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Exercise Physiology > Cardiovascular Disease > Flashcards

Cardiovascular Disease Flashcards

1
Q

Cameron, Selig & Hemphill (2011), define a cardiovascular disease as…

A

Any detrimental condition of the myocardium, pericardium, heart valves, pacemaker and conductive tissues, or cerebral, coronary, and peripheral circulations thereof.

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2
Q

List three prevalent consequences arising from cardiovascular disease;

A

1) hypertension
2) coronary artery disease (CAD)
3) ischemia
4) chronic heart failure (CHF)
5) myocardial infarction (MI)
6) peripheral vascular disease (PVD)
7) peripheral arterial disease (PAD)

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3
Q

True or false: CVD is responsible for 35% of mortalities in Australia, with 1 in 4 people living independently with markers of this condition.

A

True

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4
Q

There are a number of KNOWN risk factors for developing CVD, these risks can be classified in three general categories. What are they?

A

1) metabolic risk factors
2) cardiovascular risk factors
3) behavioral and lifestyle risk factors

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5
Q

In your own opinion, what are some factors that would contribute to a significant reduction in chronic heart disease deaths?

A

List them on a piece of paper - understand why it is important to work towards such things…

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6
Q

Your client, a 59 y/o woman with no known heart condition, is referred to you for lifestyle intervention. She presents with an assessment summary from her GP:
Weight: 71kg; Height: 159cm; Waist: 89cm; BP: 139/91;
LDLs: 3.02mmol/L; HDL: 1.69mmol/L; BG: 6.89mmol/L
Currently completes 90minutes per week of moderate physical activity
Previously smoked (has since quit more than 6 months ago).

How many risk factors are present, and what are they?

A 
Age +1
BMI >25 +1
Waist +1
LDL +1
HDL -1
PA -1
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7
Q

What are the defining criteria for CVD risk?

A

Age - m>45; f>55 y/o
Smoker - 30kg/m^2; waist >102(m), >89(f) cm
Hypertension - SBP >=140mmHg, DBP >=90mmHg, or on hypertensive medication
Dyslipidemia - LDLs >3.37mmol/L; HDLs 5.18mmol/L, or on lipid-lowering medication
Pre diabetes - IFG between 5.55mmol/L and 6.94mmol/L, or IGT from OGTT > 7.77mmol/L and

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8
Q

True or False: Physical activity has been shown as an important factor in disease prevention for CVD, however it may progress already diagnosed cardiovascular conditions?

A

False: Regular PA has been shown to be primary preventative measure in unestablished conditions of the heart, and also a useful secondary prevention tool in clients with established CVD - to prevent new occurrence (second event), and relapse into old, negative habits, further progressing the condition.

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9
Q

Blood Pressure = Cardiac output multiplied by arterial pressure (T/F)
Cardiac output = Stroke Volume multiplied by Heart Rate (T/F)
Ejection Fraction = the difference between stroke volume and total chamber volume (T/F)
Tachycardia = HR

A 
T
T
T
F - >100bpm
T
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10
Q

What are three effects of hypertension on the cardiovascular system?

A

1) Reduced elasticity and hardening of vessels
2) Increased risk of blockage or rupture (aneurysm)
3) Increased workload of the heart chambers to move blood around body (cardiac afterload), leading to ventricular hypertrophy.

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11
Q

What are the ranges for pre-hypertension, stage 1, and stage 2 hypertension?

A

Normal - SBP 160, DBP >100

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12
Q

In your own words, what is Laplace’s law, with respect to hypertension?

A

The larger the vessel radius, the larger the wall tension required to withstand a given internal fluid pressure.
The larger the artery, the more wall tension required to withstand the same arterial pressure. Hence increased arterial pressure increases strain on arterial walls.

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13
Q

/Exam/ What are 3 lifestyle modifying treatments for hypertension?

A

1) At least 30 mins of moderate PA on most days.
2) Cease smoking.
3) Diet modification

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14
Q

Sharman & Stowasser (2009) identified what benefits of exercise with respect to aerobic and resistance training?

A

Regular aerobic or resistance training may result in a 3/3 - 7/6 mmHg drop in BLOOD PRESSURE.

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15
Q

It is important to consider the effects of a participant’s medication, and what other three factors when prescribing exercise for CVD clients?

