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  • No Improvement in Cardiac Performance Ejection Fraction Cardiac Output

Mi cad Mi cad Presentation Transcript

  • ARTERIOSCLEROSIS – 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
  • 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 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)
  • Disease Onset Different in Different populations and Related to Combination of Risk Factors
    • Family History
    • Sex
    • Age
    • Hypertension
    • Hyperlipidemia
    • Smoking
    • Diabetes
    • Obesity
    • Physical Inactivity
  • PRIMARY ARTERIES & END ORGANS Heart Coronary Arteries Kidney Renal Arteries Brain Cerebral Arteries Legs Femoral & Abdominal Arteries
  • NATURAL HISTORY OF ATHEROSCLEROSIS Clean Artery Fatty Steaks Fibrous Plaque Clinical Lesion
  • Anatomy of Artery www.lef.org/magazine/mag2005
  • ARTERIAL HEALTH
  • SUPPLY & DEMAND Supply of Blood To do the Work
  • Triad of Signs/Symptoms
    • Burning
    • Pressure
    • Discomfort
    • Radiating down the left arm
    MI Signs/Symptoms 1) 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 toponin 3) ECG changes in the leads overlying the area of infarction
  • DIFFERENCE BETWEEN ANGINA AND INFARCT ANGINA INFARCT Similar Symptoms < 15 min > 15 min Relieved by Nitro Not relieved by Nitro Relieved by Rest Not relieved by Rest
  • SUPPLY & DEMAND
    • Prolonged ischemia (>60 min)
      • irreversible cellular damage
      • muscle death
      • Necrosis  acute 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 EFFECTIVENESS
    • Physical Work Capacity
    •  Angina Threshold
      •  Claudication Thresholdz
    •  Secondary Event (20%)
      •  Survival from Secondary Event (20%)
  • Assessment Flow-Mediated Dilation Pre
  • Fasting Four Hours after a High-Fat Meal 8-10% 4-5% Pre Pre Pre
  • Impact of Exercise Flow-Mediated Dilation = 8% Pre Pre Post 4.1 mm 4.7 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 D isord 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, 2004 Anderson, et al, Atherosclerosis 154:475-483, 2001 Ceriello, 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 EXERCISE IMPROVES ENDOTHELIAL FUNCTION
  • Overweight Men Lee 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 Cblockers  may 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