This is a quick reference guide to perform Physical Therapy Cardiopulmonary evaluation. For details on history taking and general guidelines for PT evaluation reference card, click here.
Ask for the chief complaint…
Vital Signs measurement:
- Heart Rate: 220 – Resting HR Or use Karvonen Formula
- Pulse Rate:
- Blood Pressure: sBP and dBP
- SpO2: measure at rest, during activity and after activity
- Measure recovery period.
Check visible s/s of physical exertion:
This is to define how hard or intense the exercise session is for the patient. In some cases, the patient is unable to define it correctly. The clinician can observe patient’s walking speed and ability as well as breathing pattern in order to know the intensity level for an exercise session.
This is usually done by Borg scale of the rate of perceived exertion (6 – 20)or modified rate of perceived exertion (14 – 20).
- Check for pallor
- Check for cyanosis
- Presence of Edema
- DOE or PND
It is important to check skin color and changes of color. This is bluish discoloration of the skin. It usually means lack of Oxygen peripherally or centrally.
The blueish/ purple skin color a clinician will observe on fingernails, lips, nose, the palm of the hands etc.
This is more severe. Here, the body is lacking O2 throughout. A clinician will observe more systemic symptoms like lethargic, altered mental status. If a therapist observes any of this changes, they need to notify nurse or doctor immediately. If you are working as a home health therapist, calling 911 or EMS is recommended.
This is defined as swelling of part of the body or generalized swelling. Generally, in people with Cardiopulmonary issues has dependent edema on lower extremities. Edema can be pitting and non-pitting edema. Edema can be classified into four grade depending on how long it takes for skin to come back to its normal shape. The grading system goes from 1 defined as no pitting impression and grade 4 that pitting impression takes more than 30 seconds to come to normal state.
Semilunar valve Stenosis or
A-V valve incompetencies
Heard between S1 & S 2Heard after S2 and before S 1
|S1 (“Lub”)||Beginning of systole.
Closure of Mitral (& tricuspid) valve
|Right fifth intercostal space, midclavicular line|
|S2 (“Dub”)||End of systole
Closure of Aortic ( & pulmonary) valve.
|2nd intercostal space just right to the sternum.|
|S3||Ventricular gallop||Occurs after S3|
|S4||Atrial gallop||Occurs before S 1|
|Systolic Murmur||Semilunar valve Stenosis or
A-V valve incompetencies
|Heard between S1 & S 2|
|Diastolic Murmur||A-V stenosis or
Semilunar valve incompetencies
|Heard after S2 and before S 1|
A-V = Atrioventricular valve. That is Mitral and tricuspid valve.
Semilunar valves are Aortic valve and pulmonary valve.
The order for Heart sounds with abnormal sounds are S4-S1-S2-S3
|Normal Lung sounds||Definitions||Location on body
|Bronchial||loud high pitched sound.
Shorter inspiratory than expiratory duration with a pause between each phase of ventilation.
|Close to sternum|
|Bronchovesicular||Soft high pitched sound.
Continuous throughout the ventilation.
|On back between scapula
On front between 2nd and 3rd Intercostal space
|Vesicular||Low pitches muffled the sound
Louder and higher pitch in inspiratory phase than the expiratory phase.
|Peripheral lung fields.|
Check for Lab values and Diagnostic tests:
- Laboratory tests
- Chest x-ray
- Cardiac Catheterization
- Hemodynamic monitors
- Arterial Blood Gases Study (ABGs)
This summarizes the main areas to look for while performing a cardiopulmonary evaluation for PT. Click the link below to get access to hand out for this evaluation.