Differential Diagnosis for Physical Therapy: Hematological, Cardiovascular, Immune, and Digestive System Disorders: Summary 119
SCREENING FOR CARDIOVASCULAR DISORDERS Coronary Heart Disease/Ischemic Heart Disease • Includes angina pectoris, myocardial infarction (MI), temporary cardiac ischemia • Common cause of death and disability • Can lead to heart failure, serious arrhythmias, and sudden death Arteriosclerosis: General term for arterial changes • Innermost layer of the artery becomes markedly thickened by accumulating cells and surrounding material Predisposing Factors • Age • Gender: Males • Familial history • Obesity (poor diet) • Smoking (decreases HDL increases LDL) • Sedentary lifestyle • Diabetes • Poorly controlled hypertension (HTN) Signs and Symptoms • Intermittent episodes of substernal chest pain • Triggered by physical/emotional stress that increases the heart’s demand for oxygen • Tightness/pressure that may radiate to neck, scapula, or left upper extremity • Pallor, diaphoresis, and nausea may also be present Hypertension (HTN) Systolic blood pressure consistently over 140 mmHg, and diastolic blood pressure consistently over 90 mmHg Prehypertension Systolic blood pressure between 120 and 139 mmHg, and diastolic blood pressure between 80 and 89 mmHg • Factors Affecting Blood Pressure ○ Volume of water in body ○ Salt content ○ Condition of the kidneys
• Both hemophilia A and B: Can be described as mild, moderate, or severe depending on amount of active clotting factor in blood • Signs and symptoms of blood disorders: vary depending on level of clotting factors ○ If deficiency is severe: Unexplained and excessive bleeding from cuts or injuries, or after surgery or dental work, Many large or deep bruises, Unusual bleeding after vaccinations, Pain, swelling, or tightness in joints, Blood in urine or stool, Nosebleeds without a known cause • Normal lab values: ○ Prothrombin time (PT): Coumadin ■ 12–15 seconds (higher number means greater chance of bleeding) ○ PTT (partial prothrombin time): Heparin ■ 25–35 seconds ○ International normalized ratio (INR): A calculation based on results of PT; used to monitor individuals who are being treated with the blood-thinning ■ 2.0 to 3.0 is generally an effective therapeutic range for people taking anticoagulants Guidelines for Immediate Medical Attention • Signs and symptoms of thrombocytopenia ○ Excessive or spontaneous bleeding ○ Petechiae ○ Severe bruising Guidelines for Physician Referral • May be necessary when establishing or progressing an exercise program for a client with known anemia • New episodes of muscle or joint pain in a client with hemophilia • Any unexplained symptom(s) may be a signal of bleeding • Coughing up blood in this population group must be reported to the physician medication ■ 0.8 to 1.2
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