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A 54-year-old office executive went to the emergency department complaining of sudden chest and left arm pain. He is pale, diaphoretic, and reports feeling nauseated. Differential diagnoses include gastric and musculoskeletal etiologies, myocardial infarction, pericarditis, and myocarditis. The 12-lead electrocardiogram readings indicate ST segment elevation in the anterior leads V1-6, I, and aVL, and reciprocal ST segment depression in the inferior leads. Cardiac enzymes reveal elevated levels of creatine kinase-MB (CK-MB) and troponin. Cardiac catheterization revealed an obstruction of the anterior descending branch of the left coronary artery. The patient was immediately scheduled for and underwent coronary artery bypass graft (CABG) surgery without complications. Relevant inpatient medications postsurgery include a statin, β-adrenergic blocker, and an angiotensin-converting enzyme (ACE) inhibitor. After an overnight stay in the critical care unit, the patient was transferred to the acute care ward. He was referred to physical therapy for phase I (inpatient) cardiac rehabilitation with an anticipated hospital discharge within 5 days. The patient lives with his wife and two teenage children. He smokes one pack of cigarettes per day and has elevated blood pressure and cholesterol levels. He also has diabetes mellitus and a history of atherosclerosis and coronary artery disease.

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What are the most appropriate examination tests?

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What are the examination priorities

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What are the most appropriate physical therapy interventions?

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What precautions should be taken during physical therapy examination and/or interventions?

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What is his rehabilitation prognosis?

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  • ATHEROSCLEROSIS: Plaque build-up in the arteries
  • CARDIAC CATHETERIZATION: Medical procedure in which a long, thin, flexible tube is inserted into a blood vessel (usually in the groin) and threaded to the heart vessels; performed to diagnose and/or treat certain cardiac conditions
  • CORONARY ARTERY BYPASS GRAFT (CABG): Surgical procedure involving removal of a portion of a vein or artery and grafting this vessel onto a blocked coronary artery to re-establish arterial patency
  • CORONARY ARTERY DISEASE (CAD): Atherosclerosis in the coronary arteries
  • CREATINE KINASE-MB (CK-MB): Isoenzyme more specific for cardiac muscle; extent of its elevation in serum reflects extent of cardiac muscle infarcted

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  1. Describe the pathophysiology of myocardial infarction.

  2. Discuss the role of diagnostic tests in determining the presence of myocardial infarction.

  3. Describe the role of medications post-CABG surgery.

  4. Explain the multidisciplinary approach to cardiac rehabilitation and the role of physical therapy during phase I cardiac rehabilitation.

  5. Describe the utility of activity evaluation, endurance evaluation, and walk tests in early cardiac rehabilitation.

  6. Design an appropriate plan of care for the patient in phase I cardiac rehabilitation.

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PT considerations during management of the individual status/post myocardial infarction in phase I cardiac rehabilitation:

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  • General physical therapy plan of care/goals: Increase exercise tolerance and functional capacity, maximize functional independence and safety while minimizing secondary impairments, manage risk factors associated with the condition
  • Physical therapy ...

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