心肺功能不全的物理治疗诊断与治疗：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影响因素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心动过速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间隔缺损shunts increase ventricular strain心室负担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静脉回心血量副交感神经Nerve Supply of the HeartSympathetic fibres Parasympathetic fibres Via Cardiac Plexus心丛Autonomic Nerve Supply to the HeartInnervation支配 of the Heart after TransplantationNerve supply-

6、abolished彻底消除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 血管内腔大小 risk factors: smoking

7、, hypertension, dietConsequences of Reduced Coronary BloodIschaemia- anginaMyocardial injury心肌损伤 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收缩力

8、 Factors influencing Arterial Dilatation动脉扩张Autoregulation自主调节 vasodilator metabolites血管扩张代谢物 vasoactive substances血管活性物质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 收缩压resistance of arterial wall Diastolic 舒张压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窦房结atrial fibrillation 心房颤动Increase in arterial stiffnessdecrease in elastin弹性蛋白 and increase in collagen fibres胶原纤维Reduction in lumen内腔 sizeLess responsive to autonomic stimulation postural hypotension (diz

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