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Clinical Exercise Prescription > Cardiac changes > Flashcards

Cardiac changes Flashcards

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1
Q

who should be excluced from the exercise part

A 
Unstable angina 
Resting SBP>200mmHg or DBP >110mmHg
Uncontrolled tachycardia >120b.min-1 
Significant resting  ST segment depression
Uncontrolled atrial or ventricular arrhythmias 
Aortic stenosis 
Febrile illness 
Recent embolism 
Uncompensated congestive heart failure
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2
Q

why does SV increase in healthy individuals following areobic training

A

↑ contractile function
↑ LV chamber volume (eccentric)
↑ LV muscle mass (concentric)
↑ in plasma volume

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3
Q

why does contractile function increase

A

• ↑ calcium handling proteins in cell wall and SR

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4
Q

why does LV chamber volume increase

A

Myocyte elongation as sarcomeres added in series: occurs after 5 weeks

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5
Q

why does LV muscle mass increase

A

More myocytes added in parallel (hypertrophy)

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6
Q

why does plasma volume increase

A

10% PV expansion may occur in just 10 days

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7
Q

la place’s law

A

T = ( P * R ) / M
• Where T is the tension in the walls • P is the pressure difference across the wall • R is the radius of the cylinder • M is the thickness of the wall
To keep wall tension the same, the radius and the wall thickness must be proportional

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8
Q

what alters myocradial oxygen consumption

A

tennison development
myocardial contractility
heart rate

  • wall tension is an imporatant determinant of MVO2
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9
Q

what causes growth

A 
NE and Epinephrine
Renin-angiotensin-aldosterone
GH and IGF
Thyroid hormones
mechanical stress
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10
Q

effect of NE and Epinephrine

A

Growth

stimulation of alpha and beta receptors in the myocardium cause cardiac growth

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11
Q

effect of Renin-angiotensin-aldosterone

A

Growth
– ↑ SNS activity reduces renal blood flow during exercise, ↑ renin release, thus ↑ RAA levels
– ↑ RAA levels stimulate cardiac myocytes to hypertrophy

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12
Q

effect of GH and IGF:

A

Growth
Cardiac myocytes have receptors for both GH and IGF
– Stretching of heart muscle is trigger for these hormones to activate gene expression
– IGF increases myofilament sensitivity to Ca++ thus ↑ contractile forc

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13
Q

what is the effect of thyroid hormones

A

Growth
Exercise stimulates TSH, thus thyroxin production
Thyroxin causes myocyte hypertrophy

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14
Q

effect of mechanical stress

A

Pressure overload = ↑ resistance = hypertrophy through ↑ cross sectional area (Concentric)
↑ volume overload = hypertrophy through ↑ myocyte lengthening (Eccentric)
Mechano-sensors in myocyte activated by stress:
– Surface receptors (integrins) and stretch activated ion channels ↑ CA++ influx → activate protein kinase pathways → hypertrophy

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15
Q

Physiological adapltaions to areobic training in healthy individuals

A

imporved contractility

Angiogensis

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16
Q

effect of imporved contracitility

A

Improved % shortening, time to peak shortening, relaxation time – ↑ calcium binding sites in myocytes – ↑ Na+ - Ca++ exchanger pumps speed removal of Ca back into SR – ↑ Ca stored in SR = more Ca = more contractile force – ↑ Ca sensitivity of myofilaments • Increased ATPase expression

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17
Q

effect of Angiogensis

A

Myocyte hypertrophy comes with angiogensis to increase blood flow • Increased arterial size to be equal or greater than increase in cardiac mass (over adaptation!) • Increased capillarisation

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18
Q

adaptaions to areobic training cardiovascular

Stroke volume

A 
↑ Stroke volume 0 - 18% 
– ↑ blood volume 6-10% 
– Myocardial hypertrophy 
– Improved contractile force - ↓ ESV 
– ↑ ejection fraction
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19
Q

adaptaions to areobic training cardiovascular

parasympathetic tone

A

increased parasympathetic tone
• ↑ Heart rate variability
• Slower heart rate, thus more filling time

