1、文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。A PATIENT CASE EXAMPLE文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。1.Why are you here today?2.Have you been diagnosed with a cardiac disorder in the past?3.Have you had any special tests to examine your heart like an electrocardiogram,stress test,echocardiogram,or ca
2、rdiac catheterization?文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。4.Do you experience angina or shortness of breath at rest,only with activity/exercise,or both at rest and with activity/exercise?文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。5.If you experience angina or become short of breath during activity or
3、 exercise could you please describe the type of activity or exercise which produces your angina or shortness of breath?文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。6.Can you describe your angina or shortness of breath?Can you help me understand your angina or shortness of breath by pointing to the numbers
4、 1 through 4 to describe the level of angina you experience at rest and exercise or by pointing to your level of shortness of breath using this 10-point scale or by marking this visual analog scale?文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。7.Could I feel your pulse to determine your heart rate and the
5、strength of your pulse?8.Could I place this finger probe on your index finger to obtain an oxygen saturation measurement?文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。9.Could I place these electrodes on your chest to obtain a simple single-lead electrocardiogram(ECG)?文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。
6、10.Could I take your blood pressure while you are seated and then compare it to the blood pressure while you are lying down and then standing?I would also like to observe your pulse,oxygen saturation,ECG,and symptoms when you are lying down and standing.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。11.Coul
7、d I listen to your heart and lungs with my stethoscope?While I do this I will concentrate on watching your ECG so that I can identify your heart sounds and any changes in the ECG while you are breathing deeply when listening to your lungs.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。12.Could I place 1 of
8、my hands on your stomach and 1 hand on your upper chest to determine how you breathe?13.Could I place my hands on the lowermost ribs on each side of your chest to determine how you breathe?14.Could I place my hands on your back to determine how you breathe?15.Could I wrap my tape measure around your
9、 chest at several different sites to determine how you breathe?文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。16.Now that I understand some very basic information about the manner in which you breathe could you please breathe in the manner I instruct you via sounds I make,pressure from my hands,methods I sh
10、ow to you,or different body positions?I will occasionally place my hands on your chest and wrap my tape measure around your chest to determine how you breathe during these simple tests and I will ask you to identify your level of shortness of breath using the 10-point scale or visual analog scaleIs
11、this ok with you?文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。17.Could I measure the strength of your breathing muscle by having you place this mouthpiece in your mouth and breathe in and out as deeply and as forcefully as you are able?文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。18.I would like you to now perf
12、orm the activity or exercise which produces your angina or shortness of breath.Could you please do this now?文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Thank you for giving me the chance to examine you today.I will call your physician to get some more information about you like electrocardiogram,echocard
13、iogram and pulmonary function tests that you said were performed last week as well as the arterial blood gas results,chest X-ray,and exercise test results.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Physical Therapy Examination Medical Information and Risk Factor Analysis listening to the patients past h
14、istory and primary complaints is critical in the examination process.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Examinations of Patient Appearance categorized by specific signs and symptoms 文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Angina-Methods To Evaluate Angina from Nonanginal Pain If a suspected angin
15、al pain changes(increases or decreases)with breathing,palpation in the painful area,or movement of a joint(ie,shoulder flexion and abduction)it is very likely that the pain is NOT angina.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Angina-Methods To Evaluate Angina from Nonanginal Pain it can be worsened
16、by physical exercise or activity.Therefore,if the suspected anginal pain is unchanged with the previously cited maneuvers and the pain occurred with exertion,it is SUSPECT for angina.If the suspected anginal pain is unchanged by these maneuvers,if the pain occurred with exertion,and if the pain decr
17、eases or subsides with rest,it is very likely that the pain IS angina.Finally,if the suspected pain decreases or subsides with nitroglycerin,it is even more likely that the pain IS angina.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Other Symptoms of Heart Disease dy
