TREATMENT STRATEGIES CARDIO Flashcards
CARDIAC REHABILITATION PROGRAM: goal, components
G:↓ risk of death from heart disease & reduce your risk of future heart problems following cardiac event
C: patient assessment, exercise training, physical activity, psychological management, tobacco cessation, diabetes management, lipid management, blood pressure management, weight management, nutrition counseling
Def physical exercise & physical activity
Physical exercise
- Strengthening activities working all major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms) on at least 2 days week
- At least 150 min of moderate intensity activity week or 75 min of vigorous intensity activity week
+ Spread exercise evenly over 4 to 5 days week, or every day
Physical activity
- Reduce time spent sitting or lying down & break up long periods of not moving with some activity
TISSUE PERFUSION: description & 3 ≠ steps (characteristics of each)
D: Pressure exerted by blood against wall of capillary called capillary hydrostatic pressure (CHP)
X
Colloid osmotic-pressure = form of osmotic pressure induced by proteins, notably albumin
S: image
CARDIOVASCULAR DISEASES: what is affected? Cardiac rehab
- They can affect exercise tolerance, endurance & quality of life
CR: Emotional support & education about lifestyle changes to reduce your heart disease risk, such as eating heart-healthy diet, maintaining healthy weight & quitting smoking
EXERCISE TOLERANCE: def, formule, values for man & female around 20y
Cardiorespiratory Fitness related to ability to perform large muscle, dynamic, moderate to vigorous intensity exercise for prolonged periods of time
VO2max = Q x (CaO2 – CvO2)
Max volume of O2 consumed by body each minute during large muscle group exercise at high intensity
- Average for 20yo female: 32-38 mL/kg/min - Average for 20yo male: 36-44 mL/kg/min
Characteristics of components of formule of exercise tolerance
Q: As exercise initiated & as its intensity increases, there is increasing oxygen demand from body in general, but primarily from working muscles
- To meet these requirements, CO increased by augmentation in SV and HR.
- CO primarily attributable to increase in HR, as SV typically reaches plateau at 50% to 60% of VȮ 2max
CaO2 - CvO2 : - ≠ between O2 carried by blood in arteries & veins (4-5 ml O2 per 100ml blood)
- Even in absence or minimization of change in CO, important increase in VȮ 2max during exercise can result from increased oxygen extraction
- Maximum arteriovenous oxygen difference has physiological limit of 15 to 17 ml O2 per 100ml blood
- Determinants: Number of capillaries, mitochondria, blood flow (sympathetic activity)
TREATMENT STRATEGIES OF CARDIOMYOCYTE HYPERTROPHY: description & aerobic exo vs resistance exo
- Were first to show benefit of aerobic training in myocardium after ischemic event
- Adult female rats, which were placed into groups categorized based on induced myocardial infarction with & without exercise
- 4 weeks after infarction, rats started training on treadmill,1.5 h per day, 5 days per week for 8 weeks
- Exercise intervals alternated between 8 min at 85–90% of VO2max & 2 min at 50–60%
- Results showed 15% reduction in left ventricle (LV) hypertrophy postinfarction
- Physiological cardiac hypertrophy → represented by enlargement of LV walls & LV volume → increases in maximal SV & Q during exercise → increases VO2max
- Aerobic exercise also remodels electrophysiological properties of heart, culminating in increased HR variability & decreased resting HR
- Both adaptations strongly associated with improved cardiac health & lower cardiovascular mortality
Process of myocardial remodeling influenced by hemodynamic load, neurohumoral activation & other factors still under investigation
Tableau
TS: CARDIAC AUTONOMIC CONTROL
Between 80% & 100% of HRmax, over 20 min for 3 days/week, can be effective to promote responses on cardiac autonomic control, with effects observed after two weeks
- HIIT induces greater distensibility of carotid artery, which associated improvements in baroreflex sensitivity
- Metabolic diseases, CAD & healthy conditions
TS: RESISTANCE TRAINING
First recommendations for resistance exercise in cardiac rehabilitation in 2000
- Resistance training decrease myocardial demands during daily activities such as carrying or lifting moderate-to-heavy objects
- Mild-to-moderate resistance training - modifying coronary risk factors & enhancing psychosocial well- being.
- Close monitoring of adverse cardiovascular signs & symptoms, should be performed
Ts: RESPIRATORY METABOREFLEX
Image
TS: INSPIRATORY MUSCLE TRAINING
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TS: ENDOTHELIAL DYSFCT
- Not enough nitric oxide (NO) inside of blood vessel walls. Endothelium itself makes nitric oxide, which acts as vasodilator
Drop in nitric oxide lead to: - Narrowed blood vessels, which contribute to high blood pressure
- Inflammation in artery walls, which lead to atherosclerosis
- Increased platelet production causing blood clots
TREATMENT STRATEGIES
- Vascular shear stress in response to physical activity leads to increases in nitric oxide (NO) from endothelial NO synthase (eNOS)
- Shear stress = tangential force of flowing blood on endothelial surface of blood vessel
TS: INSULIN RESISTANCE
- Insulin = Regulate body’s energy supply by balancing micronutrient levels during fed state
- Type 2 DM = Multi-factorial & include both genetic & environmental elements affecting beta-cell function & tissue (muscle, liver, adipose tissue & pancreas) insulin sensitivity
TS: HIGH INTENSITY & HYPERTENSION
- Nitric oxide (NO) availability improved after HIIT (36%) but not CMT
- Reason for improving endothelial function not fully understood
- Low- & high-intensity training exercise programs affect shear stress in arterial wall differently during exercise training
Physical exercise
Exercise improves both endothelial cell (EC) & vascular smooth muscle cell (VSMC) functions. Vascular structural adaptations to exercise include: 1) Increasing luminal diameter
2) Reducing wall thickness of conduit arteries
3) Angiogenesis
TS HYPERTROPHIC CARDIOMYOPATHY: def, causes, impact, symptoms
Definition
- Causes heart muscle to become thicker than normal
- Affects men & women equally
- Known as obstructive cardiomyopathy, hypertrophic obstructive cardiomyopathy & left ventricular hypertrophic cardiomyopathy - Most people enjoy active lifestyle & normal lifespan
Causes
- Not always known what causes but some cases it’s genetic cause
- Half of people with HCM have first degree relative (mother, father, brother…) also have HCM
Impact
Heart has 4 chambers: 2 atrium (top) & 2 ventricles (bottom). Heart relaxes to fill with blood then contracts to pump blood to rest of body
- Causes muscular walls of heart to thicken. Heart cannot hold as much blood or may not be able to pump blood very well
- HCM obstruction when tho keyed area limits or obstructs amount of blood leaving heart
- Lead to other health issues, so important to work with care team to keep heart as healthy as possible
Symptoms
- Activity intolerance or limitations with exertion
- Shortness of breath, worsened with activity or after large meals
- Chest fullness or pain, worsened with activity or sometimes after meal
- Feeling dizzy, light headed or fainting
- Heartbeat is too fast, too slow or not regular
Many people with HCM do not have any symptoms. Symptoms may change overtime. May be worse in hot & humid weather when more active if dehydrated
