LIFE STYLE SCREENING Smoking, Diet and Exercise Information Detailed
HABBITS FORM FITTE (Frequency, Intensity, Time ,Type &
Enjoyment of Exercises)
 .
SCREENING RESOURCES NEEDED POSITIVE FINDING
INFORMATION
ANTHROPOMENTRIC Check BMI, Check Fat
Body Weight Distribution of Body.
Body Height Including Presence of
Location of Body Fat
Central Obesity
General Health Screening Form , Stetho Note Fatigue, Weakness,
BP, Pulse , RR & Sphygmomanometer Malaise Fever.
Measurement of BP RR
and Pulse (Age /Gender
Related)
Medications Screening Form List of Medication
Nose And Sinus Screening Form Nasal And Sinus
Otoscope Discharge. Frequent
Colds, Changes in Smell
 ..
SCREENING RESOURCES POSITIVE FINDING
INFORMATION NEEDED

Mouth ,Throat & Otoscope & Pain, Lesion, Soreness Altered Taste.
Neck Palpations Neck => Swelling , Limitations,
Lump
Respiratory Screening Form Note Chest Pain, SOB , Cough or
System Auscultation Wheeze

Cardio Vascular Screening Form Pain with or with out Exertion ,

Auscultation dizziness in standing, sleep Apnea

Peripheral Screening Form Coldness ,Numbness ,Tingling and

Auscultation Swelling
Observation Discolored hand or Feet, Varicose
Vein
 .
 Simple and Informative way of assessing
pulmonary System is to Check Respiratory
Rate ,. Watch Chest Expansion rate or
Shoulder Elevation while Client is at rest
provide Baseline Value.
 When there is C/O Wheeze, chest pain,
Shortness of Breath , Cough, Should Receive
Special Attention.
Common Cardio Vascular Pathologies
 HEART DISEASES. (Congenital Heart Disease).
 Abnormal Heart Development Before Birth
 Responsible for more Deaths in First year of Life
than any other Defect.
 Genetic Factors Contributes.
 Prevention Focuses on Maternal Health reducing Risk
associated with Drug use, Alcohol, and Medicine.
 In Adults
 Coronary Artery Disease, Congestive Heart Failure,
Ischemic Heart Disease Rheumatic Heart Disease and
Myocardial Infarction.
 Heart Disease is one of the Primary Preventable Cause of
Death.
 CHEST PAIN Near Heart, Before After or During
Exercise Warrants Special Attention.
 PLEURISY Inflamed Membrane Around Lungs.
 Indigestion May Also present with Chest Pain Cardinal
Sign of Heart Pathology
 .
 ORTHOSTATIC HYPOTENSION , also called postural
hypotension Dizziness with Change of Position from lying to up
right due to Low BP. Sign is Dizziness When Standing Up,
Particularly due to Inadequate Venous Return.

 RHEUMATIC HEART DISEASE Best Prevented through

Infection Control, to reduce Incidence of Rheumatic Fever.
 Primary prevention of acute rheumatic fever (the prevention of
initial attack) is achieved by treatment of acute throat infections
caused by group A streptococcus. This is achieved by up to 10
days of an oral antibiotic (usually penicillin) or a single
intramuscular penicillin injection. 
 Un Modifiable Factors
 Age , Family History
 Hereditary Plays a Major Role in Determining Blood
Lipids Profile and Heart Rate Variability (Two Major
Risk Factors for CAD)

 OTHER RISK FACTORS Diabetes, Obesity, Stress,

Lack of Physical Activity, Lack of Fruit and
Vegetables Consumption
 Symptoms
 Problem with Breathing when Sleeping
 Fatigue
 Racing Heart
 “Winded” After Exercise
 Secondary Prevention
1. Control Weight
2. Eating Low Saturated Fat Diet, Eating Healthy
3. Quitting Smoking
4. Control Diabetes
5. Controlling BP, Cholesterol and Hamocystein
6. Taking Antioxidants
7. Low Dose of Aspirin
8. Engage in Physical Activity
 ARTHROSCLEROSIS