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20
Q

adaptaions to areobic training cardiovascular

A 
↑ SV 
↑ parasympathetic tone
↑ coronary collaterals 
↑ in cardiac capillary and arteriole blood flow 
↓ blood viscosity
↓ endothelial dysfunction
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21
Q

why does endothelial dysfunction reduce

A

Improved NO production promotes vasodilation

• Improved production of superoxide dismutase which mops up Reactive Oxygen Species (ROS stops NO working)

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22
Q

adaptaions to areobic training cardiovascular during exercise

A

↑ in max SV
↓ In sub-maximal exercise heart rate - but this may arise without increase in SV
↓ Systolic blood pressure response
↑ Nitric oxide production, ↑ vasodilation thus ↓ TPR
↓ In myocardial oxygen demand (measured by RPP)
Small ↓ in Submax exercise Q
Improvement in max cardiac output
↑ Arteriovenous difference - more O2 extracte

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23
Q

adaptaions to muscle from areobic training cardiovascular

A

↑ Arteriovenous difference
- V. important as may cause ↑ in peak VO2 without ↑ in Q.
↑ Mitochondrial number and quantity of aerobic enzymes
Shift towards a more aerobic muscle fibre type profile
↓ submaximal exercise muscle blood flow because of ↑ usage of delivered O2
↑ Maximal muscle blood flow
↑ Muscle capillary density
↑ Muscle fibre recruitment
↓ Blood lactate concentration during sub-maximal exercise

