Bolivarian Republic of Venezuela Ministry of Popular Power for Education.

Francisco de Miranda National Experimental University.

Program: Physiotherapy

Subject: Assessment and Diagnosis III

Course: 3rd year

Made by: Albert Gallardo Cl:25.986.991

Physiotherapeutic evaluation of the cardiovascular system.

Anamnesis: When the physiotherapist performs the respective anamnesis on the patient, he

asks the person in question to explain the "story" of what is happening to them. The

physiotherapist first asks about the symptoms. The presence of chest pain , shortness of

breath, awareness of a rapid or irregular heartbeat (palpitations) , fainting, dizziness or

lightheadedness , and swelling (edema) of the legs, ankles, feet, or abdomen suggest the

possibility of a heart disorder.

The presence of other more general symptoms, such as fever, weakness, tiredness, loss of

appetite, and a feeling of illness or general malaise (unwell), may suggest the existence of a

heart disorder. If pain, tingling, or muscle cramps occur in one leg , peripheral arterial

disease may affect the arteries in the arms, legs, and trunk (except those that supply the

heart). Next, the physiotherapist asks about:

• History of cardiovascular disease, hypertension, diabetes or cholesterol

high

• If the person is sedentary or active

• Symptoms that appear during effort or exercise and are relieved with rest
 • Consumption of pharmaceuticals, over-the-counter naturopathic products, drugs,
alcohol and tobacco

• Family history of cardiovascular disorders

Physical examination: During the physical examination, the physical therapist observes the

following aspects of the person.

• Weight and general appearance

• Vital signs (such as temperature, respiratory rate, and blood pressure)

• Eyes

• Veins in the neck

• Sounds in the heart and lungs

• Pulses

• Legs and ankles to look for any signs of inflammation

• Fur

The Physiotherapist looks for signs of paleness, sweating or dizziness, which can be subtle

indicators of cardiac disorders. The mood and sense of well-being of the person in question

should also be recorded, which can also be affected when suffering from a heart condition.

The color of the skin is assessed since paleness or a bluish or purple color (cyanosis) may

indicate a low level of red blood cells (anemia) or poor blood circulation. These signs

indicate that the skin receives an insufficient amount of oxygen through the blood due to a

lung disorder, heart failure , or other circulatory problems.

The pulse should be taken in the arteries in the neck, under the arms, at the elbows and

wrists, in the abdomen, in the groin, behind the knees, at the ankles and in the feet in order

to assess whether the flow Circulatory system is adequate and symmetrical on both sides of

the body. An abnormality may suggest the presence of a cardiovascular disorder.

The neck veins should be examined with the person lying down with the upper body

elevated to a 45° angle. These veins are examined because they are connected directly to the

right atrium (the upper chamber of the heart that receives oxygen-poor blood from the

body), so they indicate the volume and pressure of blood as it enters the right side of the

heart. heart.

The physical therapist checks for swelling (edema) caused by fluid buildup in the tissues

under the skin by pressing on the skin in the ankles and legs and sometimes in the lower

back.

The chest is examined to determine if the respiratory rate and movements are normal. By

tapping (percussion) on the chest with the fingers, the physical therapist can determine

whether the lungs are full of air, which is normal, or whether they contain fluid, which is not

normal. Percussion also helps determine whether the membrane that surrounds the heart

(pericardium) or the layers of membranes that line the lungs (pleura) contain fluid.

Respiratory sounds are heard using a stethoscope. The presence of fine crackling sounds

suggests the existence of fluid in the lungs caused by heart failure.

The Physiotherapist also palpates the abdomen to determine if the liver is enlarged. Liver

growth may indicate that there is a buildup of blood in the major veins leading to the heart.

