https://www.stuvia.com/user/assistanthttps://www.stuvia.cohttps://www.stuvia.com/user/asasista
ntm/user/assistant
Cardiovascular and
Pulmonary Physical
Therapy: A Clinical
Manual | Practice
Questions & Exam
Review
,CARDIOVASCULAR
CARDIOVASCULAR
AND PULMONARY
AND
PHYSICAL
PULMONARY
THERAPY
PHYSICAL
A Clinical
THERAPY
Manualhttps://www.stuvia.com/user/assistant
A Clinical Manualhttps://www.stuvia.com/user/assistant
https://www.stuvia.com/user/assistant
CONTENTS
Chapter 1 The Oxygen Transport System (Why the heart and lungs
are important to physical therapists) 1
Chapter 2 Pulmonology 3
Chapter 3 Cardiovascular Medicine 38
Chapter 4 Cardiopulmonary Pathology 72
Chapter 5 Pharmacology 156
Chapter 6 Cardiopulmonary Assessment 222
Chapter 7 Cardiovascular and Pulmonary Physical Therapy
Treatment 298
Chapter 8 Pediatrics 342
Chapter 9 Laboratory Medicine 393
Appendix Abbreviations 411
Glossary 415
xiii
https://www.stuvia.com/user/assistant https://www.stuvia.com/user/assistant 6/16/2026https://www.stuvia.com/user/assistant
,CARDIOVASCULAR
CARDIOVASCULAR
AND PULMONARY
AND
PHYSICAL
PULMONARY
THERAPY
PHYSICAL
A Clinical
THERAPY
Manualhttps://www.stuvia.com/user/assistant
A Clinical Manualhttps://www.stuvia.com/user/assistant
https://www.stuvia.com/user/assistant
CHAPTER 1
The Oxygen Transport System: Why the Heart and
Lungs Are Important to Physical Therapists
As physical therapists, we are concerned with the prevention, living. Individuals with a number of lung pathologies, such as
diagnosis, and treatment of movement impairments and the pneumonia, pulmonary edema, and pulmonary fibrosis, may have
enhancement of physical health and functional abilities. Our clini- difficulty not only with delivering enough air to the alveoli but also
cal practices generally deal with movement impairments; that is, with diffusion of oxygen from the alveoli into the bloodstream,
our patients usually have difficulty moving how and where they particularly during activity. Conversely, persons with asthma and
want. Most commonly, impairments are due to problems with chronic obstructive pulmonary disease, such as emphysema and
the musculoskeletal, neuromuscular, and neurological systems. chronic bronchitis, are not limited in their ability to inspire ade-
However, diseases affecting the pulmonary and cardiovascular sys- quate volumes of air, but exhibit airflow limitation during expira-
tems also result in movement impairment because of their funda- tion and develop air trapping in the distal airways, which also
mental roles in the oxygen transport system, through which interferes with effective gas exchange. In addition, abnormal gas
energy is provided for movement, as shown in Figure 1-1.6 exchange can result from impeded blood flow through the pulmo-
When an individual wants to perform an activity, the central nary capillaries, as in pulmonary embolism. Many individuals have
nervous system stimulates the appropriate muscles, and, if both normal pulmonary function, but abnormal heart function limits the
systems are intact, the desired movements are produced. How- amount of oxygen-carrying blood that can be pumped from the
ever, for activity to continue for more than a few minutes with- heart to the various tissues of the body, especially during exertion.
out local discomfort or shortness of breath, the muscles must Lastly, diseases such as atherosclerosis or the connective tissue
receive adequate blood supply carrying enough oxygen to pro- diseases affect the patency of the arteries and can impede blood
duce the energy required to sustain the activity. Under normal flow to active muscles and other tissues. Despite the wide variety
circumstances this oxygen is readily available in the air that we of pathologies just mentioned, many of the clinical manifestations
breathe; through the process of ventilation, it is inhaled through are often similar, including fatigue, weakness, and shortness of
active contraction of the inspiratory muscles and flows through breath. Notably, these are also the limiting factors experienced
progressively smaller airways to the most distal units of the lungs, by unfit sedentary individuals (i.e., your typical couch potatoes)
the alveoli. The oxygen then diffuses from the alveoli into the during activity. Thus, disorders of the pulmonary system ultimately
surrounding pulmonary capillaries, which are perfused by blood increase the work of breathing and interfere with gas exchange,
flow coming from the right ventricle via the pulmonary arteries. while abnormalities of the cardiovascular system limit the amount
Most of the oxygen is bound to hemoglobin, and the oxygen-rich of blood that can be pumped and delivered to the skeletal muscles.
