HTN and CAD

Question 1

hypertension

Answer 1

Blood pressure readings consistently over established guidelines

Question 2

Coronary Artery Disease

Answer 2

• Coronary artery disease is a common heart condition that involves atherosclerotic plaque formation in the vessel lumen. This leads to impairment in blood flow and thus oxygen delivery to the myocardium. (NIH)
• coronary artery disease (CAD) isa condition that occurs when the coronary arteries, which supply blood to the heart, become damaged or diseased.The main cause of CAD is a buildup of fat and cholesterol in the blood.This buildup can lead to a range of clinical disorders, including:asymptomatic atherosclerosis, stable angina, acute coronary syndrome, heart attack, and ischemic stroke (ACC)
• coronary artery disease (CAD) isa buildup of plaque in the heart’s arteries that can lead to a heart attack or ischemic stroke

Question 3

management of HTN

Answer 3

1) weight loss
2) aerobic exercise
3) limit sodium to <6 g/day
4) reduce alcohol
5) stop smoking –> reduce sympathetic stimulation of vessels
6) treat sleep apnea
7) pharmacotherapy
8) initial therapy

Question 4

hypotension/orthostatic intolerance disorders

Answer 4

• drop in blood pressure from supine to sit, sit to stand or supine to stand
• diagnosed by a sustained reduction in systolic blood pressure of at least 20 mmHg or diastolic blood pressure of 10 mmHg within three minutes of standing after being supine for five minutes or at a 60-degree angle on the tilt table
• common sx: lightheadedness, dizziness, falls, LOC, visual and cognitive disturbances, weakness and fatigue
• more common in older adults and women than men and younger people

Question 5

POTS

Answer 5

• postural orthostatic tachycardic syndrome
• symptoms are dizziness, fatigue, and lightheadedness
• rapid increase in heart rate of more than 30 beats per minute in adults or 40 beats for adolescents or a heart rate that exceeds 120 beats per minute within 10 minutes of rising
• symptoms are relieved by lying down again
• incidence increases with age, women>men
• menstrual cycles, infections&raquo_space;> COVID, major surgery, trauma; prolonged bedrest
• treatment - targeting low blood volume, Na+, hydration, some medication

Question 6

PT implications of orthostasis

Answer 6

• move LEs before standing
• move segmentally
• Valsalva if not contraindicated
• pressure garments

Question 7

PT implications of POTS

Answer 7

• pts with POTS tend to avoid exercise which leads to cardiovascular deconditioning
• aerobic reconditioning with some strength training (especially LEs)
• 75% maximum predicted heart rate or RPE around 13-15 in recumbent position to allow to acclimate to endurance training about 30 minutes 3-4 times per week
• slowly increase duration and intensity still in recumbent
• start to add upright but decrease intensity and duration
• add warm up and cool-downs

Question 8

Blood lipids

Answer 8

• HDL - high density lipoproteins
• “good cholesterol”
• HDL goal values:
  
  • men: >40 mg/dL
  • women: >50 mg/dL
• behaviors that raise levels of HDL: weight loss, smoking cessation, and increased aerobic exercise
• elevated triglycerides also reduce HDL- cholesterol and thus, increased the risk of MI

Question 9

LDLs

Answer 9

• low density lipoproteins
• “bad cholesterol”
• better predictor of MI risk than total blood cholesterol
  
  • high risk: 160-189 mg/dL
  • borderline: 130-159 mg/dL
  • optimal = < 100 mg/dL
• in the presence of heart disease, stroke, vascular disease, aneurysm, or type 2 diabetes, the ideal LDL cholesterol is less than 75 mg/d

Question 10

total cholesterol

Answer 10

• ration between the 2 types of cholesterol is more important than absolute values
• total cholesterol / HDL cholesterol
• the higher the ratio, the greater the risk
• ration between LDL and HDL
  
  • low HDL and High LDL > increased risk
  • can have a low total cholesterol and still be at risk due to low HDL

Question 11

PT role in CAD

Answer 11

• risk factor stratification
• prevention
  
  • exercise: aerobic, resistance training, HIIT, volume
• education on lifestyle changes both in primary and secondary prevention

Question 12

progression of CAD

Answer 12

• ischemic heart disease
• mismatch between myocardial O2 demand and supply
• imbalance results in cardiac hypoxia and accumulation of waste products most often the results of CAD
• myocardial O2 demand: ventricular wall stress (afterload); LV filling (preload); HR and contractility

Question 13

angina pectoris

Answer 13

uncomfortable sensation in the chest and neighboring anatomy as a result of myocardial ischemia

Question 14

ischemic heart disease - stable angina

Answer 14

• predictable pattern of transient chest discomfort
• pressure, tightness, squeezing, burning, heaviness (usually do not describe as pain)
• “elephant sitting on my chest”
• does not vary significantly with inspiration or movement of chest wall
• levine sign: clenched fist over sternum
• discomfort accompanied by tachycardia, diaphoresis, nausea and dyspnea (fatigue and weakness in older adults)
• relieved by cessation of the precipitating activity or condition within a short time < 20 minutes
• fixed, obstructive atherosclerotic plaque in one or more arteries, causing stenosis

Question 15

common triggers for stable angina

Answer 15

1) anemia
2) stress
3) physical exertion
4) extreme cold
5) heavy meals
6) high blood pressure