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Cardiac rehabilitation > Altered exercise response of CHD patients > Flashcards

Altered exercise response of CHD patients Flashcards

1
Q

what are the 6 components of comprehensive cardiac rehabilitation programme?

A
  • Exercise training
  • Psychological and stress counselling
  • Dietary advice
  • Advice on medications and treatments
  • Advice on risk factor modification
  • Facilitation social reintegration
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2
Q

how much does an exercise based cardiac rehabilitation programme reduce cardiac mortality?

A

10-36%

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3
Q

how much does an exercise based cardiac rehabilitation programme reduce reinfarction?

A

20-50%

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4
Q

what are the 3 main guidelines from the NICE 2013 rehabilitation guidelines?

A
  • designed to motivate people
  • being the programme as soon as possible
  • provide a range of options
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5
Q

when does post MI/PTCA rehab start?

A

2-4 weeks later

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6
Q

when does post CABG rehab start?

A

4-6 weeks later

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7
Q

what consists in stage I of cardiac rehabilitation? (4)

A
  • assessment of physical, psychological and social needs for cardiac rehabilitation
  • advice on lifestyle
  • prescription of medication
  • provision of information about cardiac rehabilitation
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8
Q

what consists in stage II of cardiac rehabilitation? (2)

A
  • comprehensive assessment of cardiac risk

- provision of lifestyle advice and psychological interventions

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9
Q

what consists in stage III of cardiac rehabilitation? (2)

A
  • structured exercise sessions

- maintain access to relevant advice and support from people trained to offer advice

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10
Q

what consists in stage IV of cardiac rehabilitation? (3)

A
  • long-term follow-up in primary care
  • offer involvement with local cardiac support groups
  • referral to specialist cardiac, behavioural pr psychological services as clinically indicate
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11
Q

what is the best single measure of an individuals cardiorespiratory fitness?

A

peak oxygen uptake

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12
Q

what is the equation for peak oxygen uptake?

A

oxygen uptake = cardiac output x aterio-venous difference

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13
Q

how much lower is the peak VO2 of cardiac patients?

A

50% lower

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14
Q

what is the relationship between VO2 and mortality?

A

inverse relationship

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15
Q

how much does 1mL.kg-1.min-1 increase in aerobic capacity reduce CV mortality risk by?

A

10%

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16
Q

how much does 1 MET increase in aerobic capacity reduce CV mortality risk by?

A

15%

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17
Q

why is peak VO2 decreased? (2)

A
  • decrease in cardiac output

- decrease in stroke volume

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18
Q

what is the core reason SV decrease in cardiac patients (2)

A

scarring/ischaemia

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19
Q

how does a decrease in SV effect TPR?

A

greater TPR

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20
Q

what is hypokinetic?

A

decreased movement due to lack of oxygen

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21
Q

what causes the myocardium to become hypokinetic in cardiac patients? (2)

A
  • subnormal production of endothelial nitric oxide

- localised overproduction of endothelin

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22
Q

how much of the blood resides in the veins at rest?

A

two thirds

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23
Q

what is the Visceral blood flow as % resting value for normal and cardiac patients?

A 
normal = 20%
cardiac = 50%
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24
Q

what 4 characteristics do cardiac patients have?

A
  • lower peak VO2
  • lower peak work rate
  • work at a higher percentage of maximum during sub maximal exercise
  • lower VO2 during sub maximal exercise
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25
Q

what resting SBP should be excluded from the exercise part of cardiac rehab?

A

> 200mmHg

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26
Q

what is eccentric hypertrophy of the heart?

A

much greater increase in chamber dimension increase in myocyte length, increase is myocyte width

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27
Q

what is concentric hypertrophy of the heart?

A

much greater increase in wall thickness increase in myocyte length < increase in myocyte width

28
Q

what is physiological hypertrophy?

A

proportional increase in chamber dimension and wall thickness

29
Q

what is La Place’s Law?

A

T = (P * R)/M

30
Q

how do we keep the wall tension the same around the heart?

A

the radius and the wall thickness must be proportional

31
Q

what 3 factors affect myocardial oxygen consumption?

A
  • tension development
  • myocardial contractility
  • heart rate
32
Q

what causes cardiac growth?(2)

A
  • Hormones

- mechanical stress

33
Q

how does NE and Epinephrine cause cardiac growth?