blood returns to the left atrium via the pulmonary veins and The result of both is manifested as exercise intolerance, which has
is pumped by the left ventricle to all the tissues of the body, direct implications for physical therapy interventions.
including the contracting muscles. In the final steps of the Because all of our clients depend on adequate cardiovascular
oxygen transport system, the oxygen dissociates from arterial and pulmonary function to participate effectively in rehabilitation
hemoglobin and diffuses across the capillary membrane into the activities, and diseases involving these systems are so prevalent
muscle cells, where it enters the mitochondria to participate in in our society, assessment of the cardiovascular and pulmonary
the oxidative metabolic processes, which ultimately produce systems should be an essential component of every physical ther-
adenosine triphosphate, ATP, for energy. apy evaluation. Clients with higher likelihood of cardiopulmo-
Then the oxygen transport pathway proceeds in the reverse nary impairment include those with two or more coronary risk
direction to eliminate metabolic by-products, particularly carbon factors (as presented in Chapter 4, Cardiopulmonary Pathology)
dioxide, which diffuse from the muscle cells into the capillaries and those over the age of 40 years. It is important to note that
and are transported back to the heart via the systemic venous sys- many individuals, especially those over 60 years of age, even
tem. The right ventricle pumps the venous blood to the lungs, though they have not been diagnosed with specific cardiovascu-
where carbon dioxide diffuses from the capillaries into the alveoli lar or pulmonary disease, may have some degree of dysfunction;
and, given adequate ventilation, is exhaled from the lungs. thus, the absence of a specific cardiopulmonary diagnosis should
Unfortunately, pathologies affecting any components of the not be taken as an indication that an individual has normal pul-
respiratory and cardiovascular systems can interfere with normal monary and/or cardiovascular function. Through clinical monitor-
function of the oxygen transport system.1-6 Persons with neurolog- ing at rest and during activity, physical therapists can detect any
ical, neuromuscular, and musculoskeletal disorders affecting the abnormal responses and make appropriate modifications in his or
thoracic cage may be incapable of moving (i.e., ventilating) enough her treatment program in order to optimize both effectiveness
air to meet the oxygen demands of many normal activities of daily and safety.
1
https://www.stuvia.com/user/assistant https://www.stuvia.com/user/assistant 6/16/2026https://www.stuvia.com/user/assistant
, CARDIOVASCULAR
CARDIOVASCULAR
AND PULMONARY
AND
PHYSICAL
PULMONARY
THERAPY
PHYSICAL
A Clinical
THERAPY
Manualhttps://www.stuvia.com/user/assistant
A Clinical Manualhttps://www.stuvia.com/user/assistant
https://www.stuvia.com/user/assistant
2 CARDIOVASCULAR AND PULMONARY PHYSICAL THERAPY
Peripheral
circulation
Pulmonary
circulation
Expired O2 flow CO2 production
VCO2
VO2
Mitochondria
Inspired CO2 flow O2 consumption
Airways/lungs Heart Muscle tissue
Figure 1-1: Scheme of the oxygen transport system showing the interactions of the respiratory, cardiovascular, and metabolic/tissue
components.
The following chapters present information related to normal REFERENCES
and abnormal respiratory and cardiovascular function, the diagno-
1. DeTurk WE, Cahalin LP. Cardiovascular and Pulmonary Physical Therapy: An
sis and treatment of dysfunction, and physical therapy assessment Evidence-based Approach. New York: McGraw-Hill; 2004.
and treatment techniques. There are also chapters focusing on 2. Frownfelter DL, Dean E. Cardiovascular and Pulmonary Physical Therapy: Evi-
medications used to treat cardiovascular and pulmonary dys- dence and Practice. 4th ed. St. Louis: Mosby; 2006.
3. Hillegass EA, Sadowsky HS. Essentials of Cardiopulmonary Physical Therapy.
function and their effects on the physiologic responses to activity, 2nd ed. Philadelphia: Saunders Co; 2001.
pediatric evaluation and treatment procedures, and laboratory 4. Irwin S, Tecklin JS. Cardiopulmonary Physical Therapy: A Guide to Practice.
medicine and implications for physical therapy. The ultimate pur- 4th ed. St. Louis: Mosby; 2004.
pose of this book is to provide the clinician with an appreciation 5. McArdle WD, Katch FI, Katch VL. Exercise Physiology—Energy, Nutrition, and
Human Performance. 5th ed. Philadelphia: Lea & Febiger; 2001.
of how various pathologies affect the oxygen transport system, 6. Wasserman K, Hansen JE, Sue DY, et al. Principles of Exercise Testing and
the resulting clinical manifestations, and the implications for Interpretation. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2004.
activity and rehabilitation.
