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Cardiac Pathologies > Cardiovascular Responses to Exercise and Exercise in Special Populations > Flashcards

Cardiovascular Responses to Exercise and Exercise in Special Populations Flashcards

1
Q

screening before starting an exercise program

A
  • May be self guided → may help person determine if should consult MD (self guided questionnaires)
  • Professionally guided → Consult MD to determine safety of staring exercise program
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2
Q

Specific stratification for “apparently healthy patients” and for “cardiac patients”

A

– Low – Moderate – High

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3
Q

exercise should include warm-up and cool-down, and this is especially important for which CV patients?

A
  • Heart Transplants
  • Left Ventricular Assisstive Device
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4
Q

Abnormal responses to exercise:

A
  • Decreased HR
  • Decrease SBP more than 10 mmHg
  • Arrhythmia
  • Angina
  • Rales/crackles develop after exercise.
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5
Q

Contraindications to Exercise/Cardiac Rehab

A
  • Unstable angina
  • Resting SBP > 200 mmHg or resting DBP >110 mmHg
  • Orthostatic BP drop of > 20 mmHg with symptoms
  • Critical aortic stenosis
  • Acute systemic illness or fever (temp ≥ 101 F)
  • Uncontrolled atrial or ventricular arrythmias
  • Uncontrolled sinus tachycardia, >120 bpm
  • Uncompensated Congestive Heart Failure (symptomatic at rest)
  • 3rd degree Atrioventricular (AV) block (without pacemaker) “complete heart block”
  • Active pericarditis or myocarditis
  • Uncontrolled diabetes
  • ??? Recent embolism
  • ??? Thrombophlebitis
  • ??? Other metabolic problems like acute thyroiditis, hypo/hyperkalemia, hypovolemia, etc.
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6
Q

exercise on a patient with potassium levels bellow 3.2 mmol/L or above 5.1 mmol/L?

A

Increased risk for life-threatening arrythmias

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7
Q

Reasons to Stop Exercise:

A
  • Onset of angina or angina-like symptoms
  • Drop in SBP >10 mmHg from baseline despite increasing workload
  • Hypertensive response
  • Shortness of breath, wheezing, leg cramps or claudication (grade 3 on a 4 point scale)
  • Signs of poor perfusion
  • Failure of heart rate to increase with increased exercise intensity
  • Noticeable change in heart rhythm
  • Significant arrhythmias
  • ST displacement (> 2 mm horizontal or downsloping depression)
  • Patient request
  • Physical or verbal manifestation of severe fatigue
  • Failure of monitoring equipment
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8
Q

review

SYSTOLIC HEART FAILURE:

A
  • Decreased CONTRACTILITY
    • Likely due to loss of functional muscle from infarction OR process affecting myocardium
  • Increased PRELOAD
    • Likely due to valvular regurgitation
  • Increased AFTERLOAD
    • Likely due to HTN
  • Changes in CHRONOTROPY
    • Heart rate is too slow or too rapid

→ All these problems lead to PUMP FAILURE

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9
Q

review

DIASTOLIC HEART FAILURE:

A
  • Diastole may be impaired due to
    • Excessive hypertrophy of ventricles
    • Changes in composition of myocardium
  • EDV may be decreased due to decreased filling of the left ventricle due to increased
    stiffness
  • Decrease in compliance of the LV, at any EDV →leads to an increase in the ventricular
    pressure
  • Overall will usually see elevated diastolic pressures → may lead to decreased cardiac output
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10
Q

Exercise Considerations for Patients with CHF:

A
  • lower baseline BP (SBP 70-90’s mmHg), need ≥ 60mmHg for organ perfusion
  • Orthostatic hypotension
  • Look for decrease in SBP, fatigue, and SOB
  • Monitor lung sounds and peripheral edema for signs of increased failure
  • Awareness of patient’s weight for fluid overload
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11
Q

Left ventricle not working efficiently:

A

Increased left atrial dilatation→ Increased pressure in pulmonary vessels→ Transudation of fluid from pulm caps

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12
Q

if the right ventricle is not working effectively →

A

Prolonged pulm HTN → Increased right ventricle afterload → Anatomical changes to right ventricle (dilatation → possible hypertrophy) → Right ventricular EDP increases → Reflects back up to right atrium & venous system

May see JVD, liver engorgement, ascities, & peripheral edema

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13
Q

• Major determinants of BP:

A
  • CO
  • Peripheral resistance
  • Both factors have several determinants
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14
Q

HTN is Dx when SBP is ≥ ____ mmHg and/or DBP is ≥ ____ mmHg

A

140/90

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15
Q

Increased pressure on LV can create →

A

Left ventricular hypertrophy → diastolic dysfunction due to poor relaxation can occur

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16
Q

Most common complications of HTN:

A

– CVD
– CHF
– CVA
– Renal failure
– Aneurysm
– PVD/PAD
– Retinopathy

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17
Q

💡peak HR?

Exercise considerations for patients with HTN
Overtime changes?

