Main Ideas
Main Ideas
Definitions
Definitions
100

Describe the anatomy and flow of blood through the 4 chambers of the heart.

Blood low in O2 flows >Sup/Inf vena cava> Right atrium>Tricuspid valve>Right ventricle>Pulmonary artery>Lungs>Blood rich in O2 flows >Pulmonary vein> left atrium>Bicuspid valve>   left ventricle> Aorta> Body

100

How to treat rhythmic arrhythmia 

  • Treatments

    • Cardioversion: normal rhythm returns spontaneously (AF)

    • Defibrillator: electrical method (VF)

    • Pacemaker: implants designed to replace the heartbeat (heart block)


100

Causes of cardiac related chest pain

Ischemia, MI, pericarditis, endocarditis, aortic dissection

100

Disturbance of heart rate (normal 60-100 x/minute)

  • Tachycardia - >100 bpm

    • Increased sympathetic stimulation

  • Bradycardia - <60 bpm

    • Normal in well-trained athletes

Rate Arrhythmia

200

Common signs and symptoms of cardiac pathologies.

  • Chest, neck, arm pain/discomfort

  • Palpitations

  • Dyspnea

  • Cardiac syncope

  • Vasovagal syncope

  • Cough
  • Cyanosis
200

Explain how DVT and pulmonary embolism is formed

Formation: DVT typically occurs when a blood clot forms in a deep vein, often in the legs. These veins are responsible for returning deoxygenated blood back to the heart.

200


  • Irregular, fast or ‘extra’ heart beat

  • Occur with arrhythmias/dysrhythmias

  • Associated symptoms

  • Light-headedness, syncope

  • Can be benign

  • Caffeine, anxiety, exercise

  • Severe condition

  • CAD, cardiomyopathy, complete heart block, ventricular aneurysm

Palpitations

200

 variations from the normal rhythm

  • Dangerous as they reduce cardiac output - perfusion of the brain and myocardium can be impaired

    • Ventricular fibrillation: non-coordinated muscular contractions of ventricular muscle

    • Heart block: irregular rate caused by an interruption in the passage of impulses through the heart’s electrical system; treated with medication and pacemakers

    • Atrial fibrillation: blood remains in the atria after they contract and ventricles do not fill properly; prone to blood clots

Rhythmic Arrhythmia

300

Describe the effects of aging on the CV system

  • Reduction in Function

    • Development of cardiac fibrosis

    • Reduction in calcium transport across membranes

    • Lower capillary density

    • Decreased adrenaline response

    • Impaired autonomic reflex control of heart rate (BP and HR control)

  • Fit and healthy adults, the heart will:

    • Pump less blood to the skin

    • Work harder under the same circumstances

  • Disease may have greater impact than CV function than aging


    • Heart disease begins earlier than formerly expected

      • Early findings in adolescents of cholesterol deposits in vessels

  • Cardiovascular disease

    • Most common cause of hospitalization and death in the older population

  • Effects of aging have less relevance at rest but considerable consequences during cardiac events

300

Medical management of a DVT 

  • Primary prevention

    • Early mobilization

    • Prophylactic use of anticoagulants

    • Elastic stockings

    • Pneumatic pressure devices (mimic calf pump)

  • Ambulation after adequate anticoagulation therapy has been administered if symptoms and condition permit

300

  • Shortness of breath (SOB)

  • Can be cardiovascular, pulmonary, or due to trauma, fever, medications, or obesity

  • Dyspnea on exertion (DOE): dyspnea with mild exertion

  • Orthopnea - breathlessness which occurs with recumbency - relieved with sitting upright


    • Can occur day or night

Dyspnea

300

partial or complete occlusion of a vein by a thrombus (clot)

  • Inflammatory reaction in the wall of the vein

  • Common complication after surgical procedures or CVA

  • Clinical manifestation of DVT may take up to 4 weeks

    • May be asymptomatic; dull ache, tight feeling, pain in calf

Venous thrombosis

400

List the common causes of angina pectoris

chest pain or discomfort occurring when heart muscle does not get enough oxygen

  • Can start behind the sternum

  • May be mistaken for indigestion

  • Can feel tight and can radiate

400

Describe how orthostatic hypotension occurs

Orthostatic hypotension: significant drop in blood pressure when standing from sitting or laying down

