Lecture 6 Flashcards
common cardiovascular conditions
- Hypertension
- Coronary artery disease
- Heart failure
- Arrhythmias
- Valve disease
- TIA and stroke
Hypertension
- Hypertension – pathological increase in BP
- Systolic >140mmHg diastolic >90mmHg
- Isolated systolic hypertension:
- systolic >140 but diastolic <90
- Increased risk of stroke, kidney disease and heart disease
treament for hypertension
• Lifestyle change – diet, exercise, smoking and stress
• Medications – Angiotensin-converting enzyme (ACE)
inhibitors that relax blood vessels by preventing the
formation of a hormone called angiotensin, a substance in
your body that narrows blood vessels.
• Frequently prescribed:
• enalapril (Vasotec),
• lisinopril (Prinivil, Zestril)
• ramipril (Altace).
exercise for hypertension
• non-hypertensive (to reduce the possibility of becoming
hypertensive) or for hypertensive patients (to reduce their
BP):
• accumulation of 30-60 minutes of moderate intensity dynamic
exercise (e.g., walking, jogging, cycling, or swimming) 4-7 days per
week in addition to the routine activities of daily living (Grade D).
• Higher intensities of exercise are not more effective
(Grade D).
• For non-hypertensive or stage 1 hypertensive:
• resistance or weight training exercise (such as free weight lifting,
fixed weight lifting, or handgrip exercise) does not adversely
influence BP (Grade D).
coronary heart disease
• Atherosclerosis of coronary arteries • Decreases blood flow to cardiac muscle • Angina pectoris signals partial blockage (some dont feel any pain) • Complete blockage = myocardial infarction (heart attack) • death of portion of heart – doesn’t recover
fixing the problem: coronary HD
- Lifestyle changes
- Medicine
- Surgery
heart failure
• Inability of heart to maintain cardiac output sufficient to
meet metabolic needs of body
exercise for coronary HD
• Aerobic activity
• moderate intensity (RPE 3-5 or 65-85% max HR), or moderate
intervals (15-30 minutes with 15-30 minutes rest – RPE 3-5)
• 10 to 15 minutes 2-3 d/week working to 30 minutes 5 d/week
• Resistance training
• 10-20 reps using 5-10 lb free weight 2-3 days/week
• Flexibility
• Recommended
common arrhythmias
• Bradycardia – heart beats too slowly
• Tachycardia – heart beats too quickly
• Atrial fibrillation – atria do not contract completely with
each beat but “quiver”
how are rhythm disorders treated
Rhythm disorders are treated with medications,
cardioversion, ablation and a few other procedures
ventricular fibrillation
• The ventricles quiver and the heart can’t pump any blood,
causing cardiac arrest
• The heart’s electrical system becomes disordered and the
heart does not beat in one strong contraction
pacemakers
• Not enough O2 is pumped through the body by the heart
to meet metabolic needs
• Made up of a generator or “battery” and leads inserted
into heart muscle
implantable cardioverter-defibrillators
A pager-sized device with leads into the heart - inserted
(usually) under the left collar bone.
• If the heart enters ventricular fibrillation, the following may
occur:
• Low-energy pacing therapy. Mild electrical impulses
that keep electrical activity steady. May feel nothing or a
painless fluttering in chest when ICD responds to mild
disruptions in heartbeat.
• Cardioversion therapy. A higher energy shock is
delivered for a more serious heart rhythm problem. It may
feel as if you’re being thumped in the chest
Defibrillation therapy. This is the strongest form of
electrical therapy used to restore a normal heartbeat. Feels
like a kick in the chest and may knock a person off their
feet.
The pain from this therapy usually lasts only a second.
There should be no discomfort after the shock ends.
valvular disease
Valve disease is when any of the valves in the heart don’t
open or close properly
• Stenosis is when the valve opening becomes narrow and
restricts blood flow.
• Prolapse is when a valve slips out of place or the valve
flaps (leaflets) do not close properly.
