Cardiovascular Disease and Exercise

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Cardiovascular Disease and Exercise
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Clinical Application of Exercise Physiology to
Cardiovascular Diseases

• Overview and scope of cardiovascular diseases
• Many forms of the disease
• Degenerative heart disease
• Coronary artery disease
• Arteriosclerosis
• Coronary heart disease

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Blood Pressure-Classification and Risk
Stratification

• Mild hypertension
• 140 159 mmHg systolic
• 90 99 mmHg diastolic
• Moderate hypertension
• 160 179 mmHg systolic
• 100 109 mmHg diastolic

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Exercise Training and Hypertension

• Chronic resistance training effects on blood
  pressure
• Reductions in blood pressure of 6-10 mmHg
• Reductions most apparent in those with mild
  hypertension
• Effects are transient- need to continue training

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Diseases of the Myocardium

• Angina pectoris
• Chest pain indicating inadequate oxygen supply
• Myocardial infarction
• Congestive heart failure
• Heart fails to pump required volume
• of blood
• Aneurysm
• Abnormally dilated wall of a blood vessel
• Creates a weak spot

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Diseases of the Myocardium

• Heart valve disease
• Stenosis narrowing or constriction
• Insufficiency fails to close properly resulting
  in regurgitation
• Prolapse enlarged valve leaflets bulge back
  into left ventricle

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Diseases of the Myocardium

• Inflammation conditions
• Endocarditis
• Pericarditis
• Congenital malformations
• Septal defects
• Shunts between aorta pulmonary artery
• Cardiac nervous system diseases
• Dysrhythmias
• Bradycardia, tachycardia, or PVCs

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Cardiac Disease Assessment

• Purpose of health screening and risk
  stratification-identifies persons
• With medical contraindications
• Needing in-depth medical evaluation
• With clinically significant disease who need
  medical supervision when exercising
• Patient history

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Cardiac Disease Assessment

• Physical examination
• Heart auscultation
• Laboratory tests
• Noninvasive physiologic tests
• Echocardiography
• Graded exercise stress test
• Ultrafast CT scan
• Electronic beam detects calcium in coronary
  arteries

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Cardiac Disease Assessment

• Invasive physiologic tests
• Radionucleotide studies
• Thallium imaging
• Nuclear ventriculography
• Pharmacologic stress testing
• Cardiac catheterization
• Coronary angiography

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Coronary Heart Disease

• Changes on the cellular level
• Vulnerable plaque
• Difficult to detect yet lethal
• Vascular degeneration begins early in life
• Myocardial infarction
• Cardiac arrest
• Angina pectoris
• Cardiovascular disease epidemic

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Coronary Heart Disease

• Coronary heart disease risk factors
• Age, gender, and heredity
• Non-modifiable risk factors
• Blood lipid abnormalities
• Hyperlipidemia
• Hyperlipoproteinemia
• Reverse cholesterol transport
• Lecithin acetyl transferase (LCAT)
• Converts free cholesterol into cholesterol esters
  facilitating its removal

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Coronary Heart Disease

• Coronary heart disease risk factors
• Exercise effects
• Small reductions in LDL-C
• Elevated levels of HDL-C
• Protects against gallstone formation

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Coronary Heart Disease

• Beyond cholesterol
• Homocysteine
• Metabolite of methionine breakdown
• Increased CHD risk
• Converted back to methionine aided by B vitamins

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Coronary Heart Disease

• Excessive body fat
• Influence on CHD is usually in its link to other
  disorders
• Cigarette smoking
• One of highest risks
• Risk is related to amount of smoking
• Physical activity
• Regular activity protects against heart disease

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Coronary Heart Disease

• CHD risk factor interactions
• Having more than one risk factor increases risk
  even more as factors interact
• Risk factors in children
• Risk factor prevalence among children is growing
• Heart disease begins at an early age

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Calculating CHD risk
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Exercise Stress Testing

• Reasons for stress testing
• Diagnosis heart disease
• Assess exercise-related chest symptoms
• Screen for entry into preventive and cardiac
  rehabilitative exercise programs
• Uncovers abnormal blood pressure responses
• Monitors effectiveness of therapeutic
  interventions
• Quantifies and evaluates functional aerobic
  capacity

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Exercise Stress Testing

• Guidelines for determining who requires stress
  testing have been established by the ACSM AMA
• Informed consent
• Tells patient risks benefits
• Establishes confidentiality, voluntary nature of
  tests and allows for asking questions

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Exercise Stress Testing

• Stress testing absolute contraindications
• Resting ECG suggesting acute cardiac disease
• Recent complicated MI
• Unstable angina pectoris
• Uncontrolled arrhythmias
• Third degree AV block without pacemaker
• Acute CHF
• Severe aortic stenosis
• Active or suspected myocarditis or pericarditis
• Recent systemic or pulmonary embolism
• Acute infections
• Acute emotional distress

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Exercise Stress Testing

• Stress testing relative contraindications
• Resting diastolic BP gt 115 or systolic gt 200
• Moderate valvular disease
• Electrolyte abnormalities
• Frequent ventricular ectopy
• Ventricular aneurysm
• Uncontrolled metabolic disorders
• Chronic infectious diseases
• Neuromuscular or musculoskeletal disorders
• Pregnancy
• Anxiety

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Exercise Stress Testing

• GXT termination
• Signs or symptoms of heart disease
• Abnormal BP response
• Physical distress of subject
• Nausea, dizziness etc.
• Equipment failure
• ECG indicated arrhythmias
• Patient requests termination

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Exercise Stress Test

• Stress test outcomes
• True positive
• Test shows CHD they do have CHD
• True negative
• Test shows they do not have CHD they dont
• False positive
• Test shows CHD they do not have CHD
• False negative
• Test shows they do not have CHD they do

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Exercise Stress Test

• Exercise-induced indicators of CHD
• Angina pectoris
• Electrocardiographic abnormalities
• ST segment elevation or depression
• Significant Q waves
• Prolonged PR interval

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Exercise Stress Test

• Exercise-induced indicators of CHD
• Cardiac rhythm abnormalities
• PVCs
• Flutter or fibrillation
• Bradycardia
• AV blocks
• Bundle branch blocks

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Exercise Stress Test

• Exercise-induced indicators of CHD
• Hypertensive exercise response
• Hypotensive exercise response
• Heart rate response

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Stress Test Protocols

• Bruce and Balke treadmill tests
• Bicycle ergometer tests
• Arm-crank ergometer tests
• Stress testing safety
• Pre-screening is critical
• Follow guidelines to determine who may be tested
  without a physicians presence