Swelling of the abdomen due to fluid buildup may indicate heart failure. By gently pressing

on the abdomen, the doctor examines the pulse and determines the amplitude of the

abdominal aorta.
Auscultation: heart sounds

Auscultation of the heart requires excellent hearing and the ability to distinguish subtle

differences in pitch and duration. Doctors with hearing problems can use stethoscopes with

amplification. High-pitched sounds are best heard with the diaphragm of the stethoscope.

Low-pitched sounds are heard better with the bell. Very little pressure should be applied

when using the hood. The excess pressure turns the underlying skin into a diaphragm and

eliminates very low-pitched sounds.

The entire precordium should be examined systematically from the site over which the tip

impingement is heard with the patient in the left lateral decubitus position. The patient

should then rotate to the supine position and auscultation should continue at the lower left

sternal border, proceed cephalad to auscultate each intercostal space, and then caudally from

the upper right sternal border. The doctor should also listen over the left armpit and above

the collarbones. The patient should then sit upright to auscultate the back, then lean forward

to assist in auscultation of aortic and pulmonary diastolic murmurs or pericardial rubs.

The main findings on auscultation are

• heart sounds

• Murmurs

• friction

Heart sounds are brief, transient sounds produced by the opening and closing of the valves;

They are divided into systolic and diastolic.

The systolic sounds are the following:

• First heart sound (S 1 )

• Clicks
The S 1 and second heart sounds (S 2 , diastolic) are normal components of the cardiac cycle

and are often expressed as “lub-dub.”

S 1 is heard just after the onset of systole and is primarily due to mitral valve closure,

although it may also include components of tricuspid valve closure. Sometimes it is heard

split and has a high pitch. S 1 is more intense in mitral stenosis. It may be soft or absent in

mitral regurgitation due to sclerosis and stiffness of the mitral valve leaflet, but is often

clearly audible in mitral regurgitation due to myxomatous degeneration of the mitral

apparatus or ventricular anomalies of the myocardium (eg. e.g., papillary muscle

dysfunction, ventricular dilation).

Clicks are only heard during systole and are distinguished from S 1 and S 2 by their high

pitch and shorter duration. Some clicks appear at different times during systole due to

changes in hemodynamic parameters. The clicks can be solitary or multiple.

The clicking sounds produced by congenital aortic or pulmonary stenosis are believed to be

due to abnormal stress on the ventricular wall. These clicks are identified at the beginning of

systole (very close to S 1 ) and are not modified by changes in hemodynamic parameters.

Similar clicks are identified in severe pulmonary hypertension. The clicks of mitral or

tricuspid valve prolapse, generally mid-systolic or end-systolic, are due to abnormal tension

on the chordae tendineae or redundant and elongated leaflets.

Clicks caused by myxomatous degeneration of the valves can occur at any time during

systole, but approach S 1 during maneuvers that temporarily decrease ventricular filling

volume (e.g. e.g., standing position, Valsalva maneuver). If ventricular filling volume

increases (e.g. (e.g., in the supine position), the clicks are closer to S 2 , particularly in

patients with mitral valve prolapse. Due to unknown causes, the characteristics of clicks can

vary significantly between exams and clicks may come and go.
The heart sounds are as follows:

• Second, third and fourth heart sounds (S 2 , S 3 and S 4 )

• Diastolic shocks

Noises produced by the mitral valve

Unlike systolic sounds, diastolic sounds are low-pitched, less intense and longer. Except for

S 2 , these sounds are usually abnormal in adults, although an S 3 may be physiological up to

age 40 and during pregnancy. S 2 appears at the beginning of diastole and is the result of the

closure of the aortic and pulmonary valves. Under normal conditions, the closure of the

aortic valve precedes that of the pulmonary valve, unless the former is delayed or the latter

is brought forward. Closure of the aortic valve is delayed in left bundle branch block or

aortic stenosis, and closure of the pulmonary valve is advanced in some varieties of the pre-

excitation phenomenon. Delayed closure of the pulmonary valve may result from increased

blood flow through the right ventricle or complete blockage of the right bundle branch. The

increased flow in the right ventricle caused by an atrial septal defect also eliminates the

normal respiratory variation associated with closure of the aortic and pulmonary valves and

produces a fixed splitting of the S 2 . Left-to-right shunts with normal flow in the right

ventricle (eg. e.g., in membranous interventricular communications) do not cause splitting

of sounds. A single S 2 may be identified in patients with aortic insufficiency, severe aortic

stenosis, or aortic atresia (in the truncus arteriosus with shared valve).

