Cardiovascular Responses to Exercise and Exercise in Special Populations Flashcards

1
Q

screening before starting an exercise program

A
  • May be self guided → may help person determine if should consult MD (self guided questionnaires)
  • Professionally guided → Consult MD to determine safety of staring exercise program
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2
Q

Specific stratification for “apparently healthy patients” and for “cardiac patients”

A

– Low – Moderate – High

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3
Q

exercise should include warm-up and cool-down, and this is especially important for which CV patients?

A
  • Heart Transplants
  • Left Ventricular Assisstive Device
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4
Q

Abnormal responses to exercise:

A
  • Decreased HR
  • Decrease SBP more than 10 mmHg
  • Arrhythmia
  • Angina
  • Rales/crackles develop after exercise.
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5
Q

Contraindications to Exercise/Cardiac Rehab

A
  • Unstable angina
  • Resting SBP > 200 mmHg or resting DBP >110 mmHg
  • Orthostatic BP drop of > 20 mmHg with symptoms
  • Critical aortic stenosis
  • Acute systemic illness or fever (temp ≥ 101 F)
  • Uncontrolled atrial or ventricular arrythmias
  • Uncontrolled sinus tachycardia, >120 bpm
  • Uncompensated Congestive Heart Failure (symptomatic at rest)
  • 3rd degree Atrioventricular (AV) block (without pacemaker) “complete heart block”
  • Active pericarditis or myocarditis
  • Uncontrolled diabetes
  • ??? Recent embolism
  • ??? Thrombophlebitis
  • ??? Other metabolic problems like acute thyroiditis, hypo/hyperkalemia, hypovolemia, etc.
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6
Q

exercise on a patient with potassium levels bellow 3.2 mmol/L or above 5.1 mmol/L?

A

Increased risk for life-threatening arrythmias

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7
Q

Reasons to Stop Exercise:

A
  • Onset of angina or angina-like symptoms
  • Drop in SBP >10 mmHg from baseline despite increasing workload
  • Hypertensive response
  • Shortness of breath, wheezing, leg cramps or claudication (grade 3 on a 4 point scale)
  • Signs of poor perfusion
  • Failure of heart rate to increase with increased exercise intensity
  • Noticeable change in heart rhythm
  • Significant arrhythmias
  • ST displacement (> 2 mm horizontal or downsloping depression)
  • Patient request
  • Physical or verbal manifestation of severe fatigue
  • Failure of monitoring equipment
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8
Q

review

SYSTOLIC HEART FAILURE:

A
  • Decreased CONTRACTILITY
    • Likely due to loss of functional muscle from infarction OR process affecting myocardium
  • Increased PRELOAD
    • Likely due to valvular regurgitation
  • Increased AFTERLOAD
    • Likely due to HTN
  • Changes in CHRONOTROPY
    • Heart rate is too slow or too rapid

→ All these problems lead to PUMP FAILURE

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9
Q

review

DIASTOLIC HEART FAILURE:

A
  • Diastole may be impaired due to
    • Excessive hypertrophy of ventricles
    • Changes in composition of myocardium
  • EDV may be decreased due to decreased filling of the left ventricle due to increased
    stiffness
  • Decrease in compliance of the LV, at any EDV →leads to an increase in the ventricular
    pressure
  • Overall will usually see elevated diastolic pressures → may lead to decreased cardiac output
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10
Q

Exercise Considerations for Patients with CHF:

A
  • lower baseline BP (SBP 70-90’s mmHg), need ≥ 60mmHg for organ perfusion
  • Orthostatic hypotension
  • Look for decrease in SBP, fatigue, and SOB
  • Monitor lung sounds and peripheral edema for signs of increased failure
  • Awareness of patient’s weight for fluid overload
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11
Q

Left ventricle not working efficiently:

A

Increased left atrial dilatation→ Increased pressure in pulmonary vessels→ Transudation of fluid from pulm caps

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12
Q

if the right ventricle is not working effectively →

A

Prolonged pulm HTN → Increased right ventricle afterload → Anatomical changes to right ventricle (dilatation → possible hypertrophy) → Right ventricular EDP increases → Reflects back up to right atrium & venous system

May see JVD, liver engorgement, ascities, & peripheral edema

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13
Q

• Major determinants of BP:

A
  • CO
  • Peripheral resistance
  • Both factors have several determinants
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14
Q

HTN is Dx when SBP is ≥ ____ mmHg and/or DBP is ≥ ____ mmHg

A

140/90

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15
Q

Increased pressure on LV can create →

A

Left ventricular hypertrophy → diastolic dysfunction due to poor relaxation can occur

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16
Q

Most common complications of HTN:

A

– CVD
– CHF
– CVA
– Renal failure
– Aneurysm
– PVD/PAD
– Retinopathy

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17
Q

💡peak HR?

