1CVD is Defined as any disease that affects the heart or blood vessels, a general name for multiple diseases that affect the heart.

2. Includes: Coronary Artery Disease(CAD), which can lead to Myocardial Infarction(heart attack), chest pain(Angina Pectoris), Stroke(brain attack)

Also includes Peripheral Artery Disease(PAD) which can cause lower leg pain(intermittent claudication)

3. The primary cause of CAD, stroke, PAD and its associated symptoms is Atherosclerosis

Atherosclerosis: Lipid deposits in, and fibrosis of, the inner layer of the artery wall.

Arteriosclerosis: Thickening and hardening of the arterial walls.

Endothelial Dysfunction: Damage to the lining cells of the arterial wall.

Ischemia: Blood flow is restricted.

Rate-Pressure product(RPP) Is the product of the heart rate(HR) times(x) the systolic blood pressure(SBP). RPP is an index of myocardial oxygen demand.

Peripheral Edema: Classic symptom of heart failure, lack of kidneys working properly(swollen ankles)

Peripheral adaptations: Beneits of exercise are caused by this, includes skeletal muscle, metabolism, endothelial function, vasodilation, blood distribution.

Sympathomimetic Agents: Mimic the sympathetic nervous system. Typically used as a stimulant so heart rate, BP, BMR, all increase.

Beta-blocking agents: Blocks catecholamines(epinephrine) from binding to b-receptors. This causes a decrease in heart rate, blood pressure. Decreases exercises tolerance because of the above. Medications of these usually end in -olol.

Antianginal agents: Angina is severe constricting pain. These agents decrease heart rate and BP in order to decrease the demand on the heart. Includes calcium channel blockers, beta-blockers.

Antiarrhythmic agents: Used to prevent fatal cardiac arrhythmias(irregular heartbeat). Works by blocking Calcium, sodium, potassium channels in the cardiac electrical conduction system.

Anti-coagulant agents: Prevents clot formation

MI begins with coronary atherosclerosis. Lesions/plaque may produce myocardial ischemia(insufficient blood supply)

Symptoms: Severe chest pain(angina pectoris)

Increased serum levels of cardiac enzymes

EKG changes(ST-segment elevation, T-wave inversion, Pronounced Q-Wave)

Effects on exercise include: Below normal aerobic capacity, reduced O2 Transport, Decreased SBP, Failure of heart rate to rise.

Myocardial ischemia: Obstruction in the coronary arties.

Two types of Ischemia: Symptomatic symptoms: Angina(most common), Dyspnea(Shortness of breath), Nausea, Diaphoresis(Sweating)

Three forms of Symptomatic Ischemia: Stable(Relieved with rest), Unstable:(Unpredictable, blockage of an artery, precursor to MI), Variant:(Occurs when coronary arteries suddenly spasm or contract, no evidence of obstruction, calcium channel blockers used to treat this.)

Silent Ischemia: Absence of symptoms. Diagnosed with stress testing(ST wave analysis). Common among diabetics, treatment is similar to those with angina.

Exercise response: Inotropic impairment(Loss of contractility) in the myocardium as a result of decreased oxygenation which equals decreased stroke volume. This decreased stroke volume may lead to increased chronotropic response(increases in heart rate). Avoid exercise in the cold.

PAD results from: Atherosclerotic changes in the peripheral arterial circulation of the lower body.

PAD results in: Ischemia in the lower body.

Diabetes, dyslipidemia and smoking are major risk factors associated with PAD.

Intermittent claudication: Most common sign of PAD. Symptoms include: Limping, pain.

Caused by: Insufficient blood flow

Ankle SBP is measured to asses the circulation.

PAD follows these guidelines: Grade 0=No symptoms, Grade 1=Intermittent claudication, Grade 2=Ischemic rest pain, Grade 3=Minor or major tissue loss from the foot.

PAD can be improved through exercise due to increases in leg blood flow. Weight bearing exercise is recommended.

A stroke, or CVA(cerebrovascular accident) is a form of cardiovascular disease but is classified as a neuromuscular disease. Results in neurological impairment.

80% of stroke are ischemic strokes due to atherosclerosis. Remainder of strokes are called hemorrhagic stroke which result from the rupture of a defective artery that carries blood to the brain(more lethal) 10% of stroke are preceded by small strokes called transient ischemic attacks(TIA).

Coronary atherosclerosis=Narrowing of the lumen of the coronary vessels. Results in myocardial ischemia.

