Despite the increased emphasis on health promotion and prevention, advances in technology, and the development of evidence-based treatment regimens, coronary atherosclerotic heart disease (ASHD) remains the leading cause of cardiovascular death and disability in the United States.1–3 All physical therapists, regardless of area of specialization or practice setting, treat patients with cardiovascular disease. Common symptoms of cardiovascular disease include dyspnea, chest pain, claudication, palpitations, syncope, and fatigue. None of these symptoms, however, are specific to a given system or cardiovascular disorder. By understanding the pathophysiology and clinical manifestations of common cardiovascular diseases, physical therapists are more likely to deliver safe interventions. The onset or change in symptoms detected during an examination may indicate the development or progression of a serious and potentially life-threatening disease.
This chapter presents the pathophysiology and clinical manifestations of most common cardiovascular diseases found in the adult. Medical care and therapeutic interventions are presented elsewhere in this text. Before discussing specific diseases, several important facts necessary to understand common pathologies of the cardiovascular system are presented. These facts provide a very brief introduction and rationale for the material presented in the remainder of the chapter.
More than half of all deaths in industrialized countries are due to cardiovascular diseases. More than 50% of all adults in the United States and in other industrialized countries die of atherosclerosis and other major manifestations of this disease.4,5 Most of the related morbidity in this country can be accounted for by atherosclerosis of the coronary arteries, the cerebral blood vessels, and the aorta and its main branches. Hypertension, an important complication of atherosclerosis, contributes to the severity of the disease and aggravates its symptoms. Accounting for approximately 10% of all cases of heart disease,6 hypertension may occur independent of atherosclerosis or precede it. Clotting disturbances complicate atherosclerosis. Thrombosis of atherosclerotic coronary arteries is the main cause of myocardial infarction (MI).7–9 Thrombi may occur without preexisting atherosclerosis and are common in the venous system.
Abnormal cardiac development during fetal life is a significant cause of disease in newborns. Within the first 2 months after conception, the heart develops through several complex embryologic processes (see Chapter 4). The true incidence of cardiovascular malformations is difficult to determine accurately. It has been estimated that approximately 0.8% of livebirths are complicated by a cardiovascular malformation.10 Although many infants born with cardiac defects have anomalies that are not life-threatening and heal on their own, almost one-third (2.6 per 1,000 livebirths)11 have disease severe enough to result in a cardiac catherization, cardiac surgery, or death in the first year of life. Ventricular septal defects represent the most common congenital cardiac malformation in infants and children.5 In adults, the incidence of this defect and others is much lower due to spontaneous or surgical closure during infancy and death before adulthood. Further information about congenital cardiac abnormalities is found in Chapter 21....