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
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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
TS: PERIPHERAL ARTERIAL DISEASE. Description, check off risk factors, symptoms, check off symptoms
Description
- Blood flows through body in tubes = arteries & veins. When arterial blocked or narrow, less blood than normal move through it. If this happens in legs or arms = PAD
- Cause pain & changes in skin color & temperature. Can make it hard to walk or stand for long periods of time. Can worse over time. If not treated & blood flow completely blocked, it can permanently damage part of body
- If you have PAD, you’re at higher risk for heart attack or stroke than people who do not have PAD. Reduced number of risk factors reduce change for developing PAD. Talk with nurse or doctor about how to prevent PAD & how yo lower risk
Check off risk factors
- High blood sugar or diabetes - Current or past smoking
- High blood pressure
- High cholesterol
- Age over 70
- Obesity, overweight - Physical inactivity
Symptoms
- Can have without know it. Make certain to let nurse or doctor know if you have symptoms some or all time
Check off symptoms
- Pain, cramping, tired felling in calf, thigh or buttock. Pain when walk & then go away when rest or feel it all time
- Leg or foot feels coal to touch
- Dry & scaly skin on leg or foot
- Poor toe nail growth
- Hair loss on feet or toes
- Sore on foot or leg that does not heal
- Leg or foot looks reddish-blue when you are sitting - Erectile dysfunction, especially men with diabetes
TS: HYPERTENSION
- Slow breathing implying “training” of reflex regulation of arterial baroreceptors due to changes in venous return & stretching of carotid sinus & aortic arch
- Training through slow & deep breathing could modify cardiovascular dynamics & favor neural connections on BP control, especially by promoting changes in respiratory pattern such as increase of expiratory phase
- Delay in respiratory muscle metaboreflex activation during physical activity: ↓ dyspnea & peripheral fatigue due to lack of blood supply
- Peripheral flow deviation responsible for interruption of exercise and/or activities of daily living due to peripheral muscle fatigue, in addition to being mediated by peripheral sympathetic hyperactivity
TS: BAROREFLEX SENSITIVITY
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GENERAL BARRIERS
- Overall, CR insufficiently available & underutilized - Patient, physician & systems factors addressed to overcome barriers to participation in CR
Barriers from physician factor: 2 ≠ groups & barriers of each
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Barriers from patient factor: 5 ≠ groups & barriers of each
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Barrier from system factor: 2 ≠ groups & barriers of each
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