Lecture 20 Flashcards
Lecture 20:
What is the Prevalence of Cardiovascular Disease?
- 4 points
- it is the leading cause of death & serious illness
~48% of US adults;today have atleast 1 type of CVD
~18 million US deaths annually - over $350 billion in annual costs
Lecture 20:
What are some reasons for the decline in death rates of CVD since 1960’s?
1.) improved public awareness & lifestyle changes
2.) better & earlier diagnoses
3.) better treatment options
4.) projected 30% decline between 2010 & 2020
Lecture 20:
What are a few forms of Cardiovascular Disease?
1.) Coronary Artery Disease (CAD)
2.) Hypertension
3.) Stroke
4.) Heart Failure
5.) Other - peripheral, valvular, congenital, etc
Lecture 20:
How many deaths does Coronary Artery Disease account for?
CAD accounts for half of cardiovascular deaths
Lecture 20:
What is Coronary Artery Disease?
The progressive narrowing of coronary arteries
- plaque formation
- atherosclerosis
- compromised blood supply to myocardium
Lecture 20:
What can Coronary Artery Disease lead to & what is it?
Can lead to myocardial infarction which is a heart attack
- irreversible heart muscle cell death due to lack of O2
Lecture 20:
What is Atherosclerosis?
Begins early in life due to genetics & lifestyle
- it is the thickening/hardening of the arteries
—> fatty streaks when infant/child & in teen years spreads to coronary arteries & then turns to plaque in 20’s
Lectrue 20:
What is Hypertension & what % of adults have it?
High blood pressure - historically above 140/90 mmHg but updated to greater than 130/80 mmHg
- 46% of US adult population has hypertension
Lecture 20:
What are some negative associations of Hypertension?
Heart must work harder to eject blood which places greater strain on arteries
- causes enlarged heart & scarred/stiff arteries
- this eventually leads to atherosclerosis & MI
Lecture 20:
What is a Stroke & its 2 types?
Occurs when cerebral arteries are affected & blood flow to brain is restricted
- 2 types = Ischemic stroke & Hemorrhagic stroke
Lecture 20:
How many strokes occur per year in the US?
495, 000 annual strokes
Lecture 20:
What is an Ischemic Stroke?
- 2 causations
Most common type where O2 delivery to brain is limited by obstructed cerebral artery & can be caused by 2 things;
1.) Cerebral Thrombosis - blood clot in brain due to narrowing of cerebral vasculature
2.) Cerebral Embolism - blood clot in heart/upper chest
Lecture 20:
What is a Hemorrhagic stroke?
- intracerebral hemorrhage = deep within brain
- subarachnoid hemorrhage = in outer layer of brain & places pressure on it
- rupture of vessel in or on the brain
Often a result of aneurysm (secondary to hypertension or atherosclerotic damage)
Lecture 20:
What can a vessel rupture lead to?
Ischemia & pressure on brain tissue which leads to death of brain tissue
Lecture 20:
What are the results of a Stroke?
Results depend on what region of brain is affected
- paralysis on one side of brain = most common
- each side of body controlled by opposite side of brain
Lecture 20:
What are the results of having a stroke in the right brain?
Vision problems, memory loss, & loss of quick inquisitive behaviour & issues on left side of body
Lecture 20:
What are the results of having a stroke in the left brain?
Speech/language problems, memory loss, & slow, cautious behaviour
Lecture 20:
What is heart failure?
The chronic, progressive weakening of the heart/myocardium due to damage to the heart & overworking it
Lecture 20:
What does heart failure cause & what contributes to it?
The heart is too weak to maintain cardiac output & hypertension is a major contributor to heart failure
- Causes include; atherosclerosis, valve diseases, viral infection, MI, edema, pulmonary edema
Lecture 20:
What is an edema vs pulmonary edema caused by heart failure?
Edema = not enough blood pressure to bring blood back to the heart, resulting in blood pooling.
Pulmonary Edema = edema in lungs caused by vessels leaving the heart becoming too rigid
Lecture 20:
What is the only fix/cure to heart failure?
Heart transplant as myocardium must be replaced as heart muscles = too weak
Lecture 20:
What is Peripheral Vascular Disease?
Diseases in any vessel that isn’t a coronary artery
- eg; varicose veins = blood pools if these valves fail
- eg; phlebitis
- Peripheral Artery Disease (PAD)
Lecture 20:
What are Valvular Diseases?
Diseases that impact heart valves & typically develop from viral infections
- limit the ability of blood to move through the heart chambers
- eg; rheumatic heart disease
Lecture 20:
What is Congenital Heart Disease?
Congenital defects that you’re born with & has possible effects on aorta, valves, & septum
- septum = not properly formed so blood may move to other side of heart without going through lungs
Lecture 20:
What is Coronary Artery Disease (CAD)?
