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Practice Pattern D represents a progression in heart disease beginning with cardiac pump dysfunction, which eventually may progress to cardiac pump failure. It is critically important that a physical therapist be able to distinguish between a person with cardiac pump dysfunction and a person with cardiac pump failure. The inclusion/exclusion criteria of Practice Pattern D list two specific pathologies that may distinguish between cardiac pump dysfunction from cardiac pump failure (ejection fraction <30% and exercise-induced myocardial ischemia) and two specific impairments that may distinguish between cardiac pump dysfunction from cardiac pump failure (hypoadaptive blood pressure response to exercise and achieved MET level during exercise testing).1 These distinguishing characteristics are listed in Box 18-1.

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Box 18-1 Patients/Clients Diagnostic Group Characteristics for Practice Pattern D

Although these tests and measures are available from the patient's medical history, they may, in fact, be history and not represent current cardiac performance. Similarly, the only aforementioned test providing specific information to distinguish cardiac pump dysfunction from failure is the ejection fraction. Another simple measurement that can be performed by a physical therapist that may provide important information to distinguish cardiac pump dysfunction from failure is observing the blood pressure response during a controlled expiratory maneuver.210 This simple test can provide important information about the disablement of heart disease and can provide a basis upon which the physical therapist can determine necessary outcomes, subsequent examinations, and specific treatment methods. The most relevant characteristics of cardiac pump dysfunction and cardiac pump failure will be presented in the following sections beginning with the microanatomy and physiology of both ...

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