  • Normal response - standing results in force of gravity causing venous pooling lower limbs

    • Compensatory mechanisms: increased HR, increased vascular resistance

  • Orthostatic hypotension - the body cannot compensate, loss of cerebral blood flow which may result in fainting

  • During supine → standing transition

    • Drop of >20 mmHg in systolic BP

    • Drop of >10 mmHg in diastolic BP

    • May see HR increase as well

  • Causes

    • Aging

      • Postural reflexes are slowed

      • Cardiac output decreases

    • Vasoactive HTN drugs

400

  • Fainting (mild form = light-headedness)

  • Reduced O2 to the brain when the heart’s pumping ability is compromised

  • Causes


    • Arrhythmias, orthostatic hypotension, aortic dissection, CAD

Cardiac syncope


400

embolus has traveled via the venous system into the heart then travels into a pulmonary artery and occludes it

Pulmonary embolism 

500

Describe the types of angina pectoris

Stable angina

  • Exertional - predictable levels of physical or emotional stress and responds promptly to rest or nitroglycerin

  • No pain at rest

  • Location, duration, intensity, and frequency of chest pain are consistent over time

    Unstable angina

  • Preinfarction angina

  • Unpredictable and not relieved by rest

    Post-infarction angina

  • After MI when residual ischemia triggers an episode

500

Describe the different types of aortic aneurysms and where they occur

Aneurysms: abnormal stretching in the wall of vessel or chamber

  • Types:

    • Thoracic aortic aneurysm - above the diaphragm

    • Abdominal aortic aneurysm - below the diaphragm

  • May be asymptomatic initially then results in:


    • Persistent vague, substernal, back and neck pain

  • Rupture - tearing of the vessel walls with bleeding into the thoracic or abdominal cavity

  • May be identified by palpation of imaging

  • Medical screening questions are critical


500

  • Very strong parasympathetic response that leads to vasodilation throughout the body

    • As a response to emotional distress, heart rate slows and vessels dilate leading to hypotension and cerebral hypoperfusion = fainting

Vasovagal syncope


500

intermittent episodes of small artery constriction to the extremities

  • Causes temporary pallor and cyanosis of the digits and changes in skin temperature

    • Cold temperature

    • Strong emotion

Raynaud’s disease

600

Management of angina

  • Short acting sublingual nitroglycerine

  • Vasodilators: beta blockers

  • Calcium channel blockers: limit heart rate and contraction of heart


600

BP regulated by 2 factors

Blood flow (determined by cardiac output) and peripheral vascular resistance (diameter of vessels)

600

  • Usually associated with pulmonary conditions

    • Can be pulmonary complication of a cardiovascular condition

    • Left ventricular dysfunction with resulting pulmonary edema presenting as cough with aggravated by exercise

    • Dry and hacking

    • Hemoptysis: productive, frothy, blood tinged sputum with pulmonary edema

Cough

600

Narrowing that prevents the valve from opening fully; chamber behind the narrow valve must work harder

Stenosis

700

List common gender differences in the CV system

Coronary Artery Disease: leading cause of death and a significant cause of morbidity among women in the US

  • Women and minorities were underrepresented in studies conducted on heart disease

  • In general, patients with smaller bodies and smaller arteries have a higher mortality rate after CABG


    • Women may have CAD and microvessel disease - just opening the artery may not be sufficient

    Coronary microvascular dysfunction

  • Tiny blood vessels to the heart become constricted - reducing blood flow

  • “Stealth” heart disease

  • May not show up on classic angiograms

  • Classic signs of reduced blood flow may not be present    

700

  • _____ pressure: when heart contracts

  • _____ pressure: when heart is relaxed 

Systolic

Diastolic

700

  • Bluish discoloration of the lips, nail beds, fingers, toes

    • Inadequate blood oxygen levels

  • Cyanosis

700

Regurgitation; valve does not close properly

Valve insufficiency

800

Explain the condition of Ischemic heart disease

AKA: Coronary Artery Disease (CAD) - coronary arteries carry O2 blood to the myocardium; one of the arteries become narrowed or blocked, areas of the heart muscle supplied by that artery do not receive sufficient O2 and become ischemic/injured = infarction may result