https://www.stuvia.com/user/assistant https://www.stuvia.com/user/assistant 6/16/2026https://www.stuvia.com/user/assistant
ntm/user/assistant
Cardiovascular and
Pulmonary Physical
Therapy: A Clinical
Manual | Practice
Questions & Exam
Review
,CARDIOVASCULAR
CARDIOVASCULAR
AND PULMONARY
AND
PHYSICAL
PULMONARY
THERAPY
PHYSICAL
A Clinical
THERAPY
Manualhttps://www.stuvia.com/user/assistant
A Clinical Manualhttps://www.stuvia.com/user/assistant
https://www.stuvia.com/user/assistant
CONTENTS
Chapter 1 The Oxygen Transport System (Why the heart and lungs
are important to physical therapists) 1
Chapter 2 Pulmonology 3
Chapter 3 Cardiovascular Medicine 38
Chapter 4 Cardiopulmonary Pathology 72
Chapter 5 Pharmacology 156
Chapter 6 Cardiopulmonary Assessment 222
Chapter 7 Cardiovascular and Pulmonary Physical Therapy
Treatment 298
Chapter 8 Pediatrics 342
Chapter 9 Laboratory Medicine 393
Appendix Abbreviations 411
Glossary 415
xiii
https://www.stuvia.com/user/assistant https://www.stuvia.com/user/assistant 6/16/2026https://www.stuvia.com/user/assistant
,CARDIOVASCULAR
CARDIOVASCULAR
AND PULMONARY
AND
PHYSICAL
PULMONARY
THERAPY
PHYSICAL
A Clinical
THERAPY
Manualhttps://www.stuvia.com/user/assistant
A Clinical Manualhttps://www.stuvia.com/user/assistant
https://www.stuvia.com/user/assistant
CHAPTER 1
The Oxygen Transport System: Why the Heart and
Lungs Are Important to Physical Therapists
As physical therapists, we are concerned with the prevention, living. Individuals with a number of lung pathologies, such as
diagnosis, and treatment of movement impairments and the pneumonia, pulmonary edema, and pulmonary fibrosis, may have
enhancement of physical health and functional abilities. Our clini- difficulty not only with delivering enough air to the alveoli but also
cal practices generally deal with movement impairments; that is, with diffusion of oxygen from the alveoli into the bloodstream,
our patients usually have difficulty moving how and where they particularly during activity. Conversely, persons with asthma and
want. Most commonly, impairments are due to problems with chronic obstructive pulmonary disease, such as emphysema and
the musculoskeletal, neuromuscular, and neurological systems. chronic bronchitis, are not limited in their ability to inspire ade-
However, diseases affecting the pulmonary and cardiovascular sys- quate volumes of air, but exhibit airflow limitation during expira-
tems also result in movement impairment because of their funda- tion and develop air trapping in the distal airways, which also
mental roles in the oxygen transport system, through which interferes with effective gas exchange. In addition, abnormal gas
energy is provided for movement, as shown in Figure 1-1.6 exchange can result from impeded blood flow through the pulmo-
When an individual wants to perform an activity, the central nary capillaries, as in pulmonary embolism. Many individuals have
nervous system stimulates the appropriate muscles, and, if both normal pulmonary function, but abnormal heart function limits the
systems are intact, the desired movements are produced. How- amount of oxygen-carrying blood that can be pumped from the
ever, for activity to continue for more than a few minutes with- heart to the various tissues of the body, especially during exertion.
out local discomfort or shortness of breath, the muscles must Lastly, diseases such as atherosclerosis or the connective tissue
receive adequate blood supply carrying enough oxygen to pro- diseases affect the patency of the arteries and can impede blood
duce the energy required to sustain the activity. Under normal flow to active muscles and other tissues. Despite the wide variety
circumstances this oxygen is readily available in the air that we of pathologies just mentioned, many of the clinical manifestations
breathe; through the process of ventilation, it is inhaled through are often similar, including fatigue, weakness, and shortness of
active contraction of the inspiratory muscles and flows through breath. Notably, these are also the limiting factors experienced
progressively smaller airways to the most distal units of the lungs, by unfit sedentary individuals (i.e., your typical couch potatoes)
the alveoli. The oxygen then diffuses from the alveoli into the during activity. Thus, disorders of the pulmonary system ultimately
surrounding pulmonary capillaries, which are perfused by blood increase the work of breathing and interfere with gas exchange,
flow coming from the right ventricle via the pulmonary arteries. while abnormalities of the cardiovascular system limit the amount
Most of the oxygen is bound to hemoglobin, and the oxygen-rich of blood that can be pumped and delivered to the skeletal muscles.
blood returns to the left atrium via the pulmonary veins and The result of both is manifested as exercise intolerance, which has
is pumped by the left ventricle to all the tissues of the body, direct implications for physical therapy interventions.