 Loss of Elasticity and Thickness of Arterial Walls,

Arteriosclerotic damage of arterial Endothelium, is
Initiated by Risk Factors like Dyslipidemia,
Hypertension, Diabetes and Smoking
 As Arterial Supply Nourishment to the Body,
Vascular Disease caused by Arteriosclerosis can
Affect all Vital Organs and Ultimately leads to Death.
 .
CAD. (Coronary Artery Disease) Results from Arteriosclerosis
affects Myocardium. Brain and Peripheral System Also
Vulnerable .

ARTHEROSCLEROSIS
Atherosclerosis is Form of Arteriosclerosis is the Commonest
vascular disease. Characterized by deposition of plaque
containing cholesterol and Lipids on the inner most layer of large
and Medium sized arteries. Deposition Narrows the Vessels ,
Leads to Hypertension , and Impaired blood flow.
 Peripheral Vascular Disease

Risk Factors Includes:

 Age + 50
 Diabetes
 Smoking
 High BP
 High Cholesterol
 Symptoms
 Early > Appearance of Extremities , May Appear
Swollen or Discolored, Individual May Complain off
Coldness, Numbness, Tingling ,Pain & usually a
Family History and Evident Spider Veins.
 PVD can be a early warning Sign of Potential Heart
Attack, Stroke or Aneurysm.
 PVD can be treated with Life Style Modification,
Medicine or Both.
 Lifestyle risk factors that can be prevented
and/or changed
 Smoking> Increases Triglycerides damages
arteries, Carbon monoxide in cigarette smoke
replaces some of the oxygen in your blood.
This increases your blood pressure and heart
rate by forcing your heart to work harder to
supply enough oxygen.
 Lack of physical activity - a sedentary lifestyle
 Being overweight
 DIET
 There is some evidence that eating oily fish (herring, sardines,
mackerel, salmon, kippers, pilchards, fresh tuna, etc.) helps to
protect against heart disease. It is probably the omega-3 fatty
acids in the fish oil that help to reduce the build-up of small
fatty lumps called atheroma. Also, fruit and vegetables, as well
as being low in fat, also contain antioxidants and vitamins
which may help to prevent atheroma from building up
 Salt> Adults should eat no more than 5 g of salt a day. Check
labels,  A tip: sodium is usually listed on the food label.
Multiplying the sodium content by 2.5 will give the salt
content. 
 Alcohol Reducing Alcohol can reduce Risk up to 38%
 Common Pulmonary Pathologies
SIDS (Sudden Infant Death Syndrome)
Unexpected death of infant under 1 year of Age. Can be prevented by urging
parents to put their babies to sleep on their BACKS i.e. (SUPINE)

RISK FACTORS
1. Babies who sleep on their Stomach.
2. Soft Bedding in Crib
3. Multiple Births
4. Premature Births
5. Mother who Drug Abuse
6. Teen Mothers
7. Poverty
 .
 Always Put Babies on Their Back to Sleep allowing
Baby to Roll around his tummy to prevent Soft Spot
(PLAGIOCEPHLY)
 Do not put babies on Soft Crib Like SOFA
 Should Not sleep with other babies or Adults But
Should Sleep in Same Room.
 Firm Surface To Sleep on,., Easy to Roll over.
 Sleep with Pacifier.
 Asthma
 A respiratory condition marked by attacks of spasm in the
bronchi of the lungs, causing difficulty in breathing. It is
usually connected to allergic reaction or other forms of
hypersensitivity

