CASE PRESENTATION
Submitted by: Sehraj kaur
MPT-I (CARDIO)
DEMOGRAHIC DATA
Name – Tilak Raj
Age- 70 years
Gender- Male
Address- Amritsar
Occupation- Businessman
Date of admission- 18.08.2024
Date of assessment- 20.08.2024
Place of assessment-Amandeep Medicity
Chief Complaints:-
• Chest pain radiating to left shoulder since 1 day
• Breathlessness and sweating since the onset of chest pain
History of present illness:-
As per the patient, he was experiencing breathlessness while walking and doing his daily
activities and especially during sleep since one week. His condition worsen and he was
experiencing pain in his central chest radiating to left shoulder then he came to
Amandeep hospital for further treatment.
Aggravating factor: Walking
Relieving factor: Sitting, half lying
• Past history of illness: not present
• Past surgical history : not present
• Medical History: Patient suffers from hypertension since 5 years and diabetes mellitus
• Drug history :Aspirin, Amlodipine, Atenolol , Metformin, Rosuvastatin
Personal history :
• Alcohol Intake: not present
• Smoking: not present
• Sleep disturbance:- present, patient sleep was disturbed due to breathlessness
Family history : Not present
Socioeconomic status:- Middle class
Dyspnea- grade 3( severe)
According to American Thorasic society dyspnea scale
Pain history:
Chest pain
• Side: chest- centre
shoulder- left
• Site: localised (central) and radiating to left shoulder
• Type: shooting pain
• NPRS:
On Observation:
• Body type: Endomorphic
• Clinical presentation: Awake
Vital signs:
• Blood pressure: 99/65mm hg
• SPO2: 95% on room air
• Temperature : 97.5° F
• Respiratory rate: 25 breaths/min
Visual inspection:
Patient appears anxious, with occasional use of accessory muscles during breathing.
On palpation:
Tracheal shift: There was no tracheal shift
Tracheal tug sign: not present
Tenderness: present
• Grade: 2
• Side: Left
• Site: Axillary lymph nodes
On examination:
Percussion: Cardiac dullness: Dull
Auscultation
• Heart sounds : Aortic: Normal
Pulmonary: Normal
Tricuspid: Normal
Mitral: Murmur
• Lung sound: Bronchial: Normal
Vesicular: Normal
Rhonchi: Normal
Crackles: Present
Differential diagnosis:
• Myocardial infarction
• Coronary artery disease.
• Angina pectoris
Investigations :-
Echo-
Angiography:-
Diagnosis
CAD-LM+ TRIPLE VESSEL DISEASE
Physiotherapy management:-
DAY 1-3: Early mobilization(IPD)
Goals:
• To clear airways
• To prevent pressure sores
• To prevent complications like DVT
• To prevent muscle weakness
• Begin gentle mobilization under close monitoring
Physiotherapy treatment(DAY 1-3)IPD
Positioning and
breathing exercises
Diaphragmatic breathing 10 reps 3 times daily
Pulsed lip breathing 10 reps 2 times daily
Incentive spirometry 5-10 breaths Every two hours
Passive/ Assisted ROM
Shoulder flexion 10 reps Twice daily
Elbow extension 10 reps Twice daily
Wrist flexion/ extension 10 reps Twice daily
Hip flexion 10 reps Twice daily
Knee flexion 10 reps Twice daily
Ankle toe pumps
Early Mobilization:
• Day 1-2: Encourage sitting at the bedside with assistance
• Day 3: Progress to standing with assistance and walking a few steps (monitor heart
rate,BP, and spo2 closely)
Day 4-6 ( Progressive Mobilization)IPD
GOALS:
• Improve functional mobility and independence
• To improve lung expansion
• To increase walking distance without breadthlessness
Day(4-6)
Chest PT Limb PT
Exercise Repetitions/ sets Joint Active ROM Exercises Repetitions/sets
Pursed lip breathing 20 reps/ 2 sets Shoulder Flexion 20reps, 2 sets
Deep breathing 20 reps/ 2 sets Abduction 20reps, 2 sets
exercises Adduction 20reps, 2 sets
ACBT Elbow Flexion 20reps, 2 sets
Extension 20reps, 2 sets
Progress from walking a few Wrist Flexion 20reps, 2 sets
steps to more with minimal Extension 20reps, 2 sets
assistance Hip Flexion 20reps, 2 sets
Self care activities Abduction 20reps, 2 sets
Adduction 20reps, 2 sets
Knee Flexion 20reps, 2 sets
Extension 20reps, 2 sets
Ankle- toe
pumps
Resisted ROM exercises
Walking around hallways for 3-5
minutes of continuous walking Stationary bicycle
DAY
(7-10)
Stair climbing with supervision
Upper limb Ergometer and self care activities
DAY 11-14: Discharge planning and Home Exercise
Program
GOALS
• To improve cardiovascular endurance
• To gain functional independence
• To improve exercise capacity
Physiotherapy treatment
• Breathing Exercises: Continue as previous days focusing on deep breathing, thoracic
expansion.
• Endurance Training: Treadmill training or stationary cycling for 5-10 minutes daily ,
progress to 10-15 minutes as tolerated
• Resistance training: Light weights or resistance bands for major muscle group( arms,
shoulders, legs) * 2 sets of 10-15 reps
• Functional mobility and ADL training : Continue walking and stair climbing
Self care activities such as dressing,
grooming
Balance and gait training( tandem walking
and balance exercises if needed)
OPD Follow-up
Goals: To build endurance and strength
Reduce the risk of re-occurence by improving cardiovascular fitness
Restore full functional independence
Treatment:
• Supervised Aerobic Exercises: Treadmill walking or stationary cycling for 20-30
minutes, 3-5 times per week
• Resistance Training: Progressive resistance exercises for upper and lower limbs * 2-4
sets of 10-15 reps
• Patient education: Educate the signs of over-exertion
Lifestyle modifications to manage risk factors (diet, stress
management)
THANK YOU
