CardiovascularAtherosclerotic Diseases

1
Cardiovascular/Atherosclerotic Diseases

• Leading cause of death in the U.S.
• Hypertension
• Coronary Atherosclerosis (CAD)
• Angina silent ischemia Myocardial Infarction
• CABG and PTCA
• Sudden cardiac death syndrome
• Congestive/chronic heart failure
• Peripheral vascular arterial disease

2
Angina and Silent Ischemia

• Classically described as discomfort in the chest,
  SOB, nausea, sweating
• ischemia
• silent ischemia
• stable angina
• unstable angina
• Management and Medications
• Antiplatelet therapy (aspirin)
• Beta Blockers
• Nitrates
• Calcium channel blockers

3
Angina and Silent Ischemia

• Goal of Exercise training
• Recommendations for exercise testing
• Contraindications
• Indications for terminating an exercise test
• Recommendations for exercise programming
• Prior to exercising
• Safe heart rate range
• What if angina occurs?

4
Myocardial Infarction

• 1.5 million Americans have an MI each year, of
  which 500,000 (1/3) persons die
• Classically characterized by
• Severe, prolonged chest discomfort or pressure
• Increased serum levels of cardiac enzymes
• ECG changes in leads overlying the infarcted area

5
Myocardial Infarction

• Usually affects the left ventricle
• Two types of infarctions described
• Transmural infarction (Q wave)
• Subendocardial infarction (non-Q wave)
• Involvement of coronary arteries
• Anterior infarctions (LAD coronary artery)
• Inferior infarctions (RCA)
• Risk of future morbidity and mortality?

6
Myocardial Infarction

• Ejection Fraction portion of blood pumped out
  with each beat
• Effects on the exercise response
• altered cardiorespiratory hemodynamic responses
  (e.g. subnormal aerobic capacity)
• reduced O2 transport capacity
• Effect of exercise training
• common rationales
• Management and Medications
• risk factor interventions

7
Myocardial Infarction

• Drug therapy
• Purpose
• decrease mortality after acute MI
• reduce complications of unstable angina
• improves symptoms in stable angina
• suppresses dysrhythmias
• Medications include
• Thrombolytics upon admission
• diuretics
• Beta blockers
• vasodilators ACE inhibitors
• Calcium channel blockers

8
Myocardial Infarction

• Recommendations for exercise testing
• Objective is to evaluate cardiac activity,
  symptoms, CV capacities
• Factors to consider re the test
• Recommendations for exercise programming
• Phase I
• Phase II-Iv
• Intensity
• Frequency
• Duration

9
CABG PTCA

• Aims of revascularization
• To increase blood flow and O2 delivery
• Reduce CVE-related morbidity mortality
• Current indications for revascularization
• Relive anginal symptoms
• Prolong life in persons with LMA CAD
• Preserve left ventricular function
• Characteristics of CABG
• Patient profile
• Saphenous vein vs internal mammary grafts

10
CABG PTCA

• Characteristics of PTCA
• Patient profile
• Biggest limitation
• Effects on the exercise response
• Reduce/eliminate ECG changes
• Reduce/eliminate anginal symptoms on exertion
• Increase physical work capacity
• Improve ventricular contractility
• Effects of the exercise training
• 20 average improvement in work capacity and
  maxVO2

11
CABG PTCA

• Management and Medications Post-surgery
• Regular aerobic exercise
• BP control
• Smoking cessation
• Stress management
• Cholesterol lowering
• S/S indicating restenosis, occlusion, progression
• Recommendations for exercise
• PTCA ? CABG ? MI