Presentation Package

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chapter
20
Cardiovascular Disease and Physical Activity
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CARDIAC ADVANTAGES

• Blood Flow
• Oxygen Uptake
• Lactate Uptake
• Autorhythmaticity

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HEALTHY vs BLOCKED ARTERY
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The Leading Causes of Death in the United States
in 2003

• Data from American Heart Association, 2006.

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Factors Contributing toDecline in Deaths

• Better and earlier diagnosis
• Better emergency and medical care
• Improved drugs for specific treatment
• Improved public awareness
• Increased use of preventive measures, including
  lifestyle changes

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Cardiovascular Diseases

• Coronary artery disease (CAD)
• Hypertension and stroke
• Congestive heart failure
• Peripheral vascular disease
• Valvular, rheumatic, and congenital heart disease

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The Leading Causes of Death From Cardiovascular
Disease

• Data from American Heart Association, 2006.

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Coronary Artery Disease

• Atherosclerosis is the progressive narrowing of
  arteries due to buildup of plaque.
• Coronary artery disease (CAD) involves
  atherosclerosis in the coronary arteries.
• Ischemia is a deficiency of blood to the heart
  caused by CAD.
• Myocardial infarction is a heart attack due to
  ischemia.

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Progressive Formation of Plaque in a Coronary
Artery
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Did You Know . . . ?

• Atherosclerosis begins in infancy and progresses
  at different rates, depending primarily on
  heredity and lifestyle choices such as smoking
  history, diet practices, physical activity, and
  stress.

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Classification of Blood Pressure for Adults Age
18 Years and Older
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Hypertension

• It is chronically elevated blood pressure.
• It causes the heart to work harder.
• It is uncommon in childhood but can appear during
  mid-adolescence.
• It places strain on arteries, causing them to
  become less elastic over time.
• It affects about 1 in every 4 adult Americans.

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Stroke

• It is also called a cerebral vascular accident
  (CVA).
• Cerebral infarction refers to when blood flow is
  blocked to one part of the brain due to a blood
  clot or atherosclerosis.
• Cerebral hemorrhage refers to a rupture of a
  blood vessel that diminishes blood flow beyond
  the rupture.

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CEREBRAL INFARCTION AND HEMORRHAGE
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Congestive Heart Failure

• Heart muscle becomes too weak to meet oxygen
  demands of the body.
• It can result from damage to heart, hypertension,
  atherosclerosis, and heart attack.
• Blood backs up in veins, causing edema.
• It can progress to irreversible damage, thus
  requiring a heart transplant.

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The Three Layers of an Artery Wall
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Illustration of fissure or rupture of an unstable
plaque in a coronary artery
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Primary Risk Factors for CADThat Can Be
Controlled

• Tobacco smoking
• Hypertension
• Abnormal blood lipids and lipoproteins
• Physical inactivity
• (continued)

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Primary Risk Factors for CAD (continued)

• Obesity and overweight
• Diabetes and insulin resistance

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Did You Know . . . ?

• The ratio of total cholesterol (Total-C) to
  high-density lipoprotein cholesterol (HDL-C) may
  be the most accurate lipid index of risk for CAD.
  Values of 5.0 and greater indicate increased
  risk, while values of 3.0 and lower indicate low
  risk.

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Controllable Risk Factors for Hypertension

• Insulin resistance
• Obesity and overweight
• Diet (sodium, alcohol)
• Use of tobacco products
• Physical inactivity

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Did You Know . . . ?

• It appears that hypertension, coronary artery
  disease, obesity, and diabetes are linked through
  the common pathway of insulin resistance.
  Metabolic syndrome, syndrome x, and civilization
  syndrome are terms used to describe this
  interrelationship.

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Percentages of the U.S. Population at Increased
Risk for Coronary Artery Disease Based on Primary
Risk Factors

• Reproduced from Caspersen, C.J. Physical
  activity and coronary heart disease. Physicians
  Sportsmedicine 1987 15(11) 43-44.

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Did You Know . . . ?

• Epidemiological evidence shows that physical
  inactivity doubles the risk of CAD. Low-intensity
  physical activity is sufficient to reduce the
  risk of this disease.

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Aerobic Training Adaptations

• Produce larger coronary arteries
• Increase heart size
• Increase heart pumping capacity
• Improve circulation of blood to vessels
  surrounding heart
• Reduce blood pressure in individuals with
  moderate hypertension

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How Exercise Reduces Riskof Disease

• Improves the hearts contractility, work
  capacity, and circulation
• Improves ratio of blood lipids
• Controls and prevents moderate hypertension
• Controls weight, reduces body fat, and increases
  muscle mass
• Alleviates stress and decreases cigarette smoking
• Reduces insulin resistance

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Comparison of the Left Main Coronary Artery in
(a) Sedentary and (b) Exercising Monkeys on
Atherogenic Diets
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Key Points

• Risk of Death During Exercise
• There is an increased risk of heart attack during
  actual exercise however, over a 24-hour period,
  those who exercise regularly have a reduced risk
  of heart attack.
• Deaths during exercise are rare.
• In people over 35, most deaths during exercise
  are caused by a cardiac arrhythmia due to
  atherosclerosis.
• Deaths during exercise in people under age 35 are
  usually caused by hypertrophic cardiomyopathy,
  congenital conditions, aortic aneurysm, or
  myocarditis.

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Risk of Primary Cardiac Arrest During Vigorous
Exercise and at Other Times Throughout a 24 h
Period

• Data from D.S. Siscovick et al., 1984, "The
  incidence of primary cardiac arrest during
  vigorous exercise," New England Journal of
  Medicine 311 874-877.

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