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24
Q

effect of 1 MET increase

A

15% better surival

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25
effect of aerobic training on total exercise capacity
18-35% increase
26
effect of aerobic training on angina threshold
10-20% increase
27
activity during first 48hrs following MI/surgery
Self Care Activities Arm and leg range of motion movement Low Resistance activities Minimal activities - active remodelling of myocardium occurring. Don’t want to exacerbate damaged area
28
what should the patinet have knowledge of before dischange
Activities that are inappropriate or excessive a safe progressive plan of exercise optimal risk reduction
29
why should they do activity post discharge
Physiological benefits Increase physical self confidence Decrease dependency on others
30
rules of walking psot discharge
``` Walk at a comfortable pace (RHR + 20bpm) Take GTN spray Know rules of chest pain Choose flat route Go with someone at first Once solo, let others know the route ```
31
post discharge walking week 1
1/4 mile | 4 days
32
post discharge walking week 2
1/2 mile | 4 days
33
post discharge walking week 3
3/4 mile | 4-5 days
34
post discharge walking week 4
3/4 mile | 4-5 days
35
post discharge walking week 5 &6
1 mile | 5 days
36
postive end points of exercise stress test
``` Reaching estimated max HR ± 10bts.min-1 Light headedness, confusion, ataxia, cyanosis, dysponea, nausea Onset of moderate – severe angina Symptomatic SVT ST depression >2mm ST elevation >1mm VT Exercise induced LBBB Onset of 2nd or 3rd degree heart block Hypotension (>10mmHg drop in BP) Hypertension (>220 mmHg SBP : >110mmHg DBP) Inappropriate bradycardia (drop in HR >10 beats / min) with increase or no change in work load ```
37
sensivity of exercise stress test
Sensitivity and specificity of stress test for diagnosis of CAD approx. 70% The above may be better / worse due to expertise / equipment / population
38
what is sensitivty
Sensitivity = % with disease who have abnormal results (test picks up something is wrong here!)
39
what is specificity
% without disease who have normal results (test picks out healthy by showing normal results)
40
prescribing exercsie using HR
etermine peak HR from test data The highest HR achieved before problems (Angina etc) Calculate training heart rate zone: 40-80% of the peak HR value use common sense
41
exercise prescriptin hreat rate reserve
Heart rate reserve (HRR) may be used if no stress test data are available – however if stress test HR data are available HRR can still be used Allows calculation of training HR zone Scope to increase HR (HRR = predicted max HR - resting HR) + resting HR Suggested 40-80% HRR
42
calculating peak HR
Healthy males = 208 – (0.7 x age) Healthy women = 206 – (0.88 x age) CAD patients = 164 – (0.72 x age) β-blocked = 203-1.49(age)
43
exercise prescrpition RPE
RPE may be used to set training exercise intensity A scale to quantify how hard the patient feels he / she is working Roughly 12-16 Habituation necessary
44
effect of anti-arrythmics of HR, BP, ischemia and exercise
HR ↓ or↔ BP ↔ Ischemia↔ Exercise capacity ↑
45
effect of anticoagulants on HR, BP, ischemia and exercise
HR ↔ BP ↔ Ischemia↔ Exercise capacity ↔
46
effect of ACE inhibitors on HR, BP, ischemia and exercise
HR ↔ BP ↓ Ischemia↔ Exercise capacity ↔
47
effect of antilipidepics on HR, BP, ischemia and exercise
HR ↔ BP ↔ Ischemia↔ Exercise capacity ↔
48
effect of digoxin on HR, BP, ischemia and exercise
HR ↓ BP ↔ Ischemi - maybe st depression Exercise capacity ↔ or ↑
49
effect of beta blockers on HR, BP, ischemia and exercise
HR ↓ BP ↓ Ischemia ↓ Exercise capacity ↑ or ↓
50
effect of calcium channel blockers on HR, BP, ischemia and exercise
HR ↓ BP ↓ Ischemia↓ Exercise capacity ↑
51
effect of nitrates on HR, BP, ischemia and exercise
HR ↑ BP ↓ Ischemia ↓ Exercise capacity ↑
52
effect of diureactics on HR, BP, ischemia and exercise
HR ↔ BP ↓ Ischemia↔ Exercise capacity ↔
53
describe the effect of digoxin
May decrease exercise HR • Improve exercise capacity in patients with atrial fibrillation or chronic heart failure • May produce false-positive results on the ECG, or ST segment depression in patients without coronary artery disease or ischemia. Use should be stopped 10 to 14 days prior to exercise test if possible
54
describe the efefct of beat blockers
Addition or change in dosage of beta-blocker will require a new graded exercise test • Relationship between %VO2 and %HRR is not altered; therefore, usual methods to calculate THR for exercise prescription are still acceptable • HRmax and training HR will be lower in persons receiving beta-blockers
55
describe the effect of calcium channel blockers
May length PR interval – facilitates Ventricular filling • Meds change will alter exercise response so new max test may be needed
56
describe the efects of nitrates
Increases angina threshold • Possible hypotension • Longer cool down to avoid post-exercise hypotension
57
describe the role of diuretcis
Diuretics may lower potassium levels (Hypokalaemia) – leads to PVC’s Possible hypovolemia – will lower BP, Q and capacity – so check hydration status
58
walk as exercise
lesuire or CV | Walking speed should achieve HR in training zone Pleasurable
59
Golf as exercise
``` METS 4-7 Aerobic / anaerobic Flat course 9 Holes at first, ↑ number slowly 3/4 swing Half set of clubs Pull or carry clubs Chest pain rules ```
60
Bowls as exercise
Bowls has NO cardiovascular benefit | But will improve coordination, flexibility and confidence in physical activity
61
Swimming as exercise
``` No swimming until sure of arrhythmia / angina / wound status METS 4 - 8 Is HR in training zone? Vary stroke Chest pain rules Cold water ```
62
who is strength training not appropriate for
``` Congestive Heart Failure Severe Valvular Disease Low ejection fractions Uncontrolled Arrhythmias Significant left ventricular dysfunction ```
63
blood pressure response during resistance training
``` ↑ intra muscular pressure ↓ muscular blood flow ↑intrathoaracic pressure ↓ Venous return ↓ → Q ↑ ↑TPR = ↑BP ```
64
acute effects of resistnce training
``` ↑ BP ⇒ ↑ RPP (HR X SBP∴MVO2) not problematic if < 80% 1RM ↑ HR 60-80% HR max during circuit weights ↑ VO2 30-50% VO2max during circuit weights ```
65
what does strength training response depend on
``` Type (isotonic / isometric) Weight lifted (% 1RM) Duration of rest intervals Starting CV fitness of person Medications ```
66
chronic eefcts of strength training
``` Muscular strength ↑ 20-30% in cardiac patients ↑ efficiency of movement Small ↑ in peak VO2 Improved blood lipid profile ? Improvement in body composition ? Reduction in BP ```
67
when should you use resistnce training
Start 4-6 weeks into supervised cardiorespiratory endurance exercise program into supervised cardiorespiratory endurance exercise program Use elastic bands, light handweights, or resistive tubing to add variety Monitor heart rate and ECG continually

Clinical Exercise Prescription (12 decks)

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