Cardiovascular Conditions and Disorders

"What is the leading cause of death in the United States and what is its underlying cause?"

Cardiovascular disease (CVD) is the leading cause of death. Its underlying cause is atherosclerosis, the development of plaque in the arteries.

"What are the modifiable risk factors for CVD?"

"Hypertension, lipid profile, exercise history, smoking, diabetes, and sedentary behavior.

"What are the nonmodifiable risk factors for CVD?"

Age, sex, and family history.

"How is hypertension (HTN) defined?"

Systolic BP of 140 mmHg or higher, diastolic BP of 90 mmHg or higher, or both (confirmed on at least 2 separate occasions).

"What factors contribute to hypertension?"

Elevated cardiac output and/or total peripheral resistance, excess salt intake, salt sensitivity, chronic kidney disease, and kidney dysfunction.

"What is primary hypertension?"

"The 90-95% of HTN cases that have unknown causes."

"How does regular aerobic exercise affect blood pressure in individuals with HTN?"

"It improves VO2max and cardiovascular efficiency and decreases systolic BP by about 5 mmHg and diastolic BP by 2 to 3 mmHg."

"How does regular resistance training affect blood pressure in individuals with HTN?"

"It decreases both systolic and diastolic BP by 3 or 4 mmHg. Resulting weight loss also has a positive effect on BP."

"What are the aerobic exercise recommendations for hypertension?"

At least 30 minutes daily at an RPE of 12 or 13, or 40 to <60% of VO2 or heart rate reserve (if HR is not affected by medication). BP is reduced for up to 4 hours after exercise, so multiple shorter bouts may be more advantageous.

"What are the resistance training recommendations for hypertension?"

"2 or 3 days/week at moderate intensity (8-12 reps at 60-80% 1RM); a lower intensity, higher volume circuit workout may be more appropriate."

"When should a client with hypertension cease exercise?"

"If BP exceeds 220 mmHg systolic or 105 mmHg diastolic."

"What is peripheral arterial disease (PAD)?"

"Narrowing of noncardiac arteries that reduces blood flow. Like CAD, it results from plaque buildup (atherosclerosis) and shares many of the same risk factors.

"What is the hallmark of PAD and how is it relieved?"

Intermittent claudication: leg pain with physical activity due to insufficient blood flow. It is relieved with rest.

"What medications are most commonly prescribed for PAD?"

"Blood thinners antiplatelet-vasoactive agents, statins to reduce cholesterol, and medications for hypertension.”

"How does exercise affect individuals with PAD?"

• Claudication often dictates intensity, limiting exercise to low-to-moderate levels.

• Exercise improves cardiovascular efficiency (lower BP and HR at a given workload)

• Training clients can increase the intensity at which claudication appears."

"What are the aerobic exercise recommendations for PAD?"

• "Walking is recommended (greater gastrocnemius use than other modes).

• Intensity is 40% to <60% HR reserve or a claudication pain level of 3 out of 4. Rest until pain subsides

"What are the resistance training guidelines for PAD?"

"They are similar to those for other clients with CAD."

"What is angina?"

Pain in the chest, neck, jaw, arm, and back that results from ischemia in the heart tissue. Ischemia means blood flow to the heart muscle drops, so the muscle does not get enough oxygen and nutrients.

"What causes angina and what is notable about the exertion level at which it occurs?"

• Usually narrowed coronary arteries from atherosclerotic plaques, it can be brought on by physical exertion, stress, or vasospasm.

• The exertion level at which angina occurs is predictable and reproducible, so a suitable symptom-free exercise intensity can be determined."

"What medications are used to treat angina?"

"Nitrates, calcium channel blockers, and beta-blockers."

"What are the effects of exercise for angina and what is the primary exercise goal?"

• Regular exercise increases heart efficiency, tolerable workload, and VO2max, and decreases body weight.

• The primary goal is to increase the amount of work that can be performed before the ischemic threshold is reached.

"What is chronic (congestive) heart failure (CHF)?"

"The inability of the heart to circulate adequate blood to meet metabolic demands."

"What is the difference between systolic and diastolic CHF?"

"Systolic origin: lower than normal contractility (failure of the left ventricle to properly contract). Diastolic origin: failure of the left ventricle to properly relax."

"How does CHF affect exercise?"

• Much lower exercise capacity, greater shortness of breath and fatigue, and low workloads.

• Medications can improve this but also affect HR and BP, impairing the body's exercise response.

• Intense exercise has shown some promise and may be safe for some individuals."

"What is a myocardial infarction (MI) and what determines its severity?"

A heart attack: reduction or cessation of blood flow to heart tissue caused by a clot or blockage of a coronary vessel. Severity depends on the amount of tissue damaged and the extent of collateral blood flow.

"What most commonly causes MI clots and what risk factors are related?"

Rupture of an atherosclerotic lesion, related to high blood pressure, hyperlipidemia, diabetes, and family history.

"Why are blood vessel bifurcations common sites of plaque rupture?"

"Bifurcations (branch points) have higher fluid turbulence."

"What must happen before an individual with a prior MI begins an exercise program?"

"A medically supervised exercise test and a period of supervised training."

"What is atrial fibrillation (AF)?"

A common, increasingly prevalent arrhythmia: an electrical malfunction in which the atria depolarize very rapidly (up to 300 times per minute), causing uncoordinated ventricular contraction. It is present in HTN, HF, coronary heart disease, and valvular heart disease.

"How does AF affect exercise and how should intensity be determined?"

• AF reduces stroke volume and cardiac output by about 20% and causes early fatigue.

• Exercise tolerance varies with comorbidities. A medically supervised graded exercise test should determine proper aerobic intensity.

"Why might someone need a pacemaker or ICD and what do these devices do?"

• Electrical disturbances causing a high, low, or disorganized HR (light-headedness or syncope).

• Pacemakers and implantable cardioverter defibrillators (ICDs) restore or optimize heart rhythm. Underlying causes include CAD, heart failure, MI, or sick sinus syndrome.

"What is valvular heart disease (VHD) and what are its causes and symptoms?"

Incompetence of one or more heart valves (stenosis, or failure to close causing retrograde blood flow), increasing pressure in and size of all chambers.

• Causes: rheumatic fever, congenital issues, infection, aging.

• Symptoms: dyspnea, fatigue, pain, palpitations.

"How does VHD affect exercise and what recommendations apply?"

• Minimal symptoms = normal exercise response

• moderate = depends on worst comorbidity

• severe (especially at rest) = exercise possibly contraindicated. Medically supervised testing and a longer warm-up and cooldown are recommended.