Impacted vessel walls due to atherosclerosis (inflammation of tunica intima) & plaque buildup
Lecture 20:
What are the 3 tunicas of the artery vessel wall & what are they made of?
1.) Tunica Intima = endothelium (vasodilators & vasoconstrictors)
2.) Tunica Media = smooth muscle & elastin (help regulate blood flow)
3.) Tunica Adventitia = collagen (supports & provides structure)
Lecture 20:
What does the inflammation from atherosclerosis cause?
Inflammation from atherosclerosis causes endothelial dysfunction;
- platelets/monocytes adhere to injured endothelium
- debris collects in intima & forms plaque
- lipids from blood deposit in plaque
Lecture 20:
What are the 4 steps of the swelling response of CAD?
1.) bloodborne irritant injures arterial wall & disrupts endothelial layer
2.) Blood platelets & immune cells (monocytes) adhere to exposed connective tissues at injury site & release migration substances
3.) a plaque composed of smooth muscle cells, connective tissues, & debris forms at injury
4.) plaque grows & narrows arterial opening, impeding blood flow
Lecture 20:
When discussing CAD, what does the endothelial injury/disruption come from?
- high blood LDL (lipid concentrate)
- free radicals from cigarette smoke
- hypertension
- high plasma homocysteine
- infection
Lecture 20:
What does plaque consist of in CAD?
- smooth muscle, inflammatory cells, lipids
- fibrous cap (thick or thin)
- thin caps = more unstable & easier to rupture
Lecture 20:
What % of MI’s do ruptures & throbosus’ account for?
70%
Lecture 20:
What is hypertension?
Constant high blood pressure levels & is poorly understood
Lecture 20:
What % of hypertension cases are idiopathic & which are secondary to other issues?
1.) 90-95% of hypertension diagnoses are idiopathic meaning occur on own & unsure of contributors
2.) 5-10% are secondary to other issues like; kidney disease, adrenal tumours, congenital defect of aorta, etc
Lecture 20:
What are 4 Uncontrollable risk factors for CAD?
1.) heredity/family history
2.) Race
3.) Sex (male>famale)
4.) Age
*goal is risk mitigation through controllable risk factors
Lecture 20:
What are some controllable CAD primary risk factors?
1.) tobacco smoke
2.) hypertension
3.) abnormal blood lipid profile (want more HDL’s & less LDL’s {cholesterol})
4.) physical inactivity
5.) obesity/overweight
6.) diabetes/insulin resistance
*as # of risk factors increases, so does risk of CAD
Lecture 20:
What are some controllable risk factors for Hypertension?
1.) insulin resistance (too much blood sugar or pancreas not releasing enough insulin to store sugars)
2.) obesity/overweight/diet/ inactivity
3.) tobacco use
4.) oral contraceptives (act on renin-angiotensin system which effects blood volume)
5.) stress
Lectrue 20:
How can physical activity help reduce risk of Cardiovascular diseases?
Moderate-vigorous PA aids with Cardiorespiratory fitness which reduces risk of developing cardiovascular disease
- no evidence for increased risk with more PA & no “ best” amount
Lecture 20:
What are 4 Physiological adaptations to exercise that may reduce risk of cardiovascular disease?
1.) increase contractility via LV hypertrophy
2.) increased diameter & capacity of coronary vessels
3.) endothelial function & vasodilation
4.) decreased vascular inflammation
*exercise improves ability of endothelium to regulate blood flow & enhance cardiac/vascular function
Lecture 20:
What are some risk factors that are lowered with exercise?
Exercise leads to;
- lowered blood pressures
- higher HDL cholesterol & lowered LDL cholesterol
- decreased inflammation
- increased endothelial function
Lecture 20:
What is the risk of heart attack & death during exercise?
Risk = very low; 1 death/396,000
*habitual exegesis = decreased risk of death by heart attack
Lecture 20:
What are the likely causes of death from heart attack based on age?
If under 35, death likely caused by genetic abnormalities or aneurysm
If above 35, death more likely caused by arrhythmia due to CAD
Lecture 20:
How does aerobic exercise help prevent future heart disease complications?
Aerobic exercise…
- increases capillary to muscle fibre ratio
- increases plasma volume e
- increases O2 supply & blood flow to heart
- increases LV function
Lecture 20:
How does resistance exercise help prevent future complications?
- decrease blood pressure & blood lipid values
- decreased body fat
- increases glucose control
- decreases stress
Lecture 20:
What is the optimal exercise trainign for reduced heart disease?
Combining resistance & aerobic training is optimal
Lecture 20:
What are the 3 elements of a comprehensive program for rehabilitation patients with heart disease?
1.) exercise & physical activity
2.) counselling (nutritional & psychological)
3.) Support Forums
