Final exam Flashcards
Acute stroke vs Transient Ischemic Attack
Both involve neurological symptoms, but TIA can not be imaged as is generally shorter in duration, with symptoms disappearing after an hour.
__% of stroke patients experience mod to severe disability.
40%
Someone who has a stroke has _% chance of experiencing a second one within __ years,
30%, 5 years
Two types of stroke
Ischemic (80%) and hemorrhagic
Main clinical treatment targets for HFrEF
Lower blood pressure
Reduce blood volume
Improve perfusion to improve contractility
Main effects of angiotensin 2
Increases SNS activity, constricts blood vessels, and increases sodium and water absorption (directly and indirectly through the release of aldosterone and ADH)
Sympathetic vs parasympathetic innervation of the heart
Parasympathetic routes act only on the SA node and AV node to slow HR, while sympathetic routes act on the nodes to increase HR and directly on myocardial tissue to increase inotropy.
ACE inhibitors. What do they do and what is the effect?
ACE inhibitors act on angiotensin converting enzyme to decrease A2 production. Decreases all the actions of A2.
“pril” drugs
ACE Inhibitors
Beta-blockers function and effect
Block the sympathetic influence on the heart, decreasing contractility and HR.
“lol” drugs
Beta-blockers
MCRAs (Mineralocorticoid receptor antagonists) function and effect.
Block aldosterone’s actions, reducing reabsorption of Na and promotes diuresis.
“one” drugs
MCRAs
Diuretics function and effect
Promote appropriate plasma levels.
“ide” drugs
Diuretics
A2 receptor blockers function and effect
Block receptors for A2 in the vasculature to prevent constriction and blood pressure. Used by patients with ACE inhibitor side effects.
“sartan” drugs
A2 receptor blockers
AR-Neprilysin blockers
Combo of A2 receptor blocker and neprilysin blocker which reduces degradation of BNP and ANP
Funny channel blocker Ivabradine
Used for those on beta-blockers with HR over 70. Acts on the SA node to decrease HR without affecting contractility.
What pharmaceutical treatments are available for HFpEF?
None. This type of HF has permanent structural damage, so the treatment focus become underlying conditions and comorbidities + diuresis to reduce congestion.
Implantable cardioverter defibrillator (ICD)
Implant able to give small shocks to correct arrhythmias or larger shocks for defibrillation.
Cardiac resynchronization therapy (CRT)
Pace maker sets rhythm of the heart. Used when individuals have QRS widening and EF
Coronary revascularization
Removal of veins from the lower leg to bridge blockages in the heart’s vasculature.
How is CKD classified?
Based on GFR. Above 60 ml/min is considered normal, 15-60 is kidney disease, and below 15 is failure
What are the two main causes of CKD?
Diabetes and hypertension
What is PD?
A condition occuring when the cells producing dopamine die. Common symptoms include resting tremor, slow movement*, and hunched posture.
5 goals of clinical or exercise treatment of HF
Improve QoL, Improve staging, Improve FC, Decrease hospital admissions, and decrease mortality.
3 useful informations from stress testing in HF
ECG (ST depression indicating ischemia), Hemodynamics (HR, SBP), Symptoms (angina, SOB)
Training can increase VO2 peak by __-__%
15-20%
Central adaptations to EX in HF patients
- Eccentric hypertrophy
- Increased vascularization
- Lower HR rest and submax
- Improved endothelial function
Peripheral adaptations to EX in HF patients
- decreased symp activity = decreased vasoconstriction
- Improved endothelial function
- Decrease anaerobic reliance
- Increase mitochondrial density
- Increase capillarization
What does the research say about EX outcomes in HF?
- No effect on 12 month all cause mortality (may have an effect >12)
- Improve QoL
- Decrease Hosp ads 12 months (not >12)
How long should someone be stable before doing IT?
2 months
How common is CKD?
1/10, but very few progress to failure and need dialysis (generally die of other factors first - CVD)
EX outcomes for PD
Decrease disease severity, Slow progression, Improve strength and exercise capacity, Improve balance and mobility.
Diagnosis cutoffs for diabetes?
HbA1C >6.5, resting plasma glucose >7, 2hPG 75ml >11.1
Exercise training in T1D vs T2D
Both can receive general benefits, but disease specific benefits are greater for T2D. Ex is also safer in T2D, and effective for decreasing insulin resistance. T1Ds should manage their blood sugar (Reduce insulin dose pre EX, consume CHO during EX) and check it often during exercise.
How does blood sugar normally respond to EX
Increases in high intensity, anaerobic exercise and decrease in aerobic exercise.
T2D exercise recommendations?
150 min/week, on 3 separate days, and no more than 2 consecutive days without EX. Strength training twice a week. IT can be effective. Supervise when feasible and those over 40 should receive a stress test before starting high intensity exercise.