S 3 manifests at the beginning of diastole in patients with a non-compliant dilated ventricle.

It occurs during the passive ventricular filling phase in diastole and usually indicates severe

ventricular dysfunction in adults; in children, it can be normal, sometimes it persists even up

to age 40 S 3 can also be normal during pregnancy. The S 3 of the right ventricle is best

heard (and sometimes only) during inspiration (because negative intrathoracic pressure
increases the filling volume of the right ventricle) with the patient supine. The S 3 of the left

ventricle is best heard during expiration (because the heart is closer to the chest wall) with

the patient in the left lateral decubitus position.

S 4 represents an increase in ventricular filling caused by atrial contraction near the end of

diastole. The noise is similar to S 3 and is heard best or exclusively with the bell of the

stethoscope. During inspiration, the S 4 of the right ventricle increases and the S 4 of the left

ventricle decreases. S 4 is heard much more frequently than S 3 and reflects a lower degree

of ventricular dysfunction, generally diastolic. S 4 is absent in patients with atrial fibrillation

(because the atria do not contract), but is almost always identified in active myocardial

ischemia or shortly after myocardial infarction.

53, with or without S 4 , it is usually heard in significant systolic dysfunction of the left

ventricle; S 4 without S 3 is common in left ventricular diastolic dysfunction.

Vital signs

• body temperature;

• the pulse;

• respiratory rate (rhythm respiratory);

• blood pressure (although notHE considersto blood pressure as a sign

(usually monitored along with vital signs).

What is body temperature?

Normal body temperature varies depending on sex, recent activity, food and fluid

consumption, time of day, and, in women, the stage of the menstrual cycle.

Normal body temperature can vary between 97.8°F (Fahrenheit) equivalent to 36.5°C

(Celsius) and 99°F equivalent to 37.2°C in a healthy adult. A person's body temperature
 can be measured in any of the following ways:

• In the mouth. The temperature can be taken in the mouth with a classic thermometer or

with a digital thermometer that uses an electronic probe to measure body temperature.

• In the rectum. The temperature taken rectally (with a glass or digital thermometer) tends
to be 0.5 to 0.7°F higher than when taken orally.

• In the armpit. The temperature can be taken under the arm with a glass or digital

thermometer. The temperature taken in this zone is usually 0.3 to 0.4°F lower than that
taken orally.

• In the ear. A special thermometer can quickly measure the temperature of the eardrum to

reflect the body's core temperature (the temperature of internal organs).

• On the skin. A special thermometer can quickly measure the temperature of the forehead
skin.

What is pulse?

Pulse is a measurement of heart rate, that is, the number of times the heart beats per

minute. As the heart pushes blood through the arteries, the arteries expand and contract

with the blood flow. Taking your pulse not only measures your heart rate, but can also

indicate:

heart rate

Pulse strength: The normal pulse rate of healthy adults ranges between 60 and 100

beats per minute. The pulse can fluctuate and increase with exercise, illness, injury, and

emotion. Women over 12 years of age, in general, tend to have a faster pulse than men.

Athletes, such as runners, who practice a lot of cardiovascular exercise, can have heart

rates of up to 40 beats per minute without presenting problems of any kind.