including the contracting muscles. In the final steps of the Because all of our clients depend on adequate cardiovascular
oxygen transport system, the oxygen dissociates from arterial and pulmonary function to participate effectively in rehabilitation
hemoglobin and diffuses across the capillary membrane into the activities, and diseases involving these systems are so prevalent
muscle cells, where it enters the mitochondria to participate in in our society, assessment of the cardiovascular and pulmonary
the oxidative metabolic processes, which ultimately produce systems should be an essential component of every physical ther-
adenosine triphosphate, ATP, for energy. apy evaluation. Clients with higher likelihood of cardiopulmo-
Then the oxygen transport pathway proceeds in the reverse nary impairment include those with two or more coronary risk
direction to eliminate metabolic by-products, particularly carbon factors (as presented in Chapter 4, Cardiopulmonary Pathology)
dioxide, which diffuse from the muscle cells into the capillaries and those over the age of 40 years. It is important to note that
and are transported back to the heart via the systemic venous sys- many individuals, especially those over 60 years of age, even
tem. The right ventricle pumps the venous blood to the lungs, though they have not been diagnosed with specific cardiovascu-
where carbon dioxide diffuses from the capillaries into the alveoli lar or pulmonary disease, may have some degree of dysfunction;
and, given adequate ventilation, is exhaled from the lungs. thus, the absence of a specific cardiopulmonary diagnosis should
Unfortunately, pathologies affecting any components of the not be taken as an indication that an individual has normal pul-
respiratory and cardiovascular systems can interfere with normal monary and/or cardiovascular function. Through clinical monitor-
function of the oxygen transport system.1-6 Persons with neurolog- ing at rest and during activity, physical therapists can detect any
ical, neuromuscular, and musculoskeletal disorders affecting the abnormal responses and make appropriate modifications in his or
thoracic cage may be incapable of moving (i.e., ventilating) enough her treatment program in order to optimize both effectiveness
air to meet the oxygen demands of many normal activities of daily and safety.
1
https://www.stuvia.com/user/assistant https://www.stuvia.com/user/assistant 6/16/2026https://www.stuvia.com/user/assistant
, CARDIOVASCULAR
CARDIOVASCULAR
AND PULMONARY
AND
PHYSICAL
PULMONARY
THERAPY
PHYSICAL
A Clinical
THERAPY
Manualhttps://www.stuvia.com/user/assistant
A Clinical Manualhttps://www.stuvia.com/user/assistant
https://www.stuvia.com/user/assistant
2 CARDIOVASCULAR AND PULMONARY PHYSICAL THERAPY
Peripheral
circulation
Pulmonary
circulation
Expired O2 flow CO2 production
VCO2
VO2
Mitochondria
Inspired CO2 flow O2 consumption
Airways/lungs Heart Muscle tissue
Figure 1-1: Scheme of the oxygen transport system showing the interactions of the respiratory, cardiovascular, and metabolic/tissue
components.
The following chapters present information related to normal REFERENCES
and abnormal respiratory and cardiovascular function, the diagno-
1. DeTurk WE, Cahalin LP. Cardiovascular and Pulmonary Physical Therapy: An
sis and treatment of dysfunction, and physical therapy assessment Evidence-based Approach. New York: McGraw-Hill; 2004.
and treatment techniques. There are also chapters focusing on 2. Frownfelter DL, Dean E. Cardiovascular and Pulmonary Physical Therapy: Evi-
medications used to treat cardiovascular and pulmonary dys- dence and Practice. 4th ed. St. Louis: Mosby; 2006.
3. Hillegass EA, Sadowsky HS. Essentials of Cardiopulmonary Physical Therapy.
function and their effects on the physiologic responses to activity, 2nd ed. Philadelphia: Saunders Co; 2001.
pediatric evaluation and treatment procedures, and laboratory 4. Irwin S, Tecklin JS. Cardiopulmonary Physical Therapy: A Guide to Practice.
medicine and implications for physical therapy. The ultimate pur- 4th ed. St. Louis: Mosby; 2004.
pose of this book is to provide the clinician with an appreciation 5. McArdle WD, Katch FI, Katch VL. Exercise Physiology—Energy, Nutrition, and
Human Performance. 5th ed. Philadelphia: Lea & Febiger; 2001.
of how various pathologies affect the oxygen transport system, 6. Wasserman K, Hansen JE, Sue DY, et al. Principles of Exercise Testing and
the resulting clinical manifestations, and the implications for Interpretation. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2004.
activity and rehabilitation.
https://www.stuvia.com/user/assistant https://www.stuvia.com/user/assistant 6/16/2026https://www.stuvia.com/user/assistant
