exercise physiology clinical application Flashcards

1
Q

factors affecting O2 supply

A

1) coronary blood flow
- perfusion pressure
- vascular resistance

2) O2 content

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2
Q

factors affect O2 demand

A

1) wall stress (P x r / (2h))
P = sys P
r = radius of LV
h = wall thickness

2) HR
incr # contraction, incr # ATP

3) contractility
incr by sympath stim

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3
Q

how does O2 extraction change with exercise

A

minimal incr O2 extract

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4
Q

factors decr O2 supply

A

Hypotension (MAP

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5
Q

factors affecting coronary vascular resistance

A

1) external compression
- intramyocardial pressure = highest in systole
- subendocardium more vulnerable

2) intrinsic regulation
- local metab (adenosine vasodilate)
- NO, EDHF (vasodilate) vs. endothelin 1 (vasoconstriction)
- alpha + b2 receptors

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6
Q

a

A

a

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7
Q

factors incr O2 demand

A

1) exercise
2) fever
3) acute HTN
4) emotional distress
5) cardiac disease (LVH)
6) drugs- amphetamines/cocaine

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8
Q

consequences of myocardial ischemia

A

1) angina
2) ST depression (decr intracellular K+)

3) decr systolic fxn, decr SBP
decr diastolic fxn, incr wedge pressure
mitral regurg

4) incr HR, BP (sympath)

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9
Q

what determines when O2 supply decr

A

severity of coronary stenosis

rest: need 90% stenosis
exercise: coronary blood flow decr with 70% stenosis

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10
Q

a

A

a

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11
Q

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A

a

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12
Q

what causes ST depression during exercise

A

decr intracellular K+ in subendocardium (early repol)

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13
Q

a

A

a

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14
Q

determinants of myocardial O2 demand with exercise (MVO2)

A

1) incr systolic BP, incr wall stress and contractility

2) incr HR

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15
Q

what is RPP

A

rate-pressure production

RPP = HRmax x SBPmax 
RPP = HR^2 x SV x SVR

HR is most important

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16
Q

equation for SVR

A

SVR = MAP/CO

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17
Q

define ischemic threshold

A

RPP where ischemia occur

inadequate supply to meet demand

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18
Q

what does ischemic threshold depend on

A

1) severity of coronary stenosis (fixed RPP)

2) abnormal coronary vasomotion (variable RPP) = varying activities causing angina

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19
Q

more severe ischemia occurs at ___ RPP

A

lower RPP

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20
Q

relationship btwn workload and RPP

A

incr workload, incr RPP LINEARLY

until threshold –> when supply can’t meet demand

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21
Q

effect of beta blocker on MVO2

A

can exercise longer time and do more work before reach SAME RPP

22
Q

effect of PCI on MVO2

A

can INCR RPP

23
Q

exercise testing protocols

A

1) staged

2) ramp = gradual incr in HR and BP (RPP)

25
how does severe myocardial ischemia affect SV during exercise
decr SV with incr workload exertional hypotension ~ severe CAD
26
what happens if you have decr HR response during exercise
chronotropic incompetence = severe CAD
27
define chronotropic index
how abnormal patient's HR is normal > 80% more severe CAD, decr max HR
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Benefits of exercise training on coronary artery physiology for patients with CAD
1) incr peak VO2, incr peripheral O2 extract, incr SV 2) decr sympathetic and decr HR/BP at submaximal exercise, decr myocardial VO2 3) no change in total body VO2
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31
how does exercise affect peak VO2
1) decrease metabolic activity (decr myocardial O2 demand) 2) can do more work before reach ischemic threshold 3) decr RPP 4) minimal incr in O2 extraction
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34
effect of exercise on altering ischemic threshold in CAD patients
1) uncommon to alter threshold- 2) High RPP when ischemia occurs 3) incr myocardial perfusion 4) less vasoconstriction
35
people with CAD ____ more than people without during exercise
vasoconstrict
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37
mechanisms of improved perfusion with exercise training (4 things)
1) corrects endothelial dysfunction 2) regress atherosclerosis 3) collaterals 4) vasculogenesis by bone marrow stem cells
38
if reach anaerobic threshold sooner, then ___
more CAD
39
what is RER
RER = respiratory exchange ratio = ratio btwn CO2 production | and O2 consumption, —> high intensity exercise (anaerboic sooner)
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43
equation for VO2 in terms of CO
VO = CO x a-v O2
44
equation for CaO2 or CvO2
CaO2 = [Hgb] x 1.34 x O2 sat
45
why to use exercise training in chronic systolic HF
1) assess functional limitations 2) predict prognosis in severe HF 3) pre-transplant eval
46
hemodynamics of LV systolic dysfunction at rest
1) incr HR, incr EDV, ESV, incr preload and afterload 2) decr SV, LVEF 3) normal or decr CO
47
hemodynamics of LV systolic dysfunction at exercise
1) limited incr CO, SV, HR, HR reserve (peak - rest) 2) high cardiac filling P = dyspnea 3) limited vasodilation
48
what is HR reserve
peak HR - rest HR narrowed with CAD because resting HR higher to compensate for lower SV and decr peak HR due to abnormal sympathetic
49
peak VO2 is more closely related to ___
cardiac output than O2 extraction so good assessment with stress test in HF
50
___ is more closely related to cardiac output than O2 extraction
peak VO2
51
functional HF class based on VO2 correlates with ___ patients
chronic heart failure
52
___ influences 1 yr survival in patients with severe LV systolic dysfunction
peak VO2 decr peak VO2, decr survival with systolic HF