Week 03 - Cardiovascular Disease

Question 1

……. leading cause of death in Australia

Answer 1

Coronary heart disease

Question 2

• Ischemia can be symptomatic (_____) or asymptomatic (________)

Answer 2

angina, silent ischemia

Question 3

Angina symptoms:

Answer 3

heavy, squeezing or constricting feeling behind the sternum, SOB, nausea, diaphoresis, can radiate to shoulders and arms, jaw.

Question 4

Angina symptoms are typically ____ in duration but can last

Answer 4

1-20s, can last >30mins

Question 5

Describe unstable vs stable angina?

Answer 5

Stable:
known cause, predictable, known amount of stress causing, relieved with rest or nitroglycerin. >70%

Unstable:
unknown cause, indicates nearly complete blockage of coronary artery (above 70% of artery), precursor to MI, treated with anticoagulants and re-vascularisation

Question 6

Myocardial infarction

Answer 6

• Cardiac ischamia resulting in myocardiocyte death

- Symptoms: severe prolonged chest pain

Question 7

Myocardial infarction usually involves the ____ ventricle

Answer 7

left

Question 8

Myocardial infarction has permanent loos of contractility (_____ ______)

Answer 8

necrotic myocardium

Question 9

What is included in step 1 of pre-dispositions to an MI?

Answer 9

Step 1:

- Hypertension, dyslipidemia, cigarette smoking, toxins and viruses artery wall

Question 10

What is included in step 2 of pre-dispositions to an MI?

Answer 10

Step 2:

• Monocytes and T cells penetrate the intima (injured vessel wall)
• Monocytes ingest LDL and covert into foam cells (fatty streak)
• Cholesterol is not cause, it comes after to help repair

Question 11

What is included in step 3 of pre-dispositions to an MI?

Answer 11

• Smooth muscle cells migrate into the intima and grow abnormally - change into foam cells - start to release collagen and proteins
• Create a fibrous hardening
• Risk of thrombus (clot, full blockage) and embolus (migrating blockage) increases
• Embolus: migrating blockage into bloodstream, cause of sudden death

Question 12

Can CAD Risk be Reduced with Exercise?

Answer 12

Yes.

• Research showing reduced risk of CAD in people who are more physically active
• More is better (dose response relationship) but some is better than none

Question 13

Can CAD be reversed?

Answer 13

Yes, “Overall, 82% of experimental-group patients had an average change towards regression. Comprehensive lifestyle changes may be able to bring about regression of even severe coronary atherosclerosis after only 1 year, without use of lipid-lowering drugs.”

Question 14

Explain a coronary Artery Bypass Graft (CABG):

Answer 14

• sternum cut down and ribs pulled apart
• heart stopped
• graft harvested from L internal mammary artery and or saphenous vein
• bypasses and builds new arterial pathway

Question 15

Explain a percutaneous intervention (PCI and PTCA):

Answer 15

• angioplasty or balloon angioplasty

- usually involves insertion of stent through insertion of catheter in arm

Question 16

CABG patients likely older, more blockages, and lower ___ than PCI

Answer 16

ejection fraction

Question 17

• Average EF in CABG patients = __%

- Average EF in PCI patients = __%

Answer 17

38%

55%

Question 18

Patency (how well it lasts) rates for saphenous vein grafts are:

• __% after 1 year
• __% after 5 yrs
• __% after 11 yrs

Answer 18

90%
80%
60%

Question 19

For CABG and PCI patients, two weeks of …. should be done before introducing ….?

Answer 19

aerobic training, RT

Question 20

___ exercises are needed early for CABG patients

Answer 20

ROM, avoid loaded upper body during the first 12 weeks

Question 21

HIIT more effective than moderate intensity IT for cardiac patients –>

Answer 21

velocity of blood reduces atherosclerosis and is safe for majority of cardiac patients

Question 22

Explain two types of CVAs?

Answer 22

Ischaemic stroke (85%): blockage, embolism, thrombosis
	- area deprived of blood due to obstruction blocking BF

Haemorrhagic stroke (15%): risk increased by aneurysm

- area bleeding, weakened vessels, wall raptures, bleeding in brain
- 50% will die

Question 23

Symptoms of a stroke:

Answer 23

Sensory and motor impairment - hemiparesis
- (weakened, inability to move), paresis (sensation loss), paralysis

Vision impairment
- (spatial neglect)

Expressive and receptive aphasia
- (communication lack, usually verbal)

Apraxia
- Lack of coordination

Question 24

Frontal lobe damage can cause:

Answer 24

can result in apathy, easy frustration, impaired cognitive functions

Question 25

Temporal lobe damage can cause:

Answer 25

can result in learning memory difficulties, possible outbursts of anger

Question 26

Effects of Exercise Training

Answer 26

• Great room for improvement
• Studies suggest up to 60% increased vo2 max (muscular fitness mostly, and some cardiac fitness)
• improved functional ability (walking speed)
• decreased reliance on assistive devices
• decreased depression and cognitive symptoms
• increased quality of life

Question 27

Anti-Coagulants purpose and side effects…

Answer 27

Prevents/inhibits blood clotting

risk of excessive bleeding

Question 28

Vasodilators purpose and side effects…

Answer 28

↓ or eliminate vasospasm of the cerebral arteries (post exertional hypotension)

Question 29

Antihypertensives purpose and side effects…

Answer 29

For those requiring strict control of BP (Affect CV response → ↓HR)

Question 30

Anticonvulsants purpose and side effects…

Answer 30

For those who have a tendency towards seizures (cognitive slowing)

Question 31

Stroke - Pre-exercise considerations

Answer 31

• Increased risk of falls (occur in 13-25% of patients in exercise trials), including poor gait and postural control
• 75% of stroke survivors have co-existing CAD
• Start slowly, low intensity, maybe sitting
• Psycho-cognitive and emotional effects:
  
  • may require a more isolated environment to avoid distraction, embarrassment
• Reduced motor control of limb
  
  • use only the uninvolved limb or strap affected limb to equipment