 How to take your pulse

When the heart pushes blood through the arteries, you will notice its beats pressing

firmly on the arteries, which are located near the surface of the skin in certain places on

the body. The pulse can be felt on the side of the neck, on the inside of the elbow, or on

the wrist. For most people, the easiest thing to do is take your pulse on your wrist. If you

use the lower part of the neck, be sure not to press too hard and never press on both sides

of the neck at the same time so as not to block blood flow to the brain. When taking your

pulse:

• With the pads of your index and middle fingers, press gently but firmly on the arteries
until you feel a pulse;

• start counting heartbeats when the second hand on the watch shows 12;

• count your pulse for 60 seconds (or for 15 seconds and then multiply by four to calculate
beats per minute);

• When counting, do not look at the watch continuously, but rather concentrate on the
heart rate;

• If you are unsure of the results, ask someone else to count for you.

If your doctor has told you to check your pulse and you are having trouble finding it,

consult your doctor or nurse for additional instructions.

What is respiratory rate?

Respiratory rate is the number of breaths a person takes per minute. Rate is usually

measured when a person is at rest and simply involves counting the number of breaths

for one minute each time the chest rises. Respiratory rate may increase with fever,

illness, and other medical conditions. When measuring respirations, it is important to

also consider whether the person is having difficulty breathing.

The normal respiratory rate for an adult at rest is between 12 and 16 breaths per minute.
 What is blood pressure?

Blood pressure, measured with a blood pressure monitor and stethoscope by a nurse or

other health care provider, is the force of blood against the walls of your arteries. Every

time the heart beats, it pumps blood into the arteries, resulting in higher blood pressure

as the heart contracts. You cannot take your own blood pressure unless you use an

electronic blood pressure monitor. Electronic blood pressure monitors can also measure

heart rate or pulse.

When blood pressure is measured, two numbers are recorded. The highest number,

systolic pressure, is the pressure inside the artery when the heart contracts and pumps

blood through the body; while the lowest number, diastolic pressure, is the pressure

inside the artery when the heart is at rest and filling with blood. Both systolic and

diastolic pressure are recorded in "mm Hg" (millimeters of mercury). This recording

represents how high the blood pressure raises the column of mercury in an old blood

pressure monitor (such as a mercury manometer or sphygmomanometer). Today, your

doctor's office is more likely to be equipped with a simple blood pressure monitor for

this measurement.

High blood pressure, or hypertension, directly increases the risk of coronary heart

disease (heart attacks) and strokes (cerebrovascular attacks). With elevated blood

pressure, the arteries may have greater resistance against blood flow, forcing the heart to

pump harder.

According to the National Heart, Lung, and Blood Institute ("NHLBI") of the National

Institutes of Health, hypertension in adults is defined as follows:

• Systolic pressure of 140 mm Hg or more

 either

• Diastolic pressure of 90 mm Hg or more

A 2003 update to the NHLBI hypertension guidelines added a new blood pressure

category called prehypertension.

• Systolic pressure 120 mm Hg to 139 mm Hg

either

• Diastolic pressure 80 mm Hg to 89 mm Hg

The NHLBI guidelines now define normal blood pressure as follows:

manner:

• Systolic pressure less than 120 mm Hg

and

• Diastolic pressure less than 80 mm Hg

Arterial gases: values, levels, importance

Arterial gases are obtained from an arterial blood sample and basically allow us to know

about the patient:

Oxygenation and carbon dioxide level

The acid base state

Values:
 NORMAL VALUES OF ARTERIAL OASES AND THEIR DEFINITION^
Normal blood gases Definition
The pH determines the acidity or alkalinity of the blood in
pH 7.35 - 7.45 relation to the Hydrogen ion (H*)
Indicates the partial pressure of carbon dioxide in the
blood. It is regulated by the lung. It provides to measure
PaCO, 35 - 45 mmHg the existence of a respiratory acid-base imbalance.

Indicates the partial pressure of oxygen in the blood.

PaO, 80- 100 mmHg (Consider age)

SW, 95 % -100 % It indicates how much hemoglobin is saturated with

oxygen.
Bicarbonate levels. It is regulated by the kidney. Helps
HCO, 22 - 26 mEq/L determine metabolic acid-base imbalances

Levels:

Whenever the interpretation of arterial gases is performed, it is necessary to have at least

the levels of the following electrolytes.