    Modifiable Risk Factors

  • Cigarette smoke (leading cause)

  • Tobacco products (increase HR and BP)

  • Elevated cholesterol levels

  • Hypertension

  • Obesity (heart has to work harder)

  • Physical inactivity

  • Impaired glucose metabolism

  • Psychological factors and emotional stress

  • Moderate alcohol consumption

    Non-Modifiable Risk Factors

  • Increasing age

  • Gender

  • Family history

  • Ethnicity

  • Social determinants of health

800

What is the most common site of a Myocardial infarction and why?

Most common site = left ventricle (chamber of the heart with the greatest workload)

800

  • Hallmark of right ventricular failure

  • Usually bilateral and dependent

    • Jugular venous distention

    • Abdominal distension - ascites

  • Peripheral edema

800

A significant drop in blood pressure when standing from sitting or laying down

Orthostatic hypotension

900

Medical Management of Ischemic heart disease

  • Prevention is the ultimate goal

    • Begins slowly in adolescence and develops slowly

  • Controlling cholesterol before atherosclerosis (thickening and hardening of arteries) has a chance to do damage

  • Exercise and physical activity

    • Moderate intensity for 30 mins on most days of the week

    • Independent of weight loss - significant beneficial effects on risk factors

    • One intervention with the ability to influence the greatest number of risk factors

    Surgery

  • Angioplasty: open an occluded artery without opening the chest using inflated balloon

  • CABG: taking a portion of a vessel from the chest or leg and grafting it on the coronary artery

  • Coronary stents: stent in place to maintain an open vessel

900

Compensated CHF: combined efforts of the 3 mechanisms achieve a normal level of cardiac output

First: failing heart attempts to maintain normal output of blood by enlarging to hold a greater volume of blood

  • Short term improvement

  • Contractility muscle decreases

Second: Nervous system increases the stimulation of cardiac muscle

  • Increase in pumping, mass, strength

  • Hypertrophy leads to increased need for O2

Third: Kidney compensation

  • Water retention = increase blood volume, exacerbates edema

  • Expanded blood volume increases the load on an already compromised heart

900

  • Cramping or leg pain

  • Brought about by consistent amount of exercise or activity

    • Result of peripheral vascular disease

    • Most functionally debilitating of symptoms

  • Claudication (leg pain)

900

  • open an occluded artery without opening the chest using inflated balloon

Angioplasty

1000

Explain the pathophysiology and treatment of hypertension (HTN)

  • BP is the force exerted against the wall of the arteries

    • Systolic pressure: when heart contracts

    • Diastolic pressure: when heart is relaxed

      • Normal:  <120 and <80

      • Elevated:  120-129 and <80

      • High: 130-139 or 80-89

      • High stage 1: >140 or >90

      • Crisis: >180 and/or >120

  • BP regulated by 2 factors

    • Blood flow (determined by cardiac output) and peripheral vascular resistance (diameter of vessels)

  • Prolonged HTN - elastic tissue is replaced by fibrous tissue; thickened artery wall has greater resistance to flow of blood

  • Prevention

    • Annual BP check

    • Physical activity/exercise

    • Weight control

    • Limitations on salt and alcohol intake

1000

Chest pain or discomfort occurring when heart muscle does not get enough oxygen

Angina pectoris

1000

 taking a portion of a vessel from the chest or leg and grafting it on the coronary artery

CABG

1100

Explain what occurs in a myocardial infarction

  • Myocardium receives blood from 2 large coronary arteries and their branches

    • 1 or more of these vessels may become occluded

    • Most common site = left ventricle (chamber of the heart with the greatest workload)

      • Common cause: clot of the anterior descending branch of the left coronary artery