A
  • 15-30% reduction in exercise capacity
  • SV increases abnormally and peak HR is lower
  • Moderate endurance training will elicit an average reduction of 5-7 mmHg for resting BP in people with HTN
    • Focus on aerobic training (ex: 10,000 steps)
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18
Q

exercise considerations for exercise in pt with resting SBP > 200 and/or DBP > 110 mmHg

A
  • Get MD clearance
  • Try to keep SBP ≤ 220 mmHg and/or DBP ≤ 105 mmHg with exercise
    • Consider UE endurance work over LE
    • Exercise should be terminated if BP > 250/110
19
Q

Exercise should be terminated if BP > _____

A

250/110

20
Q

what type of exercise is best for patients with PVD/PAD

A
  • ❗️Short, frequent bouts of activity with short rest periods when necessary
  • Work up to pain, then rest
  • Gradually increase exercise time
  • Walking is a good, functional activity
  • Swimming, rowing, biking (alternatives to walking)
  • Focus on low intensity, interval training
21
Q

💡 cold weather? pt education?

More exercise considerations for patients with PVD/PA

A
  • Cold weather can induce vasospasm
  • As pt progresses, watch out for other symptoms
  • Encourage lifestyle changes
  • Effects of medications
  • Improvement in exercise tolerance may unmask myocardial ischemia
    • These patients are at high risk for CAD
22
Q

exercise reduces or increases insulin secretion?

A

reduces

23
Q

exercise stimulates ______ production in the liver

A

glucose

24
Q

Exercise Considerations for Patients with DM

LOW BLOOD GLUCOSE – Below ______ = do not exercise

A

70mg/dL

25
Q

Exercise Considerations for Patients with DM

when glucose is less than 100mg/dL =

A

wait until glucose is at least 100 before initiating exercise

26
Q

Exercise Considerations for Patients with DM

Type 1 DM: If glucose level greater than 250 mg/dL (fasting glucose level) Most sources say to test urine for ketones → If ketones present in urine then…

A

avoid exercise

27
Q

Type 2 DM: If greater than 300 mg/dL some sources say to avoid exercise. Others say to use caution with exercise. If too high risk increases for

A

Diabetic Ketoacidosis

28
Q

General exercise considerations for patients with DM

A
  • Important to monitor BG
  • Timing of exercise:
    • Exercising late in evening increases risk of nocturnal hypoglycemia
    • Avoid exercise during periods of peak insulin activity
  • Autonomic neuropathy → in pt with DM this increases likelihood of CVD
  • Retinopathy: avoid SBP>170 mmHg and excessive jarring activities
29
Q

Athletes with DM (often type 1):

A
  • Need to do intense monitoring
  • Avoid exercising at time of peak insulin effect (BG drops!)
  • May need a longer more gradual progression to a higher level of training
  • 5-10g carb snacks for every 30-45 min of prolonged exercise
30
Q

Weight loss of _____ provides significant health benefits

A

5-10%

31
Q

intensity in obese patient should be…

goal?

A
  • 50-60%
  • Goal of 45-60 min of low to mod intensity aerobics 3-5 days/wk
32
Q

Renal failure and exercise

A
  • Begin with low intensity & gradually increase based on patient tolerance
  • Use RPE as HR may not be reliable indicator of exercise intensity
  • Leg fatigue is common complaint
33
Q

Marfan’s Syndrome:

A
  • Connective Tissue Diseases
  • Cardiac manifestations may range from minimal to severe
  • Frequent issues with:
    • Valves • Aneurysms
34
Q

radiation treatment of cancer can cause…

A
  • Pericarditis,
  • MI—ischemia and infarction,
  • vascular injury,
  • myocardial fibrosis,
  • atherosclerosis,
  • pneumonitis
35
Q

chemotherapy treatment in cancer can casue:

A
  • Cardiomyopathy
  • later stage ventricular dysfunction
  • pneumonitis
36
Q

radiation & chemotherapy can have affect on hematopoiesis:

A
  • Anemia, thrombocytopenia, neutropenia/leukopenia
  • Depends on area being irradiated (lots of bone marrow or not)
37
Q

Hot Environments: Exercise Considerations

A
  • peripheral vasodilation
  • Increased HR
  • Dehydration → Decreased blood volume → may lead to ischemia
38
Q

Cold Environments: Exercise Considerations

A
  • vasoconstriction
  • Can cause increased arterial BP
  • Need to adequately hydrate despite lack of noticeable perspiration
39
Q

High Altitude: Exercise Considerations

A
  • Higher altitude → progressive decrease in atmospheric pressure → decreases partial pressure of O2 in inspired air →decreased arterial oxygen levels
  • May see:
    – Acute mountain sickness, high-altitude pulmonary edema, & high-altitude cerebral edema
40
Q
A

hyperglycemia

41
Q
A

hypoglycemia

42
Q

peak insulin action time and exercise in patients with DM

A

DO NOT EXERCISE
peak insulin = blood glucose is at its lowest

43
Q

💡evening or mornings?

when is the best timing to exercise with patients with DM?

A
  • Exercising late in evening increases risk of nocturnal hypoglycemia
  • Avoid exercise during periods of peak insulin activity

Cardiac Pathologies (13 decks)

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