A

stimulation of alpha and beta receptors on the myocardium cause cardiac growth

34
Q

how does RAA cause cardiac growth?

A

increased RAA levels stimulate cardiac myocytes to hypertrophy

35
Q

what hormones cause cardiac growth?

A
  • NE and Epinephrine
  • RAA
  • GH and IGF
  • Thyroid hormones
36
Q

how does GH and IGF cause heart growth? (2)

A
  • stretching of the heart muscle trigger for these muscles to activate gene expression
  • IGF increases myofilament sensitivity to calcium thus increase calcium forces
37
Q

how does thyroid hormones cause cardiac growth?

A

Thyroxin causes myocyte hypertrophy

38
Q

how does pressure overload lead to increase in cardiac muscle?

A

pressure overload = increase resistance = hypertrophy through increase cross sectional area

39
Q

how does volume overload lead to increase in cardiac muscle?

A

increase volume overload = hypertrophy through increase myocyte lengthening

40
Q

how do mechanic-sensors in myocyte increase cardiac muscle?

A

surface receptors and stretch activated ion channels increase calcium influx -> activate protein kinase pathways thus hypertrophy

41
Q

what is angiogenesis?

A

the formation of new blood vessels

42
Q

what is the benefit of angiogensis?

A

increased blood flow

43
Q

how is contractility improved with aerobic training of cardiac patients?

A

improved % shortening, time to peak shortening, relaxation time

44
Q

what is the main ion that affects contractility of the heart and how?

A

calcium - increased calcium binding sites in myocytes and more calcium stored in SR

45
Q

how much does aerobic training increase stroke volume in cardiac patients?

A

0-18%

46
Q

how much does aerobic training increase blood volume in cardiac patients?

A

6-10%

47
Q

2 reasons why stroke volume increases in cardiac patients?

A
  • myocardial hypertrophy

- increased ejection fraction

48
Q

what happens to patients parasympathetic tone is cardiac patient with aerobic training?

A

it increases

49
Q

how does a decrease in blood viscosity occur in cardiac patients with aerobic training?

A

via a reduction in fibrinogen levels and platelet activation

50
Q

why is there a reduced endothelial dysfunction in cardiac patients undergoing aerobic training? (2)

A
  • improved NO production promotes vasodilation

- improved production of superoxide dismutase

51
Q

why is there an improved blood flow in cardiac patients undergoing aerobic training?

A

better endothelial function

52
Q

what happens in stroke volume during exercise in cardiac patients undergoing aerobic training?

A

max SV increases

53
Q

what happens in HR during exercise in cardiac patients undergoing aerobic training?

A

decrease in sub-maximal exercise HR

54
Q

what happens to myocardial oxygen demand during exercise in cardiac patients undergoing aerobic training?

A

decreases

55
Q

what 5 things increase in muscle in cardiac patients with aerobic training?

A
  • arteriovenous difference
  • mitochondrial number
  • maximal muscle blood flow
  • muscle capillary density
  • muscle fibre recruitment
56
Q

what happens to blood lactate concentrations during sub-maximal exercise in cardiac patients with aerobic training?

A

decreases

57
Q

what happens to peak VO2 in cardiac patients with aerobic training?

A

increases 10-50%

58
Q

what happens to total exercise capacity in cardiac patients with aerobic training?

A

increases 18-35%

59
Q

what happens to angina threshold in cardiac patients with aerobic training?

A

increases 10-20%

60
Q

what does RPP stand for?

A

rate pressure product

61
Q

what is the equation for RPP?

A

RPP = SBP x HR

62
Q

what is max exercise RPP?

A

25,000

63
Q

what activities during the first 48 hr following MI or cardiac surgery should occur?

A
  • arm and leg range of motion movement

- low resistance activities

64
Q

Activity post-discharge: weeks 1-6. Why? (3)

A
  • physiological benefits
  • increase physical self confidence
  • decrease dependency on others
65
Q

Activity post-discharge: weeks 1-6. what?

A

walk at a comfortable pace on a flat route

66
Q

what spray should a cardiac patient take with them when walking and what does it do?

A

GTN spray - coronary vasodilator

Cardiac rehabilitation (13 decks)

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