  • Zone of infarction: cells die where they have been deprived of O2

  • Zone of injury: area surrounding infarction, less damage, may return to normal

  • Caused by ischemic and injured myocardial tissues

1100

coronary arteries carry O2 blood to the myocardium; one of the arteries become narrowed or blocked, areas of the heart muscle supplied by that artery do not receive sufficient O2 and become ischemic/injured = infarction may result

Ischemic heart disease

AKA: Coronary Artery Disease (CAD)

1100

  • ______ - >100 bpm

    • Increased sympathetic stimulation

  • ______ - <60 bpm

    • Normal in well-trained athletes

Tachycardia

Bradycardia

1200

Clinical manifestations of a myocardial infarction (MI)

  • Sudden sensation of pressure (crushing chest pain - can radiate to the arm, throat, neck and back)

  • Pallor

  • SOB

  • Profuse perspiration

  • Mid-thoracic pain

  • Abdominal pain and nausea

  • In women:

    • Chronic unexplained fatigue

    • SOB - sometimes in the middle of the night

1200

Persistent elevation of systolic BP >130mmHg, diastolic BP >80mmHg (or both) measured on 2 separate occasions

Hypertension

1300

Explain the symptoms of congestive heart failure (CHF)

CHF Compensatory mechanisms

First: failing heart attempts to maintain normal output of blood by enlarging to hold a greater volume of blood

  • Short term improvement

  • Contractility muscle decreases

    Second: Nervous system increases the stimulation of cardiac muscle

  • Increase in pumping, mass, strength

  • Hypertrophy leads to increased need for O2

    Third: Kidney compensation

  • Water retention = increase blood volume, exacerbates edema

  • Expanded blood volume increases the load on an already compromised heart


Compensated CHF: combined efforts of the 3 mechanisms achieve a normal level of cardiac output

Decompensated CHF: mechanisms are no longer effective and the disease progresses to the final stages of impaired heart function

  • Can range from mild to life-threatening fluid overload

  • Symptoms usually develop gradually so many people do not recognize or report the symptoms

1300

  • Development of ischemia with resultant necrosis of myocardial tissue

  • Any prolonged obstruction depriving the heart muscle of O2 can cause MI

  • Risk factors are same as CAD

  • Occur more frequently in the early morning hours

Myocardial infarction (MI)

1400

Medical management and exercise conditions of CHF

Medical management

  • Diet and exercise

  • Sodium restricted diet

  • Limited fluid intake

  • Pharmacotherapy:


    • Reduce hearts workload

    • Increase muscle strength and contraction

    • Decrease kidney compensation response

  • Medications


    • ACE inhibitors: increase renal blood flow and decrease vascular resistance - enhance diuresis

    • Diuretics: control fluid buildup

    • B-blockers: act on cardiac tissue to reduce contraction and rate


Exercise considerations

  • Monitor vital signs before, during, and after exercise

  • Monitor for decreasing BP

  • Monitor for dyspnea - aerobic capacity is likely impaired

  • Low RPE - light to somewhat hard

  • Exertional dyspnea - should not exceed a rating of mild

  • American College of Sports Medicine


    • Moderate intensity

    • 40-60% VO2 max

    • 2-6 minute bouts

    • 2 mins of rest

    • Gradually increase intensity and duration

    • Individual goals and expected outcomes in mind

    • Avoid exercise taking vasodilator medication

1400

 condition in which the blood is unable to pump sufficient blood to supply the body’s needs; caused by inadequate pump performance; backup of blood into the pulmonary veins = pulmonary congestion

  • Left ventricular failure = CHF

  • Right ventricular failure = cor pulmonale

  • Common complication of ischemic and hypertensive heart disease

  • CHF may develop after an MI

Congestive heart failure (CHF)


1500

Explain the electroconductive pathway through the heart and how an arrhythmia occurs

Electroconductive pathway:

  • HR and rhythm is regulated by the SA node

  • Signal travels through the conduction system

    • Through walls of atria

    • Down to AV node

    • Walls of ventricles

1500

When heart is extensively damaged, cardiac enlargement occurs, heart cannot completely eject blood from the left ventricle

Cardiomyopathy

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