Embed Size (px)
Citation preview
ARTERIOSCLEROSIS – ARTERIOSCLEROSIS –
ATHEROSCLEROSIS – ATHEROSCLEROSIS –
A general hardening of the arteries
A a specific type of arteriosclerosis, refers to the accumulation of lipid in the walls of the arteries, gradually leading to an arteriosclerotic condition or a reduced blood flow
A a specific type of arteriosclerosis, refers to the accumulation of lipid in the walls of the arteries, gradually leading to an arteriosclerotic condition or a reduced blood flow
ATHerosclerosis • Accumulation of plaque--progressively narrowing artery
• Significant ‘lesions’ – ischemia and LV dysfunction,
• Typical sites– Lining of the coronary artery
– Abrupt curvature or branching
• Active (unstable) or quiet (stable) – unstable fissure, rupture, and/or swell
– cascade of events sudden/complete obstruction= MI
LEADING CAUSES OF DEATHLEADING CAUSES OF DEATH
Mycardial Infarction
• More than 1.5 million Americans have an MI each year– Approximately 500,000 or 1/3 die
• Chance of event can be reduced – Reduction/control of Risk Factors– Decreased total and LDL cholesterol reduce
plaque instability – Prolonged ischemia (>60 min)
• Family History
• Sex• Age
• Family History
• Sex• Age
• Hypertension• Hyperlipidemia• Smoking• Diabetes• Obesity• Physical Inactivity
• Hypertension• Hyperlipidemia• Smoking• Diabetes• Obesity• Physical Inactivity
Disease Onset Different in Different populations and Related to Combination of Risk Factors
Disease Onset Different in Different populations and Related to Combination of Risk Factors
PRIMARY ARTERIES & END ORGANSPRIMARY ARTERIES & END ORGANS
HeartCoronary Arteries
HeartCoronary Arteries
KidneyRenal Arteries
KidneyRenal Arteries
BrainCerebral Arteries
BrainCerebral Arteries
LegsFemoral & Abdominal Arteries
LegsFemoral & Abdominal Arteries
CleanArteryCleanArtery
Fatty SteaksFatty
Steaks
Fibrous PlaqueFibrous Plaque
Clinical LesionClinical Lesion
NATURAL HISTORY OF ATHEROSCLEROSISNATURAL HISTORY OF ATHEROSCLEROSIS
Anatomy of Artery Anatomy of Artery
www.lef.org/magazine/mag2005
ARTERIAL HEALTH ARTERIAL HEALTH
SUPPLY & DEMANDSUPPLY & DEMANDSupply of Blood Supply of Blood To do the WorkTo do the Work
Triad of Signs/Symptoms
• Burning• Pressure• Discomfort• Radiating
down the left arm
• Burning• Pressure• Discomfort• Radiating
down the left arm
MI Signs/Symptoms1) Severe, prolonged chest pain/pressure—radiate to the arms, back, neck, associated w/ sweating, nausea, or vomiting.2) increased serum levels of cardiac enzymes:CK; CPK toponin3) ECG changes in the leads overlying the area of infarction
DIFFERENCE BETWEEN ANGINA AND INFARCT
DIFFERENCE BETWEEN ANGINA AND INFARCT
ANGINA INFARCTANGINA INFARCT
Similar Symptoms
< 15 min > 15 min
Relieved by Nitro Not relieved by Nitro
Relieved by Rest Not relieved by Rest
Similar Symptoms
< 15 min > 15 min
Relieved by Nitro Not relieved by Nitro
Relieved by Rest Not relieved by Rest
SUPPLY & DEMANDSUPPLY & DEMAND
• Prolonged ischemia (>60 min) • irreversible cellular damage • muscle death•Necrosisacute MI
2 Types of infarctions
• Transmural – full thickness of ventricular wall
• Subendocarial – limited to inner half of the myocardium
• Impact of mortality – Left Ventricular damage ejection fraction– Level of ischemia
Exercise Impact
• Subnormal aerobic capacity (50-70% of predicated)
• Reduced O2 transport is primarily due to diminished cardiac output – decreased contractile, ejection fraction and SV
• Increased anginal symptoms
• Chance of exercise-induced ventricular arrhythmias
Benefits of Exercise
• increased max O2 consumption (~20%)
• improvement in Ve
• reduce symptoms angina/HR/ BP
• increased HR variability
• decrease in weight, fat, BP, LDL
• increase in HDL
• improved psycho
EXERCISE EFFECTIVENESSEXERCISE EFFECTIVENESS
• Physical Work Capacity
• Angina Threshold
• Claudication Thresholdz
• Secondary Event (20%)
• Survival from Secondary Event (20%)
• Physical Work Capacity
• Angina Threshold
• Claudication Thresholdz
• Secondary Event (20%)
• Survival from Secondary Event (20%)
AssessmentAssessment
Flow-Mediated DilationFlow-Mediated Dilation
Pre
FastingFasting
Four Hours after a
High-Fat Meal
Four Hours after a
High-Fat Meal
8-10%8-10%
4-5%4-5%
PrePre
PrePre PrePre
Impact of ExerciseImpact of Exercise
Flow-Mediated Dilation = 8%Flow-Mediated Dilation = 8%
PrePre Post
4.1 mm4.1 mm 4.7 mm4.7 mm
Faulx, et al, American Heart Journal 145:943-951, 2003
Iiyama, et al. American Heart Journal 132:779-782, 1996
Hashimoto, et al. International Journal of Obesity: Relar Metab Disord 22:477-484, 1998.
Caballero, A.E., Obesity Research 11:1278-1289, 2003.
Celermajer,et al. J Am Coll Cardiol 24:471-476, 1994.
Faulx, et al, American Heart Journal 145:943-951, 2003
Iiyama, et al. American Heart Journal 132:779-782, 1996
Hashimoto, et al. International Journal of Obesity: Relar Metab Disord 22:477-484, 1998.
Caballero, A.E., Obesity Research 11:1278-1289, 2003.
Celermajer,et al. J Am Coll Cardiol 24:471-476, 1994.
Tsai, et al. Clinical Science 106:315-319, 2004Anderson, et al, Atherosclerosis 154:475-483, 2001Ceriello, et al, Circulation 106:1211-1218, 2002
Tsai, et al. Clinical Science 106:315-319, 2004Anderson, et al, Atherosclerosis 154:475-483, 2001Ceriello, et al, Circulation 106:1211-1218, 2002
Hamby et al, Diabetes Care 26:2119-2125, 2003
Watts, et al, Journal Pediatrics 144:620-625, 2004
Walsh, et al, JAP 95:20-25, 2003
Hamby et al, Diabetes Care 26:2119-2125, 2003
Watts, et al, Journal Pediatrics 144:620-625, 2004
Walsh, et al, JAP 95:20-25, 2003
EXERCISE IMPROVES ENDOTHELIAL FUNCTIONEXERCISE IMPROVES ENDOTHELIAL FUNCTION
Overweight Men
Lee et al, Am J Clin Nutr 69:373-380, 1999Lee et al, Am J Clin Nutr 69:373-380, 1999
-May take one or more meds after acute MI-Beta Blockers greatly reduced HR- No change in exercise response
- Vasodilators- Diuretics
-Ca Cblockersmay increase exercise tolerance (improve heart function)
Medications
Intensity 40-80% of Vo2 max RPE: 11-15
Frequency: 3 x wk
Duration: 20-40min
Mode: Depends on individual, encourage PA in daily living
Exercise Programming