A

Meds - Beta-blockers reduce VO2, heart rate and may impair thermoregulation (use RPE, and ensure hydrated)

Active cool down to avoid large drop in SBP which may cause syncope due to venous pooling.

HYPERtensive exercise response - SBP>250 or DBP>115 = terminate session, refer to Dr.

HYPOtensive exercise response - SBP drop>10 below resting value despite increased workload = terminate session and refer to Dr.

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16
Q

When do you delay exercise if you have a session with a client who has been diagnosed with hypertension?

A

ESSA recommends delaying exercise if resting BP is greater than or equal to 180/110 mmHg.

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17
Q

Ischaemia is a lack of blood supply to the myocardium? (T/F)

A

True - it results in the coronary arteries being unable to meet O2 demands of the heart and hence cause Angina/chest pain.

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18
Q

Class II AP is early onset chest pain with ordinary activity. What are the other 3 classifications of Angina Pectoris - AP?

A

Class I - no chest pain with ordinary physical activity, does occur with prolonged or strenuous exertion.

Class III - marked limitation of ordinary activity, Chest pain may be worse after meals, in the cold or when stressed.

Class IV - inability to conduct any physical activity without discomfort, Chest pain even occurs at rest.

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19
Q

Ischaemia lasting longer than 40 minutes typically causes a myocardial infarction (MI), T/F?

A

False - it only takes 20 minutes of constant ischaemia to provoke a MI.

20
Q

When monitoring for Ischaemia/Angina on an ECG, you may expect signs of ST elevation/depression and T-wave inversion, T/F?

A

True - however T-wave inversion may return to normal if the episode is not severe.

21
Q

PTCA, what is it?

A

Percutaneous Transluminal Coronary Angioplasty; coronary intervention to open up blocked arteries to allow for enhanced blood flow.

22
Q

CABG, what is is?

A

Coronary Artery Bypass Graft Surgery; surgical bypass of a coronary stenosis (narrowed/blocked section in a coronary artery), providing a new route for blood flow to that portion of the myocardium.

23
Q

In addition to medication and surgical repair options, exercise has been shown to protect against ischaemia by decreasing resting HR and SBP, in turn reducing myocardial O2 demand to below supply threshold, T/F?

A

True.

24
Q

Acute Angina, what do you consider with exercising?

A

Do not exercise, if present pre-session. STOP exercise if pain develops during session.

25
Q

Stable Angina, what do you consider with exercise?

A

Medical clearance, intensity at least 10bpm below angina threshold, and monitor with ECG or at least HR and RPE.

26
Q

What is Coronary Artery Disease (CAD) in your own words?

A

build up of plaque within the inner walls of coronary arteries due to progressive atherosclerosis.

27
Q

Atherosclerosis is hardening of arteries due to plaque build-up (a substance made of cholesterol, fats, cellular waste products, calcium and fibrin), T/F?

A

True - it is a type of arteriosclerosis which is the general term for thickening and hardening of arteries.

28
Q

What is a Myocardial Infarction (MI) in you own words?

A

blockage of blood to some heart tissue long enough to cause irreversible damage or tissue death.

29
Q

A MI may result in a number of cardiac problems, such as decreased contractility. What are 3 other problems arising?

A

1) decreased stroke volume
2) decreased ejection fraction
3) increased left ventricular end diastolic pressure
4) SA node arrhythmia
5) heart failure

30
Q

Reported signs and symptoms of MI trump all observations. Like chest pain, what are 2 other expected symptoms and signs a client may report?

A 
Shortness of breath
Feeling gassy (reflux-like symptoms)

It is also important to check ECG traces for ST elevation, T-wave inversion and a pathological Q wave (i.e. abnormally large).

31
Q

Lifestyle modification following MI may include what 3 top options?

A

smoking cessation (and alcohol if known issue)
blood lipid profile modification (dietary modification)
physical activity modification (regular exercise)

32
Q

When considering exercise for clients who’ve had a MI we look to reduce ____;
increase _____;
monitor decreased _____, as well as ______ arrhythmias.

A

reduce workload due to inhibited capacity resulting from reduced haemodynamics through the left ventricle (contractile force, stroke volume, ejection fraction);

increase rest periods due to altered autonomic function (HR response is increased);

monitor decreased blood pressure response as well as increased risk of ventricular arrhythmias.

