Final Exam Flashcards
what is the leading cause of serious illness and death in the United States
Cardiovascular disease
The death rate from cardiovascular disease is steadily declining since the 1960s. Why?
- improved public awareness and lifestyle changes
- better and earlier diagnosis
- better treatment options
what are the 4 main cardiovascular diseases
- Coronary Heart disease
- hypertension
- stroke
- heart failure
what type of cardiovascular disease accounts for half of the cardiovascular deaths
Coronary Heart Disease
Explain what Coronary Heart Disease is
- Progressive narrowing of coronary arteries
- fatty plaque formation
- atherosclerosis
- blood supply to myocardium compromised
- myocardial ischemia leads to angina pectoris
what can CHD lead to
myocardial infarction
- heart attack
- irreversible heart muscle cell death due to lack of O2
when does coronary heart disease and atherosclerosis first begin to develop
- begins in early life
- fatty streaks appear in infancy
- fatty streaks appear in coronary arteries in teens
- fibrous plagues develop in 20s
- results from a combination of genetics and lifestyle
define hypertension
1. high blood pressure 140/90mmHg 2. heart must work harder to eject blood 3. places greater strain on arteries 4. causes enlarged heart, scarred stiff arteries 5. eventually leads to atherosclerosis
what percent of the US population does hypertension affect
32%
According to the JNC8 guidelines, what are the recommended blood pressure values for:
- Age >=60
- General pop under 60
- Diabetic, all adults
- age greater than 60: SBP <150 DBP <90
- General pop under 60: SBP<140 DBP<90
- Diabetic: SBP<140 DBP<90
Hypertension is more common in what race
Black Americans
what do strokes affect
affects cerebral arteries by restricting brain blood flow
what is the most common type of stroke
ischemic stroke
what is an ischemic stroke
- obstructed cerebral artery limits O2 delivery
- cerebral thrombosis
- cerebral embolism
what is a hemorrhagic stroke
- intracerebral hemorrhage
- subarachnoid hemorrhage
- vessel in or on brain ruptures
- arises from aneurysms
- rupture causes ischemia and pressure on brain resulting in death of brain tissue
what is affected by a stroke on the right side of the brain
- vision problems and memory loss
2. quick, inquisitive behavior
what is affected by a stroke on the left side of the brain
- speech, language, memory loss
2. slow caution behavior
explain Heart Failure
- Chronic, progressive weakening of the heart
- Too weak to maintain cardiac output
- Results from damage to and overworking of heart
what causes heart failure
Hypertension is main contributor (75% of cases)
-other causes atherosclerosis, valve diseases, viral infection, MI
what does heart failure cause
edema and pulmonary edema
what type of cardiovascular disease ultimately requires a heart transplant
heart failure
what are the 3 other categories of cardiovascular diseases
- Peripheral Vascular disease
- Valvular diseases
- congenital heart disease
what are 2 types of peripheral vascular diseases
- arteriosclerosis
2. varicose veins
what are valvular diseases
- often from viral infections
2. rheumatic heart disease
what does congenital heart disease potentially affect
aorta
valve
septum
what makes up the layers of the vessel walls
- Tunica intima: endothelium
- Tunica Media: smooth muscle cells and elastin
- tunica adventitia: collagen
what was the early theory regarding coronary heart disease
initial injury to endothelium
- Platelets, monocytes adhere to injury (PDGF)
- Smooth muscle cells and lipids migrate to intima
- Collection of debris in intima plaque
what is the recent theory regarding coronary heart disease
Monocytes attach between endothelial cells
- Become macrophages
- Ingest oxidized LDL-C
- Become large foam cells, form fatty streaks
- Endothelial cells slough off
- Expose underlying connective tissue
- Allows platelets to attach
- Endothelial injury not always precipitating event
where does endothelial injury or disruption come from
- High blood LDL
- Free radicals from cigarette smoke
- Hypertension
- High plasma homocysteine
- Infectious microorganisms
what disease is now considered to be a inflammatory disease
atherosclerosis
what are the 4 uncontrollable CHD risk factors
- heredity
- race
- sex
- age
what are the 6 controllable CHD primary risk factors
- tobacco smoke
- hypertension
- abnormal blood lipid profile
- physical inactivity
- obesity
- diabetes
what are the 7 controllable risk factors for hypertension
- Insulin resistance
- Obesity, overweight
- Diet (sodium, alcohol)
- Tobacco use
- Oral contraceptives
- Stress
- Physical inactivity
which is more important when trying to decrease risk for CHD: physical activity of fitness
physical activity
if you ran 6mph for 1 hour per week, how would that affect your risk for CHD
decrease by 42%
if you weight trained for 30 min per week, how would that affect your risk for CHD
decrease by 23%
if go for a brisk walk 30 min per day how would that affect your risk for CHD
decrease by 18%
what are the 4 physiological adaptations to exercise that may reduce the risk for CHD
- increased contractility via LV hypertrophy
- increase diameter and capacity of coronary vessels
- increase endothelial function and vasodilation
- decrease vascular inflammation
what effects does exercise have on CHD risk factors (7)
- lower bp
- lower LDL
- higher HDL
- lower total cholesterol relative to HDL
- decreased inflammation
- increased endothelial function
- increased insulin sensitivity
exercise exerts biggest effect on what risk factor
blood lipid profile
what are 3 physiological adaptations to exercise regarding hypertension
- increased plasma volume