18、spnea Fatigue Dizziness Light headedness Palpitations a sense of impending doom 文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Examinations of Patient Appearance skin color of the peripheral extremities.Pale or cyanotic skin in the legs,feet,arms,and fingers is associa
19、ted with poor cardiovascular function.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Examinations of Patient Appearance Diagonal earlobe crease.This phenomenon has been investigated for many years and recently was once again found to be highly predictive of heart disease 文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人
20、删除。Anthropometric measurements body weight finger pressure on an edematous area Girth measurements skin-fold caliper measurements calculation of the body mass index measure the percentage of body fat and lean muscle mass文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Jugular venous distension it is often due
21、 to right-sided heart failure.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Palpation of the Radial Pulse Palpation of the radial pulse can provide important information about the status of the cardiovascular system.Measurement o
22、f the Systolic Blood Pressure and Pulse During Breathing and Simple Perturbations of the Breathing Cycle文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Measurement of the Systolic and Diastolic Blood Pressure and Pulse in Different Body Positions文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。To Determine the Status
23、of the Cardiovascular System observation of a decrease in systolic and diastolic blood pressure without a subsequent increase in heart rate when changing body position from supine to standing is considered a positive sign for autonomic nervous system dysfunction.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删
24、除。To Determine theHealth of the Cardiovascular System A cardiovascular system that responds rapidly to body position change is likely in a better state of health than a cardiovascular system that responds sluggishly.Both an unchanged or decreased heart rate after standing for 30 seconds(compared to
25、the heart rate at 15 seconds)is suggestive of autonomic dysfunction.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。a sluggish or hypoadaptive(less than normal)heart rate and blood pressure response during a change in body position supine to standing should be considered abnormal and suggestive of an unhealt
26、hy cardiovascular system.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。a more adaptive rapid increase in heart rate and blood pressure after moving from a supine to standing position(approximately 30 seconds)is likely associated with a healthier cardiovascular system文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。E
27、xamination of the Pulse and Arterial Blood PressureDuring Functional Tasks and Exercise Frequent monitoring of the heart rate and blood pressure may be the best way to examine the safety of exercise and help to establish guidelines and procedures for functional or exercise training.文档仅供参考，不能作为科学依据，请
28、勿模仿；如有不当之处，请联系网站或本人删除。an increase in the diastolic blood pressure when the diastolic blood pressure should be decreased(or low)is a strong indicator of cardiovascular dysfunction.文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Potential indirect measures of cardiac function Symptoms and functional classifica
29、tion Cold,pale,and possibly cyanotic extremities Jugular venous distension and peripheral edema Heart sounds Pulse Electrocardiography Blood pressure文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Standard measurement of cardiac function Cardiac catheterization Echocardiography Swan-Gans catheterization Cent
30、ral venous pressure Cardiac enzymes ANP and BNP Radiologic evidence文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Exercise Testing文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Indications for Exercise Testing:Diagnosis of Coronary Artery Disease Assessment of Prognosis in Coronary Artery Disease Evaluation of Func
31、tional Capacity Evaluation of Therapy for Coronary Disease Determination of Exercise Prescription文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Absolute Contraindications to Exercise Testing Acute MI(within 2 days)High-risk unstable angina Uncontrolled cardiac arrhythmias Active Endocarditis Severe aortic s
32、tenosis Decompensated heart failure Acute pulmonary embolus or infarction,DVT Acute noncardiac disorder affecting or aggravated by exercise Acute myocarditis,pericarditis Physical disability precludes safe and adequate test Inability to obtain consent文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Relative C
33、ontraindications to Exercise Testing Left main coronary stenosis or equivalent Moderate aortic valvular stenosis(?)Electrolyte disorder Tachyarrhythmias or Bradyarrhythmias Atrial fibrillation with uncontrolled ventricular response Hypertrophic Cardiomyopathy(?gradient)Mental impairment leading to i
34、nability to cooperate High-degree AV block文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。ECG Lead Placement for Exercise Testing文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Protocols for Exercise Testing文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Blood Pressure Responses:Exercise Testing Dependency on cardiac output a