Exercise considerations for patients with HTN
Overtime changes?

A
  • 15-30% reduction in exercise capacity
  • SV increases abnormally and peak HR is lower
  • Moderate endurance training will elicit an average reduction of 5-7 mmHg for resting BP in people with HTN
    • Focus on aerobic training (ex: 10,000 steps)
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18
Q

exercise considerations for exercise in pt with resting SBP > 200 and/or DBP > 110 mmHg

A
  • Get MD clearance
  • Try to keep SBP ≤ 220 mmHg and/or DBP ≤ 105 mmHg with exercise
    • Consider UE endurance work over LE
    • Exercise should be terminated if BP > 250/110
19
Q

Exercise should be terminated if BP > _____

20
Q

what type of exercise is best for patients with PVD/PAD

A
  • ❗️Short, frequent bouts of activity with short rest periods when necessary
  • Work up to pain, then rest
  • Gradually increase exercise time
  • Walking is a good, functional activity
  • Swimming, rowing, biking (alternatives to walking)
  • Focus on low intensity, interval training
21
Q

💡 cold weather? pt education?

More exercise considerations for patients with PVD/PA

A
  • Cold weather can induce vasospasm
  • As pt progresses, watch out for other symptoms
  • Encourage lifestyle changes
  • Effects of medications
  • Improvement in exercise tolerance may unmask myocardial ischemia
    • These patients are at high risk for CAD
22
Q

exercise reduces or increases insulin secretion?

23
Q

exercise stimulates ______ production in the liver

24
Q

Exercise Considerations for Patients with DM

LOW BLOOD GLUCOSE – Below ______ = do not exercise

25
# Exercise Considerations for Patients with DM when glucose is less than 100mg/dL =
wait until glucose is at least 100 before initiating exercise
26
# Exercise Considerations for Patients with DM Type 1 DM: If glucose level greater than 250 mg/dL (fasting glucose level) Most sources say to test urine for ketones → If ketones present in urine then...
**avoid exercise**
27
Type 2 DM: If greater than 300 mg/dL some sources say to avoid exercise. Others say to use caution with exercise. If too high risk increases for
**Diabetic Ketoacidosis**
28
General exercise considerations for patients with DM
* **Important to monitor BG** * **Timing** **of exercise:** * Exercising late in evening increases risk of nocturnal hypoglycemia * Avoid exercise during periods of peak insulin activity * **Autonomic neuropathy** → in pt with DM this increases likelihood of CVD * **Retinopathy:** avoid SBP\>170 mmHg and excessive jarring activities
29
Athletes with DM (often type 1):
* Need to do intense monitoring * **Avoid exercising at time of peak insulin effect** (BG drops!) * May need a longer more gradual progression to a higher level of training * 5-10g carb snacks for every 30-45 min of prolonged exercise
30
Weight loss of _____ provides significant health benefits
5-10%
31
intensity in **obese** patient should be... goal?
* 50-60% * Goal of 45-60 min of low to mod intensity aerobics 3-5 days/wk
32
Renal failure and exercise
* Begin with low intensity & gradually increase based on patient tolerance * Use RPE as HR may not be reliable indicator of exercise intensity * Leg fatigue is common complaint
33
Marfan’s Syndrome:
* Connective Tissue Diseases * Cardiac manifestations may range from minimal to severe * Frequent issues with: • Valves • Aneurysms
34
**radiation** treatment of cancer can cause...
* Pericarditis, * MI—ischemia and infarction, * vascular injury, * myocardial fibrosis, * atherosclerosis, * pneumonitis
35
**chemotherapy** treatment in cancer can casue:
* Cardiomyopathy * later stage ventricular dysfunction * pneumonitis
36
radiation & chemotherapy can have affect on hematopoiesis:
* Anemia, thrombocytopenia, neutropenia/leukopenia * Depends on area being irradiated (lots of bone marrow or not)
37
Hot Environments: Exercise Considerations
* peripheral vasodilation * Increased HR * Dehydration → Decreased blood volume → may lead to ischemia
38
Cold Environments: Exercise Considerations
* vasoconstriction * Can cause increased arterial BP * Need to adequately hydrate despite lack of noticeable perspiration
39
High Altitude: Exercise Considerations
* Higher altitude → progressive decrease in atmospheric pressure → decreases partial pressure of O2 in inspired air →decreased arterial oxygen levels * May see: – Acute mountain sickness, high-altitude pulmonary edema, & high-altitude cerebral edema
40
hyperglycemia
41
hypoglycemia
42
peak insulin action time and exercise in patients with DM
**DO NOT EXERCISE** peak insulin = blood glucose is at its lowest
43
# 💡evening or mornings? when is the best timing to exercise with patients with DM?
* Exercising late in evening increases risk of nocturnal hypoglycemia * Avoid exercise during periods of peak insulin activity