 Asthma Triggers > House dust mites, animal dander, molds,

pollen and cockroach droppings. Air Borne Allergens Smoke ,
Cold Dry Air, Intense Emotional Expressions, Endocrine
Factors Menstrual Cycle, thyroid Disease, Medication>
Aspirin, NSAIDS ( AERD)
 Samter’s Tirade.(previously)
 .
 For Children Parents Should be Advised
decrease or Eliminate Triggers of Asthma.
 For Adults Work Place Irritants Need to be
Determined.
 Products
Various Products are available Like
 Specialized Bedding
 Water Filters
 Air Filters
 Mold Control Products
 .
 Use Of Bronchodilators
 Exercise Swimming as it is Less Asthmogenic
 Other exercise may Lead to Fatigue and Dyspnea
 Sleep Apnea
 Common and serious sleep disorder that causes
Cessation of breathing(for 10 or More seconds)
during sleep. The airway repeatedly becomes
blocked, limiting the amount of air that reaches lungs.
Patient may snore loudly or making choking noises as
He tries to breathe.
 brain and body becomes oxygen deprived and Patient
may wake up. This may happen a few times a night,
or in more severe cases, several hundred times a
night.
 ,
 May Be Associated with Irregular Heart Beat, High
BP, Heart Attack and Stroke.
 Individual Complains of Excessive day time sleep,
problems with weight, High BP , Snoring and
Obstruction
 Related Problems May Include Depression, Learning
Difficulties , Falling Asleep During Work or Driving

• SLEEP APNEA CLIENTS ARE USUALLY OBESE

 Prevention
• Reducing the Risk Factors that are causing the
Problem Use of Alcohol, Excessive Weight ,
Smoking and Congestion.
• Avoid Sedatives and Antihistamines that causes
Drowsiness .
• Change Sleep Posture to Side Lying .
• Raise Head Side By 6 inches to reduce
Respiratory Effort.
• Reduce weight and Eating Schedules.
 COPD
1. Chronic Bronchitis
2. Emphysema
3. Asthma
4. Bronchaiectasis
5. Cystic Fibrosis
 (RPD)Restrictive Pulmonary Diseases

1. Pneumonia
2. Pleurisy
3. Pleural effusion
4. Pneumothorax
5. ARDS & Neuro Muscular Diseases
6. Fibrosing alveolitis
 COPD Patterns
Blue Bloated
1. Obese,
2. Mild dyspones,
3. Copious Sputum
4. Low PO2
5. High PCO2
6. Cor Pulmonale
7. Central Cynosis
8. Perepheral Oedema Due to
Na Retention.
9. Increased RV.
Pink Puffer
1. Thin,
2. Anxious
3. Severe Breathlessness
4. No Sputum, Normal PO2 &
PCO2
5. Central cyanosis but No
corpulmonale until late
stage
6. Increased Lung Capacity
due to hyper ventilation.
 PREVENTION
Approximately 75% of COPD cases are attributed to cigarette smoking .
Occupation-related exposures may account for another 15% of COPD cases
and genetic factors, asthma, respiratory infections, and indoor and outdoor
exposures to air pollutants also play a role . Thus, COPD largely can be
prevented. Prevention of COPD begins with reducing and/ or eliminating
smoking initiation among teenagers and young adults and encouraging
tobacco cessation among current smokers. More than 20 million workers in
the United States have been exposed to gases, vapors, fumes, and dusts that
may cause COPD . Public health programs and policies that focus on tobacco-
use prevention and cessation, reducing occupational exposure to dusts and
chemicals, and reducing other indoor and outdoor air pollutants are critically
important. Early treatment and control of asthma may also prevent the
development of COPD.
American Thoracic Society
 STRATEGIES

 1. Conduct assessment of COPD

environmental risk factors in addition to
smoking and occupational exposures.
 2. Assess current health care practices,
including the proper use of spirometer.
 3. Identify specific public health research
needs for COPD prevention.
References

1. Prevention Practice A Physical Therapist’s Guide to Health,

Fitness and Wellness.
By Catherine Rush Thompson
2. Tidy’s Physiotherapy 12th Edition
By Ann Thompson
3.Mayo Clinic
4.www.cdc.gov