Na+, CI-, K+ and ideally also with the serum albumin level.

Importance:

Its importance lies in the fact that thanks to arterial gases it is possible to carry out an

objective assessment of the patient's respiratory function and acid-base balance.

Electrocardiography: theoretical foundations, characteristics, modalities and

interpretation

The electrocardiogram is a recording that reflects the electrical activity of the heart,

carried out with the help of a device known as an electrocardiograph. The

electrocardiograph is a device designed to show the direction and magnitude of electrical

currents produced by the heart. Because current flows in multiple directions of the heart

muscle, this device obtains the result of all the vectors that are generated at a given

moment by using electrodes (electrical contacts) placed in different parts of the body on

the skin.

Characteristics:

The usual electrocardiogram consists of 5 waves: P, Q, R, S and T. Some authors prefer

to call slow-course graphoelements waves: P and T, calling fast-course phenomena

deflection: Q, R and S

P wave: It is the first wave of the electrocardiogram. It represents atrial depolarization.

It normally measures 0.06 s to 0.10 s in width and 0.5 mm to 2.5 mm in height. This

wave is positive in all leads except VR and is occasionally flattened or downright

negative in D3. In the precordial lead V1 it can be biphasic

PR or PQ Space The length of the PR or PQ space fluctuates between 0.12 and 0.20 s,

it also encompasses the course of this excitation through the specific muscular system of

the ventricular myocardium itself.

QRS ventricular complex It is formed by the succession of 3 rapid waves, which

represent the depolarization of the ventricular myocardium. It normally measures 0.06 s

to 0.08 s. Below these values no disturbances are described. Its width and voltage can

increase.
ST Segment This segment, together with the T wave, represents the forces originated in

the process of recovery or ventricular repolarization. For pedagogical purposes, we will

study them separately, although the existence of an ST-T complex must really be

considered. It has already been said that the ST segment would correspond to the period

between depolarization and repolarization. For this reason, it must theoretically be

isoelectric, since at that moment no action current should flow as the muscle fiber is

completely depolarized.

T WAVE The T wave, together with the ST segment, integrates the graphoelements of

the ventricular recovery or repolarization process. It represents the same path taken by

the depolarization wave that generated the ventricular QRS complex, but it has 2

elements that differentiate both phenomena. It has a width of 0.10 s to 0.25 s

QT space It includes from the beginning of the ventricular complex (Q wave) to the end

of the T wave. It measures approximately 0.36 s, on average, in normal people with a

normal heart rate.

TP space It is the sector of the electrocardiogram between the end of the T wave of a

cardiac cycle and the beginning of the P wave of the following cycle.

POINT J It is the place of union of the processes of ventricular depolarization and

repolarization. It is located at the point marked by the final portion of the S wave and the

beginning of the STT complex. This point should be isoelectric, but we have seen that

all physiological variations of the ST segment shift it.

U WAVE It is the 6th. electrocardiogram wave which, we repeat, is not constant and

rather infrequent. Its duration is 0.16 s to 0.24 s; It has a positive direction, although it

can be negative, because in reality it owes its orientation to the direction of the T wave

on which it shows a great dependence. Its origin is not well established, although it is

assumed that it corresponds to the late activation of some sectors of the ventricular
myocardium.

Electrocardiography modalities:

• Conventional.
• Intracavitary electrogram (EEF, pacemaker).

• High resolution ECG.

• Monitoring/telemetry.

• Cardioversion/defibrillation.

• Stress ECG.

• Holter.

• Implantable Holter

• Event recorder.

Interpretation:
4. ECG INTERPRETATION
4.1. ECG WAVES AND INTERVALS
CHARACTERISTICS OF SINUS RHYTHM:
□ 60-100 beats per minute
□ P wave before the QRS complex
□ PR interval should be normal and constant (0.12-0.20 sec)
□ P wave morphology should be normal
□ The RR interval must be equal; If it is irregular, it is called an
irregular rhythm.

