Treatment Strategies Cardiovascular Physiotherapy

Question 1

Cardiorespiratory Fitness

Answer 1

Related to the ability to perform large muscle, dynamic, moderate to vigorous intensity exercise for prolonged periods of time.

Question 2

Exercise Tolerance - VO2max

Answer 2

VO2max = Q x (CaO2 - CvO2)
Gold standard for exercise capacity.
Max volume of O2 consumed by the body each minute during large muscle group exercise at a high intensity.

Question 3

Q x (CaO2-CvO2)

Answer 3

Q: HR x SV. SV starts to ↑, then plateau at 50-60% VO2max, then HR↑
CaO2-CvO2: arterial - venous difference in O2, how much O2 is being extracted by the muscles. 4-5ml difference at rest, 25% of O2 utilized,15ml during exercise, 85% of O2 being utilized.

Question 4

Cardiovascular Effects of Exercise Training (14)

Answer 4

↑ Cardiac output
↓ Resting HR
↓Sympathetic tone, ↑ parasympathetic tone
↓ Inflammation
↓ Insulin resistance
↑Muscle strength, mass, function
↑O2 extraction
↓ Sarcopenia
↓ Vasoconstriction
↓ Hypertension
↓ LV afterload
↑ Resp. muscle strength
↑ Minute ventilation
↓ Dyspnea

Question 5

Physiological vs Pathological Cardiac Hypertrophy

Answer 5

Physiological: result of exercise, LV cardiac muscles get bigger but the LV chamber gets bigger as well, ↑ SV → ↑Q → ↑VO2max. Strongly associated with lower cardiovascular mortality.
Pathological: LV cardiac muscles get bigger and result in a smaller LV chamber.

Question 6

Aerobic vs Resistance Exercise Affect on the Heart

Answer 6

Aerobic vs Resistance
Eccentric LV hypertrophy vs concentric LV hypertrophy
LV dilation and ↑LVWT vs Minimal ↑ in volume and ↑LVWT
Cardiomyocyte proliferation vs no
Both reversible

Question 7

Baroreflex

Answer 7

Baroreceptors (in carotid sinus and aorta) identify change in BP. Send signals to cardiac regulatory system to.
Aerobic exercise: DBP stays the same, SBP ↑
Resistance exercise: DBP ↑ and SBP ↑
HIIT stretches carotid artery which improves baroreflex sensitivity. Slow breathing, changes in venous return, stretching of carotid sinus and aortic arch, ↑ barosensitivity.

Question 8

Cardiac Nutrition

Answer 8

During diastole cardiac muscle fibers are relaxed and blood flow is maximal, ↑ nutrition.
During resistance exercises, DBP ↑, so maximal nutrition is when doing resistance exercise during diastole.

Question 9

Metaboreflex

Answer 9

During exercise respiratory muscles and other skeletal muscles need blood flow. Resp. muscles need it more so metaboreceptors send message to brainstem to promote vasoconstriction in legs -> muscle fatigue. This reflex hyperactivated in cardiovascular patients.
This trigger can be delayed by respiratory muscle training.

Question 10

Endothelial Function

Answer 10

Endothelium makes nitric oxide, which acts as a vasodilator. Releases it due to sympathetic nerve signal.
Vascular shear stress in response to physical activity leads to increase in NO. Exercise promotes angiogenesis.
A drop in NO leads to vasoconstriction, ↑BP, inflammation in artery walls (arthrosclerosis), ↑ platelets (blood clots)

Question 11

Physical Exercise - Effect on Cardiac Function

Answer 11

Cardiac remodeling: physiological: hypertrophy + ↑ chamber size.
↑ myocardium nutrition (diastole) (↑ w/ resistance training)
Lower metaboreflex threshold (longer until fatigue)
↑ Baroreflex sensitivity
↑ Endothelial function (Nitric oxide)
Angiogenesis (capillary formation)