Scientific Research Journal of India Volume: 2, Issue: 3, Year: 2013

RESPIRATORY PHYSIOTHERAPY IN TRIPLE VESSEL DISEASE WITH POST CORONARY ARTERY BYPASS GRAFTING SURGERY (CABG)
Shanmuga Raju P (MPT)*, Renkha Rao (MCh), Rajendhra Kumar J (MD), SuryaNaryana Reddy V (MS)

ABSTRACT We are presenting a case of 47 years of old female with triple vessel disease and coronary artery bypass graft surgery. Her complaint was chest pain and shortness of breath since last 5 months. Coronary angiogram revealed triple vessel disease and she underwent three coronary artery graft surgery on 24th February, 2013. Second day aftter CABG, she developed dyspnoea, reduced chest expansion and decreased arterial O2 saturation. She was treated with daily session involving positioning, chest percussion, deep breathing exercise, manual mobilization exercise and passive and active limb movements. We observed that receiving chest physiotherapy has significant effect in recovery of post CABG patient after 3 weeks of follow up. Our aim of case study is to describe effects of respiratory physiotherapy in post operative CABG in triple vessel disease. Keywords: Triple vessel disease, Coronary artery bypass grafting, respiratory physiotherapy

INTRODUCTION India have 29.8 million symptomatic patients with coronary artery disease (CAD).
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Approximately, one sixth of the world population lives in India

(1)

. Coronary artery bypass graft

(CABG) surgery is challenging for coronary artery

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disease. CABG is associated with an occurrence of pulmonary complications,

(2)

eosinophils 03%, monocytes 05%, basophilis 00% and ESR is 30mm/1hours. Biochemistry: Sodium 136 mmol/L, potassium 4.1 mmol/L, chlorides 106 mmol/L, fasting serum glucose 103 mg/dL. Urine level is 100ml. Blood group is O negative. Chest expansion

defined

as

any

pulmonary abnormality that occurs during the post operative period . A decrease in pulmonary

function is well known after open heart surgery. Chest physiotherapy is routinely used in order to prevent or reduce pulmonary complications after surgery. Post operative treatment includes early mobilization, change in position,
(3)

measurements were 58 cm at axilla level, 83 cm at nipple level and, 79 cm at xiphoid level.

breathing

exercises and coughing techniques .

CASE REPORT A 47 year old female patient was diagnosed to have triple vessel disease; coronary angiogram revealed triple vessel coronary artery disease and was referred to department of cardiothoracic surgery at Chalmeda AnandRao Institute of Medical Sciences, Karimanagar on 24th February 2013. Medical history was chest pain and shortness of breathlessness since last 5 months. She was known case of type to II Diabetes mellitus, but no history of hypertension. Coronary angiogram showed triple vessel disease with left ventricular dysfunction. She underwent coronary artery bypass grafts surgery and three grafts were placed, one graft was placed to obtuse marginal 1 (OM 1), second graft was placed to left anterior descending artery and third graft was placed to right coronary artery. She was hemodynamically stable on first post operative day but on second postoperative day, she had aspirated gastric contents and developed hypoxia due to asphyxia. Her blood pressure was 149/81 mm/Hg, pulse 106 per/minute, heart rate 123 per/minute, respiration rate 16 breaths per/minute, and temperature was 1000 F. Complete blood picture show hemoglobin 6.5 gm/cumm, WBC 5,800 cells/cumm, neutrophils 78%, lymphocytes 17%, DISCUSSION Patient undergoing cardiac surgery (CS), in most number of cases post operative pulmonary
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Figure:

Before

CABG

and

respiratory

physiotherapy transthoracic 2D echo cardiogram show decrease Left ventricular systolic function (LV ejection fraction (EF) 20.3 %).

Figure:

After

CABG

and

respiratory

physiotherapy transthoracic 2D echocardiogram show improve LV systolic function (LV ejection fraction 55.3 %).

Scientific Research Journal of India Volume: 2, Issue: 3, Year: 2013

dysfunction developed with a significant reduction in lung volume, respiratory function, and lung compliance and increased work of breathing
(4-5)

anteroseptal wall and apical part of LV were hypokinetic and reduced LV systolic function. Second day after surgical procedure (CABG) she had aspirated gastric contents and developed hypoxia due to asphyxia. Three week after respiratory physiotherapy treatment, her chest expansion, arterial O2 saturation and cardiac function were improved (EF 55%). She was discharge and advised follow-up.

Atelectasis and hypoxemia are among the main pulmonary complications post operatively of CABG
(6)

. Respiratory therapy is often used in the

prevention and treatment of post operative complications as retention of secretions, atelectasis and pneumonia . In our case, before CABG, an
(7)

electrocardiogram shows Q wave in V1 V2 V3 & V4 chest lead are poor progression of R wave in chest lead V5 and V6. After CABG Q wave are present in V1 and V4 chest lead, no new ST- T changes. Before surgical procedures transthoracic 2D echocardiogram shown normal valves and normal size chambers. Anterior wall, lateral wall,

CONCLUSION Our case report showing that post operative respiratory physiotherapy is an effective

management for a patient with coronary bypass graft surgery for reducing in pulmonary

complications.

REFERENCES 1. Aggarwal A, Sourabh A, Goel A, Sharma V, Dwivedi S. A retrospective case control study of modifiable risk factors and cutaneous markers in India patients with young coronary artery disease. J R Soc Med Cardio 2012, vol:1(38); p: 1-8. 2. O Donohue WJ Jr. Postoperative pulmonary complications. When are preventive and therapeutic measures necessary? Post grad Med 1992, 91(3): 167-170. 3. Westerdahl E, Lindmark B, Almgren SO, Tenling A. Chest physiotherapy after coronary artery bypass graft surgery- A comparison of three different deep breathing techniques. J Rehab Med 2001; 33: 79-84. 4. Westerdahl E, Lindmark B, Eriksson T, Friberg O, Hedenstierna G, Tenling A. Deep breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery. Chest. 2005; 128(5): 3482-8. 5. Feltrim MIZ, Jatene FB, Bernardo WM. Em pacientes de alto risco, submetidosa revascularizacao do miocardio, a fisiotherapia respiratioria pre-operatoria previne as complica coes pulmonares? Rev Assoc Med Brac.2007; 53(1): 1-12. 6. Renault JA, Costa- Val R, Rossetti MB. Respiratory physiotherapy in pulmonary dysfunction after cardiac surgery. Rev Bras Cir Cardiovasc.2008; 23(4): 562-9.

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7. Lopes C, Brandao CM de A, Nozawa E, Auler Junior JOC. Benefits of non-invasive ventilation after extubation in the post operative period of heart surgery. Rev Bras Cir Cardio Vasc 2008; 23 (3): 344-350.

CORRESPONDING AUTHOR: *Dr. P. Shanmuga Raju, MPT, Asst. Professor & I/C Head, Department of Physical Medicine & Rehabilitation, Chalmeda Anand Rao Institute of Medical Sciences, Karimngar- 505001, Andhra Pradesh, INDIA. E-mail: shanmugampt@rediffmail.com

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