► Basic interpretation of the ECG

 4. INTERPRETATION OF THE
ECGECG WAVES AND INTERVALS
4.1.
□ P wave ) Atrium depolarization
• <0.25mV (<2.5mm)
• Duration 0.07-0.11 sec (2-3 mm)
• Rounded, symmetrical
• It is best seen in lead II
• It has to precede the QR complex

• QRS complex >

Ventricle depolarization
• < 3.5mV (30mm)
• Duration 0.06-0.1 see (1.5-2.5mm)
• Narrow, peaked
• More size because the ventricle has more mass than the atrium or Q wave:
It is negative. Duration < 0.04 see.
o R wave: It is larger
o S wave: It is any negative wave that follows the R wave.
► Basic interpretation of the ECG

4. ECG INTERPRETATION
□ T wave ) Ventricle repolarization
• < 0.5mV (< 5mm)
• Duration 0.2 see (5 mm)
• positive wave
• Negative Disease symptom (except in
aVR)

• U wave Uncertain meaning Repolarization papillary muscles or Purkinje fibers

• 0.1-0.2mV (0.3-2mm)
• Very small
• Positive
• Appears just after the T wave and before the P wave
• It is not always present. It is best seen in V3 or V4

► Basic interpretation of the ECG

 4. INTERPRETATION OF THE
□ ECG
PR interval Propagation of the stimulus from its formation in the SA node until
the beginning of ventricular activation.
• Duration 0.12-0.2 sec (3-5 mm)

□ QT interval -> Ventricular depolarization and repolarization

• Duration 0.30- 0.44 see (7-11 mm)

► Basic interpretation of the ECG

4. INTERPRETATION OF THE
ECG
□ PR segment End of atrial depolarization at the beginning of ventricular
depolarization
• Not used in clinical practice

□ ST segment Represents a
period of inactivity between I
ventricular depolarization and the
beginning of ventricular
repolarization.
• Important in the diagnosis of
myocardial lesions

► Basic interpretation of the ECG

 4. INTERPRETATION OF THE
ECG
4.2. HEART RATE
□ REGULAR RHYTHM. METHOD 1
■ Look for R wave that coincides with thick vertical line.
• Mark the following thick lines with the values 300, 150, 100, 75, 60.50
respectively.
• Look for the next thick line (R wave) and estimate HR (normal

► Basic interpretation of the ECG

4. INTERPRETATION OF THE ECG

4.2. HEART RATE
□ REGULAR RHYTHM. METHOD 2
■ Frequency= 1500/ RR interval (small boxes)

Normal HR 60-100
(15-25 frames
little ones)

HR: 1500/15= 100 beats/min

► Basic interpretation of the ECG
4.2. HEART RATE
□ IRREGULAR RHYTHM Different RR intervals
 4. INTERPRETATION OF THE
ECG
• Count the number of R waves in 30 large squares and
multiply the number by 10 to obtain an approximate heart
rate per minute

HR=6 R waves x 10= 60 beats/min

► Basic interpretation of the ECG

Stress testing: mechanics and evolutionary processes.

The stress test, also known as ergometry, consists of an examination of physical

resistance through various exercises that serve to assess the prognosis of a heart disease

under study or already diagnosed.

This technique is used to detect angina pectoris or a coronary condition in patients

suffering from chest pain and, in this way, assess the heart's response to effort through

an electrocardiogram and the determination of other parameters.

The main rationale for this test is to reveal pathologies that do not present symptoms

when the patient is at rest, but that become symptomatic when performing physical

exercise.
In these cases, if a patient has coronary heart disease, the obstruction in the arteries is

not enough to cut off all blood flow when at rest, but when performing physical effort,

the amount of blood needed is greater and, therefore, Therefore, it becomes insufficient.