35、nd peripheral resistance Normal responses:Increase in SBP(20-30 mmHg)No change or fall in DBP Inadequate rise in SBP:Myocardial ischemia,severe LV systolic dysfunction,aortic or LVOT obstruction,drug therapy(-blockers)Exercise-Induced Hypotension(10 mmHg below baseline)Severe myocardial ischemia(50%
36、positive predictive value for left main or 3-vessel disease),valvular heart disease,cardiomyopathy no evidence of clinically significant heart disease(dehydration,antihypertensive therapy,prolonged strenuous exercise)文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Heart Rate Response to Exercise Testing Acce
37、lerated Heart Rate Response:Deconditioning,prolonged bed rest,anemia,metabolic disorders,conditions associated with decreased blood volume or low systemic vascular resistance,autonomic insufficency Chronotropic incompetence:Inadequate exercise effort,drug therapy(-blockers),Prognostic Significance:(
38、Peak HR-Resting HR)/(220-age-Resting HR)0.80(Lauer,1999)Peak HR 1.0 mm)in leads without Q-waves(other than V1 or aVR)Drop in systolic blood pressure 10 mmHg(persistently below baseline)despite an increase in workload,when accompanied by any other evidence of ischemia Moderate to severe angina(grades
39、 3-4)Central nervous system symptoms(ataxia,dizziness,near syncope)Signs of poor perfusion(cyanosis or pallor)Sustained ventricular tachycardia Technical difficulties monitoring the ECG or systolic BP Patients request to stop文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Relative Indications for Termination
40、 of an Exercise Test ST changes(horizontal or downsloping 2 mm)or marked axis shift Drop in systolic blood pressure 10 mmHg(persistently below baseline)despite an increase in workload,in the absence of other evidence of ischemia and no presyncopal symptoms Increasing chest pain Fatigue,shortness of
41、breath,wheezing,leg cramps,or claudication Hypertensive response(SBP 250 mmHg and/or DBP 115 mmHg)Development of bundle-branch block(LBBB)that cannot be distinguished from ventricular tachycardia;?Evidence of anterior ischemia Arrhythmias other than sustained ventricular tachycardia(frequent multifo
42、cal PVCs,ventricular triplets,SVT,heart block,or bradyarrhythmias)General Appearance(diaphoresis,peripheral cyanosis)文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Criteria for Reading ST-Segment Changes on the Exercise ECGST DEPRESSION:Measurements made on 3 consecutive ECG complexes!ST level is measured r
43、elative to the P-Q junction 3 key measurements(P-Q junction,J-point,60-80msec after J-point-use 60 msec for HR 130 bpm When J-point is depressed relative to P-Q junction at baseline:Net difference from the J junction determines the amount of deviation When the J-point is elevated relative to P-Q jun
44、ction at baseline and becomes depressed with exercise:Magnitude of ST depression is determined from the P-Q junction and not the resting J point文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Criteria for Reading ST-Segment Changes on the Exercise ECG ST ELEVATION:60 msec after J point in 3 consecutive ECG c
45、omplexes文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Criteria for Abnormal and Borderline ST-Segment Depression on the Exercise ECG ABNORMAL:1.0 mm or greater horizontal or downsloping ST depression at 60 msec after J point on 3 consecutive ECG complexes BORDERLINE:0.5 to 1.0 mm horizontal or downsloping
46、ST depression at 60 msec after J point on 3 consecutive ECG complexes 2.0 mm or greater upsloping ST depression at 60 msec after J point on 3 consecutive ECG complexes文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Morphology of ST-Segment Deviation during Exercise Testing文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人
47、删除。Value of Right-Sided ECG Leads during Exercise Testing for the Diagnosis of CAD文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Horizontal ST-segment Depression during Exercise Testing文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Downsloping ST-Segment Depression during Exercise Testing文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处
48、，请联系网站或本人删除。ST-Segment Depression in Early Recovery Period after Exercise Testing文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Upsloping ST-Segment Depression during Exercise Testing文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Morphology of ST-Segment Depression Predicts Severity of Coronary Artery Disease(Golds
49、chlager,1976)文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Exercise-Induced ST-Segment Elevation with Prior Anterior Myocardial Infarction文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Exercise-Induced ST-Segment Elevation in the Setting of Prior Inferolateral MI文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Exercise-Indu
50、ced Anterior ST-Segment Elevation as Reflection of LAD Ischemia文档仅供参考，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Indications for Exercise Testing in the Diagnosis of Obstructive Coronary Disease CLASS I:Adult patients(including those with RBBB or less than 1 mm or resting ST-depression)with an intermediate pre
