Physiotherapy Assessment in Cardiac Disease: Structure, Measures, and Tools

A comprehensive physiotherapy assessment is essential to profile a cardiac patient’s health status, define problems precisely, and evaluate functional capacity and limitations. This requires both a subjective appraisal of the patient’s experience and an objective examination of clinical findings. Without a systematic approach, it is difficult to design a targeted, effective treatment plan—and once treatment begins, outcomes should be continuously re-evaluated against patient goals.¹²

Data Collection

Patient identifiersName, age, address, phone, hospital/ID number, referring clinician, diagnosis and referral reason (where available).

Medical history & context

• Current symptoms: chest pain, dyspnoea, fatigue, palpitations, oedema.

• Past illnesses: cardiac/vascular, pulmonary, other relevant conditions.

• Medications: anticoagulants, antihypertensives, lipid-lowering agents, etc.

• Family history: heart disease, hypertension, diabetes, dyslipidaemia.

• Social history & lifestyle: living situation, work, physical activity, tobacco, alcohol, other substances.

This background anchors clinical reasoning and treatment planning.¹²

Subjective Assessment

Key symptoms & clinical features

Chest painClarify location (retrosternal, left-sided, radiating to neck/arm), triggers (effort, rest, nocturnal), intensity, quality (pressure, burning, stabbing), duration, aggravating/relieving factors (exertion, rest, nitrates), radiation (left arm, jaw, back), and associates (dyspnoea, diaphoresis, nausea, palpitations, anxiety).¹

PalpitationsOnset context (rest, activity, stress), duration (seconds/minutes), and co-symptoms (dizziness, syncope, chest pain).¹

Dyspnoea

• Orthopnoea: breathlessness lying flat, eased by sitting.

• Paroxysmal nocturnal dyspnoea (PND).

• Exertional dyspnoea: with walking, stairs, light activity.

• Cough/wheeze presence.¹

OedemaTiming (AM/PM), response to rest/activity; ankles, feet, legs.¹

Risk factors & broader history

Family cardiac history, smoking, physical activity, diet, alcohol/substances; prior MI, heart failure, valve disease; social supports and daily activities. Consider claudication, paraesthesia, limb colour/temp changes, non-healing wounds.¹²

Objective Assessment

Aim: define clinical status precisely and inform planning, monitoring, and risk stratification. Focus on circulatory status, respiratory function, fluid balance, overload signs, and modifiable risks.

Physiological measurements

Height, weight, temperature, ECG, blood pressure, heart rate, central venous pressure (when available), fluid balance, and—where indicated—cardiac output, stroke volume, ejection fraction, pulmonary artery occlusion pressure (PAOP). Functional capacity can be profiled with CPET or graded exercise protocols (e.g., Bruce, Balke, Naughton).¹²

Clinical examination

Inspection: general appearance, posture, consciousness; skin colour/texture/temperature, diaphoresis, cyanosis, peripheral oedema; skin turgor for dehydration/overload. Assess neck vessels (carotid pulse, jugular venous pressure) for intravascular volume and filling status.¹

Palpation

Assess pulse quality and rhythm; apical impulse location, intensity, amplitude, duration (synchronous with carotid). Extremities: skin temperature/texture, pitting oedema, capillary refill, peripheral pulses (radial, femoral, popliteal, dorsalis pedis, posterior tibial).¹

Outcome Measures & Test Tools

• Borg RPE Scale: perceived exertion/dyspnoea to titrate training intensity.¹

• 6-Minute Walk Test (6MWT): submaximal functional capacity; validated in cardiac populations.¹

• Shuttle Walk Test: externally paced, progressive assessment of exercise capacity and rehab response.¹

• CPET: gold standard for integrated heart–lung performance (VO₂max, ventilatory response, anaerobic threshold, HR dynamics).¹

• Heart rate monitoring: rest and exercise—rhythm, rate, irregularities.¹

• Blood pressure: rest ± exercise—detect hyper/hypotensive responses.¹

• Central venous pressure (when indicated): filling pressure and fluid status, especially in heart failure.¹

Meticulous documentation ensures continuity and enables outcome evaluation and progression decisions.¹²

Sources:

1. Pryor, J. A. (Ed.). (2010). Physiotherapy for respiratory and cardiac problems. Royal Brompton Hospital, London, UK.

2. Fritz, D. PhD, APRN, FNP-BC, & McKenzie, P. MSN, APRN, ANP-BC. (2008). Cardiopulmonary Physiotherapy.