The result is the appearance of angina pectoris that translates into alterations in the

electrocardiogram.

The 6-minute walk test has proven to be a very useful tool in the functional evaluation

of patients with chronic respiratory diseases, including patients with pulmonary

hypertension. For its correct interpretation and clinical use in patient monitoring, it is

essential to standardize the technique.

Aim

Carrying out the PC6min has the main goal of carrying out an objective evaluation of

the functional capacity to exercise, which goes beyond the traditional question about

how many blocks you walk or how many floors you climb on a staircase, which has

very subjective answers.

It should be performed in patients with moderate or severe exercise limitation, whether

due to respiratory or cardiac causes, and is not a substitute but a complement to the

cardiopulmonary test, since it cannot differentiate the causes that cause dyspnea as the

latter does.

Indications

The clearest indication is related to the measurement of response to medical

interventions in patients with moderate to advanced heart or lung disease. It has also

been used as a unique measurement of the patient's functional status, as well as a

predictor of death and morbidity.

 Table 1. Indications for the 6-minute walk test in clinical practice and its degree
recommendation 11

Indication Recommendation*

Diagnosis of arterial desaturation with exercise b

Functional evaluation of patients with COPD, EPD. PPH and CHF b
Prognostic evaluation of patients with COPD, EPD, PPH and CHF b
Functional evaluation of patients with cystic fibrosis c
Prognostic evaluation of patients with COPD or CHF prior to surgery (lung volume reduction
surgery, transplant) c
Evaluation of the benefits of therapeutic interventions (supplementary oxygen, rehabilitation,
surgery) b
COPD: Chronic Obstructive Pulmonary Disease : EPD: Diffuse Interstitial Lung Disease: PPH Primary Pulmonary
Hypertension: CHF: Congestive Heart Failure.
* Level of recommendation according to the standards of evidence-based medicine.

Limitations

Patients with some chronic functional limitation to ambulation could perform the exam

with the aids they usually use (canes, prostheses, etc.). In this case it should not be

related to the theoretical values of a healthy population.

Contraindications

Absolute contraindications

• Unstable angina in the first month of evolution.

• Acute myocardial infarction in the first month of evolution.

• Inability to walk due to acute event (v. gr. sprained ankle, foot injury, leg fracture,

etc.).

Relative contraindications
• Heart rate > 120 per minute at rest.

• Systolic blood pressure > 180 mmHg.

• Diastolic blood pressure > 100 mmHg.

• Arterial oxygen saturation at rest <89%.

Safety measures in the six-minute walk test

This examination must be performed in type I or II hospitals, under the supervision of a

specialist in respiratory diseases. The place where the test is performed must have

security measures to handle any emergencies. There must be a help bell in emergency

situations and there must be a cardiorespiratory resuscitation cart with easy and quick

access.

Have the following supplies: oxygen, salbutamol inhaler, sublingual nitroglycerin,

aspirin.

The technician who performs the examination must be a professional trained in

recognizing critical emergencies.

The doctor does not need to be present during the entire procedure. An exception to this

is the request of the treating doctor or if the doctor, in charge of the technique, considers

it necessary for a specific patient.

If the patient is receiving oxygen therapy, they should continue with the indicated dose.

If the patient uses walking aids, they must use them during the test.

If hospital policies require it, the patient must sign an informed consent before

performing the procedure.

Ergometry:

Ergometry consists of subjecting the patient to the greatest possible effort, reaching the

threshold of fatigue or maximum level of resistance. You should inform the specialist if

you experience dizziness, shortness of breath, cold sweat, chest pain or nausea.

To perform the test, first, the specialist will place flat, adhesive patches called electrodes

on the patient's chest area. These patches will record the electrical activity of the heart
during the exam.

The person who undergoes this test performs physical exercise on a treadmill or on a

stationary bicycle, exercises that increase in intensity according to the specialist's

instructions.