- decrease in overall sympathetic nervous activity
- increase vasodilation and vascular remodeling
what 3 risk factors does exercise decrease regarding hypertension
- decrease body fat
- decrease blood glucose levels
- decrease insulin resistance
what is the risk of a heart attack and death during exercise
- very low, 1 death in 396,000 person hours of exercise
2. habitual exercise decreases risk of death
how does aerobic exercise help prevent future complications with patients who have heart disease
- increase capillary muscle fiber ratio
- increase plasma volume
- increase or maintain O2 supply to heart
- increase blood flow to heart
- increase LV function
what does a comprehensive program for patients with cardiovascular disease consist of
- exercise
- counseling (nutritional, psychological, sexual)
- support forums
by what percent does exercise rehabilitation improve outcomes for mortality and death
- 20% lower total mortality
2. 26% lower risk of death from subsequent MI
definition of being overweight
- Body weight exceeds standard weight for given height and frame size
- Not precise terminology
- Does not account for body composition
definition of obesity
- Excessive body fat (men >25%, women >35%)
2. Borderline obese: men 20 to 25%, women 30 to 35%
what are the overweight and obese classifications for BMI
- Overweight: 25.0 to 29.9 kg/m2
2. Obese: 30.0+ kg/m2
how has the prevalence of overweight and obesity changed over the years
- prevalence of overweight has not changed much
2. obesity continues to increase
in what age range has the prevalence of obesity decreased
2-5 year olds
how does age affect fat mass and lean body mass
increases fat mass
decrease body mass
on average, how much weight does a person over the age of 25 gain per year
.7-1 pound per year
what are 3 factors controlling body weight
- hormones
- appetite
- energy expenditure changes in response to weight loss or decreased intake
what are 3 ways the body may use to regulate around a set point
- RMR
- TEM
- TEA thermal effect of activity
define RMR
Body’s metabolic rate in the early morning
60 to 75% of total energy expenditure
define TEM
Energy expended to digest, store nutrients, etc.
10% of total energy expenditure
May be defective in obese individuals
define TEA
Energy expended to accomplish activities
15 to 30% of total energy expenditure
the balance of RMR TEM and TEA helps in what 3 ways
- helps body adapt to increase or decrease kilocaloire intake
- controlled by sympathetic nervous system
- key for maintaining weight around set point
what are 3 physiological factors affecting obesity
- heredity/genetics
- hormonal imbalances
- altered basic homeostatic mechanisms
3 lifestyle factors affecting obesity
- cultural habits
- inadequate physical activity
- improper
obesity and being overweight are associated with what 6 things
- Cardiovascular disease
- Type 2 diabetes
- Cancer (endometrial, breast, colon)
- Liver, gallbladder disease
- Osteoarthritis
- Sleep apnea
what are the 2 types of body fat distribution and what genders are associated most with them
- upper body (android) men
2. lower body (gynoid) women
what measurement identifies fat distribution
waist hip girth ratio and visceral fat index
which of the 2 body fat distribution types have a higher risk for CVD, elevated blood lipids, and diabetes
android
what 8 things does weight loss reduce the severity of
- Angina pectoris
- Hypertension
- Congestive heart disease
- Heart attack recurrence
- Varicose veins
- Diabetes
- Orthopedic problems
how do hormone treatments for weight loss work
- decrease appetite
- increase RMR
- serious side effects, life threatening
what are the surgical treatments for weight loss
- intestinal bypass
2. gastri banding or bypass
how does EPOC affect metabolism
increases post exercise metabolism
what are the body mass and composition changes with exercise
- decrease total weight
2. decrease fat mass
what effect does exercise have on RMR
may increase RMR with training
exercises effect on TEM
pre and postmeal exercise increases TEM
2. chronic exercise training inconclusive
exercises effect on fat mobilization
- during exercise FFA mobilization increases
2. possible causes: hGH, sympathetic stimulatino
what range of VO2 max does fat oxidation rates reach peak
55-72% VO2 max
what is Type I diabetes
- autoimmune (B-cells destroyed, no insulin
- insulin dependent diabetes
- 5-10% of all diabetes cases
What is type 2 diabetes
- Loss of insulin sensitivity (insulin resistance)
- Non-insulin-dependent diabetes mellitus (NIDDM)
- 90 to 95% of all diabetes cases
who develops gestational diabetes and how common
develops in pregnant women
4% of pregnancies
what are the 2 types of glucose tolerance tests
oral and intravenous diagnostic tests
signs of type 1 diabetes
- Excessive urination, thirst
- Weight loss, extreme hunger
- Fatigue, irritability
Signs of type 2 diabetes
- Any type 1 symptom
- Persistent infections, sores
- Vision changes
- Tingling, numbness in limbs
what 6 health problems can diabetes cause
- cardiovascular disease
- kidney disease
- neural disease
- eye disorders
- dental disease
- amputations
3 treatments for type 1 diabetes
- insulin administration
- diet
- exercise
4 treatments for type 2 diabetes
- weight loss
- diet
- exercise
- recently developed drugs
how does physical activity affect type 1 diabetes
- exercise complicates glycemic control
- hypoglycemia a risk
- can lead to unacceptable plasma glucose fluctuations
how does physical activity affect type 2 diabetes
- Exercise enhances insulin sensitivity
- Muscle contraction mimics insulin action
- Lowers blood glucose
- Decreases insulin requirement
- Short-term (72 h) effect