Revascularization attempts to: Increase blood flow and o2 to the heart and reduce cardiovascular morbidity(diseased state) and mortality(death)

Two techniques: Coronary artery bypass graft surgery(CABGS): Bypassing the portion of the defunctional coronary artery by using a saphenous vein from the patients own log.
Percutaneous Transluminal Coronary Angioplasty: Directing a balloon catheter to the site of the lesion. The balloon is then inflated which produces compression of the plaque and stretching the vessel wall which increases the diameter of the vessel.

PTCA can be performed with or without Stent Therapy: A steel mesh tube is placed at the site of the lesion in an attempt to prevent restenosis of the vessel, remains permanently in the artery.

CHF is the fastest growing cardiac related diagnosis in the USA.

Leading reason of hospitalization in those 65+

CHF: Characterized by the inability of the left ventricle to pump blood due to loss of muscle, loss of contractility, these are termed Systolic Dysfunction

and or: Due to an inability of the filling of the left ventricle termed Diastolic Dysfunction

Whether due to systolic or diastolic dysfunction, the left ventricle is unable to supply blood to the tissues.

Signs and symptoms: Fatigue, dyspnea, difficulty sleeping fat(Orthopnea), awakening at night short of breath(paroxysmal noctural dyspnea)

In the 80's, excerise for CHP patient were discouraged. There are benefits of exercise and exercise does not lead to further heart damage but does not benefit the heart.

COPD is an airflow obstruction attributable to either chronic bronchitis or emphysema.

Most COPD is caused by smoking.

Asthma is similar but NOT related to COPD.

Chronic Bronchitis is long lasting inflammation fo the bronchi.

Emphysema is a condition characterized by the destruction of the bronchioles(little tubes) and the alvbelor walls.

Symptoms include: Smoking, cough, sputum production, wheezing, dyspnea.

Spirometry tests are used to diagnos COPD.

A pulse oximeter monitors arterial blood gases which can help determine if someone is becoming hypoxic(oxygen deficiency)

Beta-2-agonists(inhalers):Stimulate beta-2 receptors in the lungs which causes vasodilation to help breathe better.

Corticosteroids: Anti-inflammatory long-term medication.

Mast cell stabilizers: Inhaled antihistamines

Exercise prescription: Frequency=3-7 days a week. Intensity=50% of VO2 peak, 3-4 on Dyspnea scale. Duration=20-30 minutes. Type=Large muscle groups, aerobic, walking to begin with.

Asthma: Chronic inflammatory lung disease characterized by reversibe airway obstruction

There is an increased bronchial responsiveness to different stimuli, which can trigger an allergic reaction.

Exercise-induced asthma: Without other symptoms(Airway obstruction 5-15 minutes after exercise)

Mild asthma: Breathing limitations do not restrain submaximal exercise.

Moderate to severe asthma: Breathing limitations restrain submaximal exercise.

Asthma triggers: Lumen narrowing, excessive mucus production caused by allergens, drugs, exercise, infections, air pollutants, chemical irritans, weather/temp and food allergies.

Effect on exercise: In well controller individuals with asthma there is NO effect on exercise response.

Proper warm-up and cool-down can prevent or reduce exercise-induced asthma.

Mechanical Lower back pain or leg pain is mostly caused by a lumbar strain/sprain. Very little is caused by a degenerative disc disease or herniated disc.

Treatment: NSAIDs, pain relievers, corticosteroids, muscle relaxants.

Back belts: Injuries are more severe when wearing them, they give false confidence, not recommended.

Exercise should include core strengthening, abdominal, rotators, flexors, hips.

First Trimester: Fetus is undergoing the most important growth.

Myths of exercise while pregnant: No heart rate above 130bpm: Not true, use RPE.

No abdominal work: It's fine and beneficial.

Exercise will deprive the baby: Not true, the baby will get what it needs from the mother eating healthy.

Exercise prescription: 150 minutes of moderate intensity aerobic activity per week. Use rate of perceived exertion

Arthritis: Inflammation of one or more joints. Is the leading cause of disability.

Characterized by degeneration of articular cartilage, bony overgrowth.

Causes are unknown, possible mechanical events(wear and tear) or molecular events. No current cure.

Women are at higher risk. Non modifiable is genetic predisposition, modifiable includes men and womens job habits(construction, cleaning), injuries, excess body mass.

Inflammation: Red, hot, swollen, painful.

Treatment: Weight control, medications(Acetaminiphen=tylonel), corticosteroids. physical activity.

Physical activity can reduce pain and improve function. General rule is that 1 minute of vigorous intensity=2 minutes of moderate intensity.

Balance activities if at risk for falling.

S.M.A.R.T(Start low and go slow)(Modify activity when symptoms increase)(Activities should joint friendly)(Recognize safe places/ways to be active)(Talk to health professional)