These are the guidelines to follow:

Every three minutes the level of effort is increased automatically so that the heart speeds

up.

During this same time interval, blood pressure monitoring is carried out.

When the patient cannot withstand any more effort, he or she must inform the specialist

and the patient will move on to the recovery phase.

It is important that the patient makes the maximum possible effort so that the results are

reliable.

In total, the test lasts 60 minutes.

Through continuous monitoring and regular blood pressure measurements, the doctor

will be able to observe the patient's progress and cardiac response at all times.

What does the patient need?

The main recommendations for carrying out the stress test are:

The patient should wear appropriate footwear (preferably sports shoes) and comfortable

clothing to facilitate the achievement of the exercise.

If the person who is going to undergo the test is taking any medication, the specialist

will inform them if they should stop the treatment before, since some drugs can interfere
with the results of the exam.

One of the main recommendations is that the patient should not eat large meals before

performing the test, nor should they undergo it on an empty stomach.

It is important not to drink drinks containing caffeine or alcohol for at least three hours

before taking the test, in the same way that it is not advisable to make great physical

effort during the twelve hours before the test.

In men with a lot of hair, it is advisable to shave the chest area so that the

electrocardiogram recording is of higher quality.

Results

The results of this test can be normal or abnormal.

Normal results

A normal diagnosis is understood to be when the heart rate does not exceed the

theoretical maximum heart rate and the rhythm is constant and uniform.

Abnormal results
If the findings are not favorable this may be due to abnormal heart rhythms

(arrhythmias) during exercise or changes in the electrocardiogram that may suggest a

blockage in the coronary arteries that carry blood to the heart.

Anamnesis

Personal information

NAME: Ramón Gallardo

C: 7,524,233

AGE: 61 years

GENDER: Male

OCCUPATION: Structure fabricator

DIAGNOSIS: High blood pressure

HISTORY OF ILLNESS:

Intense pain in the chest for 8 years, located on the left side near the sternum. He has

had no pain for 3 years. Works in industrial constructions.

subjective assessment

chest pain : NO

respiratory distress: NO

awareness of rapid or irregular heartbeat (palpitations) : NO fainting: NO dizziness or

lightheadedness : NO swelling (edema) of legs, ankles, feet or abdomen: NO

fever: NO weakness: NO tiredness: yes

Loss of appetite: NO

general malaise (indisposition): YES

History of cardiovascular disease, hypertension, diabetes , or high cholesterol:

Hypertension

Sedentary or active: ACTIVE

Symptoms that appear during effort or exercise and are relieved with rest: YES

Drug consumption, over-the-counter naturopathic products, drugs, alcohol and tobacco:

Drug consumption, alcohol consumption.

Family history of cardiovascular disorders: Hypertension

Evaluation of vital signs:

Body temperature: 37C

Pulse: 80p x min

Respiratory rate (respiratory rate): 16 rx 1m

Blood pressure:

Systolic pressure of 140 mm Hg

Diastolic pressure of 90 mm Hg

POSTURAL PHYSICAL EXAM:

Postural attitude

Normal (X) altered()

Skin evaluation

Color: (X) normal () erymatous () ecchymosis () others

Condition: (X) normal () dry () shiny

Edema: (X) none () mild () moderate () severe

Swelling: () yes (X) no

Bedsores: () yes (X) no

Wounds: () yes (X) no

Scar: () none () good condition () attached (X) keloid

Sensitivity assessment

Superficial: (X) preserved () altered

Deep: (X) preserved () altered

Osteoarticular Evaluation:

Joint status:

Normal (X) stiffness() hypomotility () hypermobility ()

Joint width:

Normal (X) altered()

Neuromuscular evaluation

Tone:
Hypotonic () normal (X) hypertonic ()

Trophism:

Hypotrophy () normal (X) hypertrophy ()

Elasticity:

Normal (X) contractured () shortened()

Force:

Normal (X) altered()