CVD

CVD

1. Condition

   • Ischaemia
     • Causes Angina
       • Class 1
         • Pain with hard ex
       • Class 2
         • pain during mod ex
       • Class 3
         • limitation normal activ
       • Class 4
         • occurs at rest
       • treament
         • surgery
           • CABG
             • coronary bypass graft surgery 
           • PTCA
             • baloon and stent 
         • lifestyle
           • diet
           • exericse
             • aerobic
               • 3-5days week
                 • mod level
                   • 30-60min day
             • resistance
               • 2-3days week
                 • mod leve.
                   • 8-10reps/ 2-4sets
                     • full body
             • stretching
               • 2-3days week
                 • 2-4 sets
             • considerations
             • contraindications
       • Medications
         • nitrates
           • convert niitrates to nitric oxide
             • promotes dilation
               • increase in blood flow to heart
           • glycerly trinitrate
   • Hypertension
     • Men 26.9%, women 19.5%
     • causes blood vessels to scare
       • less elastic
     • Management
       • Exercise
         • 30min most days
           • Aerobic 7/6 drop in BP
             • Resistance training 3/3 BP drop
       • Diet
       • Stop smoking
     • leads to
     • Medications
       • ACE inhibitor
         • block conversion of angiotensin 1 to 2
           • 2 is vasocontrictor
             • lowers BP
         • catopril
           • enalapril
             • ramipril
         • causes cough
       • Angiotensin II receptor antagonists
         • binds to specific receptors for 2
         • losatan
           • irbesartan
             • temisartan
         • no cough
       • Beta blocker
         • block activity of adrenaline at b receptor
           • prevents sympathetic acceleration of heart
             • reduce cardiac ouput
               • reduce BP
         • selective b1 receptors
           • atenolol
             • bisprolol
               • reoprolol
         • non selective
           • cause brochoconstriction
             • timolol
               • pindolol
       • Calcium channel antagonists (Blocker)
         • decrease entry of calcium into heart
           • effect cardiac contractility and conduction
         • verapamil
           • diltiazem
       • Diuretic
         • reduction in fluid load, increase urine
           • lowers BP
   • Artherosclerosis
     • Can cause
     • prolonged (20min)
     • chest pain
       • cells become hypoxic
     • leads to
   • MI
     • leads to
     • reduced capacity due to scaring
       • reduced ejection, stroke volume, bp response
   • Coronary artery disease
     • plaque builds up
       • break off
       • blood clots forms on
     • leads to
   • Chronic heart failure
     • failure of LV or RV to pump sufficent blood
       • LV failure causes < CO LV filling pressure and LV hypertrophy
     • management
       • CABG
       • heart transplant
       • reudction in fluid and sodium
       • Exericse
     • signs
       • SOB
       • feet swelling
       • weakness
       • weight gain
   • PAD
     • Occulsive disease of lower limb
       • Cause intermittent claudication
         • painful cramping of leg or hip muscles&nbsp;
     • Stages
       • 1: Asymptomatic
       • 2 intermiddent claudication
       • 3. pain at rest
       • 4. gangrene/ tissue loss

2. Risk

   • Low
     • Absense of dysthrymthia
     • absense of angina
     • normal bp/ hr during ex
     • functional capacity (>7mets)
     • resting ejection fraction >50%
       • % of blood leaving heart everytime it contracts&nbsp;
   • Moderate
     • presense of angina at high levels (>7mets)
     • mild ischamia during ex
     • fuctional capacity <5Mets
     • ejection 40-59%
   • high
     • dsyrhythmiais
     • angina
     • abnormal HR/ BP during ex
     • presense of heart failure, MI, depression
     • ejection <40

3. Contraindictations for exercise

   • hypertension
     • postpone
       • BP> 180/110
     • cease
       • BP >250/115
   • unstable Angina
   • hypotension
     • SBP drop of >20
   • uncontrolled arrhymthmias
   • uncontrolled tachycardia >120
   • uncontrolled diabetes