Cardiovascular complaints

Question 2

Why is a decrease of 20 mmHg in diastolic pressure during performance testing considered a concerning indicator?

Answer 2

• A significant decrease in diastolic blood pressure suggests an abnormal drop in peripheral resistance.
• Since cardiac output is dependent on both the blood ejected by the heart and the resistance it faces in the blood vessels, a drop in this resistance could imply that the heart is not able to pump blood as efficiently as it should be during exercise. This inefficiency could be due to the heart pumping out more blood than the vessels can resist or manage, possibly indicating a dysfunction in the heart’s ability to respond to exercise stress.
• This abnormal decrease in diastolic pressure could be caused by various cardiovascular issues. It may indicate a problem with the heart valves (like aortic regurgitation), the heart muscle itself (such as in cardiomyopathy), or other conditions that affect how the heart pumps blood.
• Significance During Exercise: During exercise, the body demands more oxygen and nutrients, which requires an increase in cardiac output. If the diastolic pressure drops significantly, it suggests that the cardiovascular system is not adapting correctly to these increased demands. This can be a sign of underlying cardiac dysfunction that might not be apparent during rest.

Question 3

What is considered a normal response of blood pressure during exercise?

Answer 3

Systolic BP = 0,3 to 0,4 mmHg increase per Watt.
Diastolic BP = Remains constant or decreases slightly. A drop of 20mmHG during exertion is an alarm signal!

Question 4

What is considered a normal systemic MEAN ARTERIAL PRESSURE?

Answer 4

100 mmHg

Question 5

What is considered a normal pulmonary MEAN ARTERIAL PRESSURE?

Answer 5

15 mmHg

Question 6

Explain: INSULIN SENSITIVITY

Answer 6

How effectively the body responds to insulin, a hormone produced by the pancreas that regulates blood sugar levels. When cells are more sensitive to insulin, they are better able to take in glucose (sugar) from the blood for energy.

Question 7

What are the leading causes of cardiac death in the athletic population?

Answer 7

36% hypertrophic cardiomyopathy.
17% coronary artery anomalies.
8% left ventricular hypertrophy.
6% myocarditis.
4% arrhythmogenic right ventricular cardiomyopathy.

Question 8

Explain: CARDIAC FATIGUE

Answer 8

• Temporary decrease in the heart’s ability to maintain normal function during or after prolonged exercise.
• Drop in left ventricle ejection fraction (LVEF).
• (Well) trained athletes after > 6 hours up to 5% decrease.
• Untrained <3 hours up to 4% decrease.
• Changes in contractility, relaxation and systolic/diastolic ventricular function RV > LV).

Question 9

How long does it take to someone recover from cardiac fatigue?

Answer 9

Transient recovery in next 48 hours.

Question 10

Explain: ATRIAL FIBRILATION

Answer 10

• Due to increase in vagal tone.
• An irregular and very fast heart beat.
• Irregular impulses are originated elsewhere in the heart.
• Symptoms: Dizziness; breathlessness; fainting; palpitation; chest pain.

Question 11

How does prolonged and intense exercise leads to myocardial fibrosis?

Answer 11

Intense and prolonged exercise has been associated to adaptation in the heart such as myocardial fibrosis, which refers to the excessive deposition of collagen fibers in the heart muscle (myocardium).

Question 12

Which biomarker is used to diagnose cardyomyocyte death?

Answer 12

TROPONIN
- When cardiomyocytes are damaged or die, the cell membranes become disrupted, and cellular contents, including troponin, are released into the bloodstream. This release is a key indicator of heart muscle injury.
- Elevated levels of cardiac-specific troponins (particularly troponin I and T) in the blood are a hallmark sign of myocardial infarction and other forms of heart muscle damage. Blood tests for troponin are one of the primary diagnostic tools used in the evaluation of patients with suspected acute coronary syndrome.

Question 13

Explain: HYPERTROPHIC CARDIOMYOPATHY (HMC)

Answer 13

• Genetic disorder.
• Left ventricular hypertrophy without chamber dilation.
• ## Increased thickening/fibrosis of the left ventricular wall without a specific cause.

Question 14

Explain: HEAR FAILURE

Answer 14

Occurs when the heart is unable to pump enough blood to meet the demands of the body.

Question 15

What are the 2 types of hypertrophic cardiomyopathy?

Answer 15

(A) OBSTRUCTIVE: Ventricular wall and septum thickening. This can block (obstruct) blood flow from the left ventricle to the aorta (the body’s main artery). Reduced ejection fraction.
(B) NON-OBSTRUCTIVE: Ventricular wall thickening without blocking blood flow. Ejection fraction is maintained.

Question 16

Explain: DILATED CARDIOMYOPATHY

Answer 16

• The dilation and weakening of the left ventricle.
• Impairment of the heart’s ability to pump blood efficiently, leading to a decrease in cardiac output.
• Thinner ventricular wall, leading to a reduced ejection fraction and gradually increasing the end-systolic and end-diastolic volumes (dilation).

Question 17

Explain: Arrhythmogenic right ventricular dysplasia (ARVC)

Answer 17

• A progressive loss of myocardium and its replacement by fat and fibrotic tissue.
  T- he right ventricle stretches out (dilate), becomes thin and contracts poorly. As a result, the heart has a weakened ability to pump blood.