33
Q

If you cannot monitor a MI client with an ECG, what five reactions to exercise must you monitor? HBOEF

A 
Heart rate
Breathing rate
Oxygen saturation
Effort
Feeling of dizziness/ light-headed/ confusion
34
Q

List 4 signs or symptoms of Chronic Heart Failure (CHF)

A

1) SOB
2) Peripheral Oedema
3) Irregular Pulse/ heart palpitaitons
4) fatigue and difficulty sleeping
5) weakness/ faitness
6) loss of appetite/ indigestion
7) weight gain (esp. abdominal area)

35
Q

CHF reduces CO, ventilation and peripheral blood flow, thus a client with this has a decreased exercise capacity. it is important to consider these when prescribing exercise as the client may succumb to ________ due to increased glycolysis and reduced oxidative phosphorylation.

A

Client may succumb to acidosis due to reduced O2 transport and increased demand on immediate energy stores.

36
Q

What is the AEP-Client Process/

A

1) gather info: interview and referral
2) determine risk: risk factor ID and stratification
3) baseline and limitations: health and fitness tests
4) prescribe exercise/refer: FITT guidelines or better AHP to see.

37
Q

What are some key physiological, observational and reported adverse signs and symptoms of a cardiac episode?

A 
Physiological:
tachy/brady/palpitations
hyper/hypotension
dizziness/ syncope/ light-headed
chest pain/discomfort spreading to neck, jaw, arms
severe breathlessness
general/localised fatigue
      Observable:
Flushed/pale skin
heavy/rapid chest movements
excessive sweating
       Reported:
feeling weak/dizzy/nauseous
heart palpitations/ chest or indigestion pain
difficulty conversing (SOB)
38
Q

Name 1 fitness test in each of CV, CR, Pul, Balance/Mobility, Flexibility, and Strength for assessing cardiac clients.

A

CV:
ECG; BP; HR; O2Sat
CR:
Submax VO2 - mod bruce; astrand; queens college
Pul:
FVC; FEV1; FEV1/FVC; Tidal Volume; Minute Vent
Balance/Mobility:
6MWT; TU&G; S2S; Stalk stand; multi-directional reach
Flexibility:
Joint ROM; S&R
Strength:
Dynamometer; timed P-ups/S-ups; 10RM; isokinetic str

39
Q

What are the Aerobic FITT VPP(Volume/Pattern/Progression) guidelines for CVD clients?

A

F: >5d moderate
I: mod and/or vig for most, light/mod for deconditioned
T: 30-60min purposeful mod (

40
Q

ACSM (2014) recommends a warm-up consisting of 5-10mins light/mod cardio and endurance activities, followed by at least 20-60 mins of conditioning in aerobic, resistance, neuromotor, and/or sport activities.
This should be followed by a 5-10mins colldown similar to the warm-up, and finished off with at least 10 minutes of stretching. T/F?

A

True, now re-read that prescription!

41
Q

Measurement of intensity for most cardiac patients should rely on a combination of RPE, and observable signs of stress due to medications they may be on, T/F?

A

True - RPE of 8-13 is ideal (light-mod)

42
Q

What are the Muscular Strength FITT S(Sets)PP guidelines for CVD clients?

A

F: major muscle groups 2-3d/week
I:60-70% 1RM (mod-vig) for novice-intermediate middle aged; 40-50%1RM (light) for older adults; 48hr between sessions
P: progress volume before resistance

43
Q

Drugs for Hypertension follow an ABCD pattern, which stand for…

A

A- Angiotensin-converting enzyme (ACE) inhibitors/ angiotensin II receptor blockers
B- Beta-blockers
C- Calcium channel blockers
D- Diuretics

44
Q

Describe the role of ABCD drugs for hypertension

A

A- lower blood pressure by decreasing systemic vascular resistance and inhibit bradykinin(vasodilator) breakdown.
B- prevent adrenergic acceleration of HR thereby reducing CO, BP, contractility and conduction.
C- decrease contractility, conducion, and vascular tone, thereby decreasing the same as above.
D- reduce fluid load thereby dropping BP.

45
Q

A typical drug prescribed to improve symptoms of Angina are nitrates, T/F?

A

True - these drugs are taken up by endothelial cells and convert to nitric oxide which promotes dilation of vessels, improving blood flow and decreasing preload.

Exercise Physiology (12 decks)

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