• Regurgitation is when blood leaks backward through a
valve, sometimes due to prolapse
valve repair or replacement
Parts of valves or their supporting structures can be
surgically repaired
• Mechanical or live tissue valves can replace any of the
valves in the heart
objectives of a cardiac rehab program
• Regardless of cardiac condition, cardiac rehab programs
have very similar objectives:
• Optimize function within the limits imposed by the disease
• Educate patients and family on risk factors
• Return patient to daily activities and roles
benefits of exercise for the cardiac patient
• Controls hypertension • Decreases/increases weight • Improves lipid profile • Decreases stress • Improves endothelial function • Increase in strength, flexibility & endurance to maintain ADL’s and independence
program structure
4 month program (paid for by private insurance)
• Run by nurses, kinesiologists
• Start and end with GXT and bloodwork (lipids, glucose)
• One month of 3x/week classes
• 30 minutes lecture
• 60 minutes exercise
• Rest of the three months on own with what has been
learned.
• After 4 months – encouraged to buy a membership
• South end of city: Reh –Fit centre
• North end of city: Wellness Institute
exercise prescription for cardiac rehab
• Aerobic: large muscle activities, arm/leg ergometry
• RPE 11-16/20
• > 3 days/week, 20-60 minutes, 5010 minute warm-up and cool-down
• Strength: circuit training
• 30-40% 1RM upper body, 50-60% 1RM lower body. Avoid Valsalva
• 2-3 days/week, 2-4 sets, 12-15 reps, 8-10 exercises
• Gradually increase resistance over time
• Flexibility: upper and lower ROM. Static stretches holding 10-30
sec
• 2-3 days/week
stretching considerations
- Total body stretch
- Be aware of incisions
- Shoulder pain (position during surgery)
- Head higher than heart reduces dizziness
other considerations when working with a cardiac rehab patient
- Be aware of signs of distress
- Avoid extreme temperatures
- Discourage large meals before activity
- Help client with emotional distress
authorities on exercise prescription
• CACPR – Canadian Association of Cardiovascular
Prevention and Rehabilitation
• ACSM – American College of Sports Medicine
• AAVCPR – American Association of Cardiovascular and
Pulmonary Rehabilitation
• AHA – American Heart Association
what does TIA stand for
Transient ischemic attack
& stroke
transient ischemic attack & stroke
TIA – cerebral blood flow is hampered and O2 is not
reaching brain tissue
• Causes non-permanent neurological symptoms
• Stroke is a complete blockage or hemorrhage of blood
circulation to the brain tissue
signs of stroke
F- face is it drooping
A- arms can you raise both
S- Speech is it slurred or jumbled
T- time to call 911 right away
outcomes of stroke
- Speech/language impediments
- Loss of balance
- Emotional changes
- Memory loss
- Altered self-concept
- Loss of intellectual function
- Depression
- Hemiparesis or hemiplegia
effect of stroke on ability to exercise
• Lowered functional capacity
• Reduced aerobic capacity partly due to impaired motor function
following brain trauma (VO2max up to 70% lower than healthy
counterparts)
• More rapid fatigue and less efficient movement and ADLs
• More breathlessness
benefits of exercise for stroke
Improved peak oxygen consumption, better workload response,
improved blood pressure, lower resting heart rate, and lipids
• faster walking speed and less ambulation assistance required
exercise prescription for stroke
• Aerobic:
• Cycle ergometer, treadmill, seated stepper, arm ergometer
• 40-70% estimated max VO2, 3-5 days/week, 20-60 min or multiple
bouts of 10 min
• Strength:
• Isometric, wt machines, free weights (grip?)
• 3 sets, 8-12 reps, 2 days/week
• Flexibility:
• 2 days/week before or after aerobic or strength – no ballistic mvmt
• Balance: 2 days a week
exercise considerations
• Exercise Positioning ?
• Resistance Training ?
• Communication ?
Blood pressure, pain, coordination, balance, enjoyment…
