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Clinical Exercise Prescription > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Outline 2 key studies advocating the benefits of exercise for health

A

Paffenbarger- Harvard Alumni - 27% lower mortality if expending >2000 calories a day
Blair - fitness lowers mortality

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2
Q

Quantify the benefit of increased MVPA

A

Extra 10 mins approximately - 10% reduction in mortality
150 MVPA a week - 30-40% less
750 - 50% less

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3
Q

What conditions has strong evidence for the benefit of exercise?

A

CHD, stroke, HTN, hyperlipidaemia, type 2 diabetes Mellitus, metabolic syndrome, colon cancer, breast cancer, depression

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4
Q

What conditions have moderate evidence for physical activity?

A

Hip fracture, lung cancer, endometrial cancer

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5
Q

How much exercise should children do a day?

A

60 minutes minimum

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6
Q

Define preload and afterload

A

Blood in ventricles before contraction - EDV

Blood in ventricles after contraction - ESV

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7
Q

How do you calculate stroke volume, ejection fraction and shortening fraction?

A

Preload - afterload
((EDV - ESV) / EDV) * 100
((EDD - ESD / EDD) * 100

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8
Q

What 3 factors affect HR

A

SNS
PNS
Adrenaline

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9
Q

What 2 factors affect afterload?

A

Contractility

Systemic vascular resistance

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10
Q

What 2 factors affect contractility?

A

Myocardial mass

Length-tension relationship of myocardial fibres

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11
Q

What 4 factors affect preload?

A

Ventricular size
Venous size
Ventricular plasticity
Length-tension relationship of myocardial fibres

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12
Q

What 2 factors affect venous return?

A

Blood volume

Pumps- muscular/respiratory/ventricular

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13
Q

How much blood does the average adult have? Where is most of it?

A

5L

2/3 in veins

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14
Q

What organs use the most blood at rest and during exercise?

A

27% liver and 22% kidneys

84% muscles

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15
Q

What is the main blood vessel that determines vascular resistance? Outline the process of it’s vasodilation

A

Arterioles

Endothelium releases NO due to autonomic stimulation, which penetrates the smooth muscle and causes dilation

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16
Q

What stimulates vasodilation?

A

Increased: NO, bradykinin, prostaglandins, K+, CO2, lactate
Decreased: pO2

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17
Q

What stimulates vasoconstriction?

A

Increased SNS activity, releasing noradrenaline causing the alpha receptors to constrict

18
Q

How does exercise increase venous return?

A

Muscles contract
Increased SNS
Constriction of venous smooth muscle

19
Q

What is the effect of respiration on venous return

A

Expiration - increase thoracic pressure - push blood to heart
Inspiration - decrease thoracic pressure - pull blood to heart

20
Q

What affects afterload?

A 
Volume of blood in arteries
Pressure in aorta
Compliance of aorta
Size of aorta/pulmonary arteries
Inertia of blood
Total peripheral resistance
21
Q

What is the effect of increased afterload?

A

Decreased stroke volume - increased preload
Decreased velocity of contraction and ejection
Increased O2 consumption

22
Q

What triggers the cardiovascular response to exercise? Where are they? How do they work?

A

Mechanoreceptors - muscle spindles - detect stretch and increase SNS
Metaboreceptors - muscle spindles - detect raised lactate/prostaglandin/phosphate/acidity and increases SNS
Baroreceptors - carotid sinus and aortic arch - increased arterial stretch and so lowers SNS, raises PNS thus lowering BP
Chemoreceptors - carotid sinus and aortic arch - raised CO2 cause raised SNS
Bainbridge reflex - more RA filling causes stretch causing increased SNS

23
Q

What are the branches of the left and right coronary artery?

A

Left anterior descending, left marginal artery, left circumflex

Right marginal artery and posterior interventricular arter

24
Q

What are the limits to coronary perfusion?

A

Tachycardia
Low diastolic pressure
Ischaemic heart disease

25
Q

Outline the process of atherosclerosis

A

Endothelial injury - fatty streak - macrophages invade and become foam cells -
either: necrosis - calcium infiltrate - hardening of artery
Or: growth factor - smooth muscle cover - stable/unstable plaque - occlusion

26
Q

What coronary artery is responsible for: anterior, septal, lateral, inferior, posterior, atrial MI?

A 
LAD
LAD
LCx
RCA
RCx
RCA
27
Q

What factors can lead to endothelial injury?

A 
Normal wear and tear
Fibrinogen
Free radicals
HTN a
Turbulent flow
Viral
Carbon monoxide
28
Q

How does an unstable plaque lead to an MI?

A

Plaque ruptures - platelet aggregation - thrombus - occlusion - distal ischaemia

29
Q

Where would the MI be if the LAD, Right coronary/marginal or LCx was occluded?

A

Anterioseptal
Inferior and right hand side
Lateral

30
Q

How does an unstable angina differ from a stable angina?

A

Pain at rest/with less provocation and is more painful
May have a thrombus
May have biological markers

31
Q

What are the ECG changes associated with ischaemia, injury and infarction?

A

T wave inversion +/- ST depression
T wave inversion and ST elevation
Pathological Q waves

32
Q

Explain the mechanism behind ECG changes in ischaemia and injury

A

Slow to repolarise and remains more positively charged

Delayed depolarisation and tall T waves due to potassium leakage from dead cells

33
Q

Outline the stages of change in an ECG after an MI

A

Normal - Tall T waves - ST elevation - Pathological Q waves and T wave inversion, less ST elevation - Pathological Q waves and upright T waves

34
Q

What is the 1 year mortality for an MI in: proximal LAD, middle LAD, distal LAD, Left circumflex, small inferior

A 
25
12
10
8
7
35
Q

When do cells start dying and when are 80% and 100% of cells dead?

A

30 minutes
3 hours
6 hours

36
Q

Why do enzymes leak and what determines when they leak?

A

Cell dies so holes appear in the cell membrane

Size and solubility

37
Q

Name 3 enzymes that are looked for after an MI, the reference range, when they initially appear, when they peak and how long they remain elevated for

A

Troponin - <0.004ng - 4-6 hours - 12-24 hours - 6-8 days
CK - 14-179IU - 4-6 - 12-36 - 3-4
CK-MB - <10.4ng - 4-6 - 12-24 - 2-3
LDH - 105-333IU - 8-12 - 48-72 - 7-10

38
Q

Initial treatment of MI

A

Morphine, oxygen (sometimes), GTN spray, aspirin

39
Q

List some medication to be taken after an MI

A

Heparin, beta blockers, ace inhibitors, calcium channel blockers, statins

40
Q

What is the WHO’s definition of health?

A

A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity

Clinical Exercise Prescription (12 decks)

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