心肺功能不全的物理治療診斷與治療：L2. Functional Anatomy and Monitoring of the Function of the Cardiovascular System

1、Physiotherapy Diagnosis & Management of Cardiopulmonary DysfunctionLecture 2Functional Anatomy and monitoring of the function of the Cardiovascular SystemMain Objective of this LectureTo appreciate the relationship between:anatomy of the heartfactors that may affect its performance影響因素Effective Pati

2、ent ManagementRequires an Understanding of anatomy of the heartphysiology of the cardiac functionThe heartChambers & Valves Muscles Conducting System Blood Supply Consequences of Pericardial心包 ProblemsFluid in the Pericardial Sacfibrous component of the pericardium compression force on the heart car

3、diac output, blood pressure dyspnoea, tachycardia心動(dòng)過(guò)速Consequences of Pericardial ProblemsInflammation of the Pericardial Sac (Pericarditis心包炎) Pain Pericardial Rub心包摩擦音 ECG Changes Physiotherapy ConsiderationsEmergency- stop physiotherapy treatment Differentiate between pericardial pain and chest pa

4、in (angina) Caution : exercise may further aggravate the inflammation Septal Defects間隔缺損shunts increase ventricular strain心室負(fù)擔(dān)alteration of pulmonary blood flowright ventricular hypertrophyValves of the HeartFactors affecting Cardiac OutputLeft myocardial 心肌 complianceEnd diastolicPressureEnd diasto

5、licVolumeCardiac outputFactors affecting Cardiac OutputVentricular filling心室充盈Cardiac outputVenous Return靜脈回心血量副交感神經(jīng)Nerve Supply of the HeartSympathetic fibres Parasympathetic fibres Via Cardiac Plexus心叢Autonomic Nerve Supply to the HeartInnervation支配 of the Heart after TransplantationNerve supply-

6、abolished徹底消除None or delayed response to heart rate changes No pain fibres to indicate ischaemia (no signs of angina even if ischaemia exists)Factors affecting Coronary Blood Flowdiastolic pressure end diastolic volume right ventricular hypertrophy 右心室肥大vessel lumen size 血管內(nèi)腔大小 risk factors: smoking

7、, hypertension, dietConsequences of Reduced Coronary BloodIschaemia- anginaMyocardial injury心肌損傷 Myocardial infarction梗死 Cardiac enzymes 心肌酶Monitoring of the CVSFunction of the CVSprovide blood supply to active tissuetemperature regulationFactors influencing Cardiac Outputheart rate Contractility收縮力

8、 Factors influencing Arterial Dilatation動(dòng)脈擴(kuò)張Autoregulation自主調(diào)節(jié) vasodilator metabolites血管擴(kuò)張代謝物 vasoactive substances血管活性物質(zhì)Clinical Examination of the CVSarterial pulse blood pressure jugular venous pulseheart sounds Clinical Examination of the CVSArterial pulserate rhythm amplitude 振幅Pulse PointClini

9、cal Examination of the CVSBlood PressureSystolic 收縮壓resistance of arterial wall Diastolic 舒張壓ventricular filling 心室充盈Mean organ perfusion Cardiovascular Fitness Increase maximal oxygen consumption (VO2max) Less effort to perform a similar workloadblood pressure heart rate Regular exercise improves c

10、ardiovascular fitnessthe Role of a CPT Promote & Maintain cardiopulmonary fitness Education- minimize risk factors Prescribe- appropriate exercise and activities Improve and maintain cardiac work efficiencyExpected outcomeImproved functional capacityLower resting heart rate and blood pressureHigher

11、maximal oxygen consumptionEffects of Aging on the CVSDecreased pacemaker cells in the SA node竇房結(jié)atrial fibrillation 心房顫動(dòng)Increase in arterial stiffnessdecrease in elastin彈性蛋白 and increase in collagen fibres膠原纖維Reduction in lumen內(nèi)腔 sizeLess responsive to autonomic stimulation postural hypotension (diz

12、ziness) Increase in arterial wall thicknessArteriosclerosis動(dòng)脈硬化, hypertensionPhysiotherapy Considerationsduring exercise prescription for the elderlydecreased aerobic capacity reduced stroke volume, myocardial contractility, cardiac output atrial fibrillation心房顫動(dòng) / hypertensionDetermine whether the blood supply is sufficient to meet the demandSummaryAnatomy of the ca