Cardiovascular Disorders

1. Cardiovascular Disorders Chapter 20

2. Circulatory System Heart 4 chambers Right and left atria superiorly Right and left ventricles inferiorly Systole vs. diastole Valves Atrioventricular Semilunar

3. Circulatory System (cont.) Pulmonary circuit Systemic circuit

4. Circulatory System (cont.)

5. Blood and Lymph Disorders Anemia Abnormal reduction in red blood cell (RBC) volume or hemoglobin concentration Functions of iron Caused by impaired RBC formation, excessive loss, or destruction of RBCs RDA iron—15 mg per day (females)

6. Blood and Lymph Disorders (cont.) • Effects on physical activity • ↓ maximum aerobic capacity • ↓ physical work capability at submaximal levels • ↑ lactic acidosis • ↑ fatigue • ↓ exercise time to exhaustion • Predisposing factors • Iron deficiency develops gradually through several stages before anemia is evident

7. Blood and Lymph Disorders (cont.) Iron deficiency anemia Characterized by deficient hemoglobin synthesis Early S&S Fatigue, tachycardia, blood mixed with feces, pallor, and epithelial abnormalities Later S&S Cardiac murmurs, congestive heart failure, loss of hair, and pearly sclera

8. Blood and Lymph Disorders (cont.) • Management • Iron supplement • Avoid caffeine • Exercise-induced hemolytic anemia • Intravascular hemolysis • Can occur in both high- and low-impact activities • Rarely severe enough to cause appreciable iron loss

9. Blood and Lymph Disorders (cont.) Sickle cell anemia Abnormalities in hemoglobin structure Result: characteristic sickle-shaped RBC Fragile and unable to transport O2 Impact of excessive exercise in high heat, humidity, or altitude Potentially asymptomatic

10. Blood and Lymph Disorders (cont.) • S&S • Recurrent bouts of swollen, painful, and inflamed hands and feet • Tachycardia • Severe fatigue • Headache • Pallor • Muscle weakness • No known treatment to reverse the condition • Hydrate; use caution in conducive environments

11. Blood and Lymph Disorders (cont.) Hemophilia Bleeding disorder characterized by deficiency of selected proteins in blood-clotting system Inherited disease 3 types depending on deficient clotting factor Hemophilia A, B, and C

12. Blood and Lymph Disorders (cont.) • S&S include: • Many large or deep bruises • Joint pain and swelling • Intramuscular bleeding • Blood in the urine or stool • Prolonged bleeding from cuts or injuries • Treatment • Mild hemophilia A—prescribed injections of desmopressin • Severe hemophilia A or hemophilia B—infusion of clotting factors • Hemophilia C—plasma infusions

13. Blood and Lymph Disorders (cont.) Reye’s syndrome Severe disorder of young children following an acute illness, usually influenza or varicella infection Disrupts body’s urea cycle, resulting in: Accumulation of ammonia in blood Hypoglycemia Severe brain edema Critically high intracranial pressure

14. Blood and Lymph Disorders (cont.) • Aspirin may trigger the condition • Characterized by: • Recurrent vomiting beginning within a week after onset of condition • Child either recovers rapidly or lapses into a coma with intracranial hypertension • Death may result from brain edema and cerebral herniation • Management: hospitalization

15. Blood and Lymph Disorders (cont.) Lymphangitis Inflammation of the lymphatic channels Results from infection at site distal to the channel Pathogenic organisms Direct—through an abrasion or wound Indirect—complication of an infection

16. Blood and Lymph Disorders (cont.) • S&S • Local inflammation and infection—manifested as red streaks • Headache, loss of appetite, fever, chills, malaise, and muscle aches • Can progress rapidly • Management: immediate physician referral; hospitalization is usually necessary

17. Syncope Syncope—sudden, transient LOC; “fainting” Near syncope—sense of impending LOC or weakness Primary causes Cardiac and circulatory causes Metabolic causes Neurologic causes Reflex syncope Miscellaneous

18. Syncope (cont.) • Most frequent cause—neurally mediated syncope (NMS) • Sudden drop in blood pressure reducing blood circulation to the brain • S&S—typical NMS • Occurs while standing • Often preceded by prodromal symptoms • Restlessness, pallor, weakness, sighing, yawning, diaphoresis, and nausea • Followed by lightheadedness, blurred vision, collapse, and LOC

19. Syncope (cont.) Syncope that suggests a serious disorder: Occurring with exercise Associated with heart palpitations or irregularities Associated with family history of recurrent syncope or sudden death

20. Syncope (cont.) • Management • Responds well to avoiding stimuli that trigger the event • If syncope does occur: • Assess and monitor vital signs • Place the individual in a safe, lying down position • LOC >few minutes, breathing or cardiac impairment—activate EMS

21. Shock • Heart unable to exert adequate pressure to circulate enough oxygenated blood to vital organs • Could be due to: • Damaged heart • Low blood volume • Blood vessel dilation

22. Shock (cont.) • Result • Heart pumps faster, but due to ↓ volume, pulse is weak and BP ↓ • Circulatory distress—if not corrected, can lead to unconsciousness and death • Occurs in injuries involving severe pain, bleeding, fracture, or intra-abdominal or intrathoracic injuries • Severity varies with variety of factors • Types of shock

23. Shock (cont.) S&S Restlessness, anxiety, disorientation, or dizziness Cold, clammy, moist skin; initially pale, but later may appear cyanotic Profuse sweating and extreme thirst Eyes dull, sunken, with pupils dilated Nausea and/or vomiting Shallow, irregular breathing, but may also be labored, rapid, or gasping Pulse—rapid and weak

24. Shock (cont.) • Management: • Activate EMS • Maintain an open airway • Control any bleeding • Maintain body temperature • Body position

25. Blood Pressure Disorders Blood pressure Force per unit area exerted on walls of an artery Result of: Cardiac output Total peripheral resistance Reflects effectiveness of circulatory system

26. Blood Pressure Disorders (cont.) • Systolic (SBP) • Pressure when left ventricle contracts and expels blood into the aorta (120 mm Hg) • Diastolic (DBP) • Residual pressure in aorta between beats (70–80 mm Hg)

27. Blood Pressure Disorders (cont.) Hypertension (high blood pressure) Sustained elevated blood pressure >140 mm Hg SBP or >90 mm Hg DBP Risk factors Age, diabetes, heredity, high blood lipids, obesity, race, sex, smoking

28. Blood Pressure Disorders (cont.) Guidelines for clearance to participate in sport and physical activity Mild or moderate No participation until physician clearance Often allowed to participate if BP is controlled and there is no target organ damage or heart disease Stage 2 Physical activity restricted until hypertension is well controlled

29. Blood Pressure Disorders (cont.) • Treatment • Two-fold • Reduce systolic and diastolic blood pressure • Prevent long-term complications • Methods • Nonpharmaceutical treatment • Lifestyle modifications • Aerobic exercise • Pharmaceutical treatment • Diuretics • Antihypertensive

30. Blood Pressure Disorders (cont.) Hypotension Fall of >20 mm Hg from a person's normal baseline SBP Caused by a variety of factors Shock Acute hemorrhage Dehydration Orthostatic hypotension Overtreatment of hypertension Physically active people usually have no need for concern

31. Sudden Cardiac Death an unexpected death resulting from sudden cardiac arrest within 6 hours of an otherwise normal, healthy clinical state leading cause of death in young athletes

32. Sudden Cardiac Death (cont.) Cardiac causes of SCD Hypertrophic cardiomyopathy Abnormal thickness of left ventricular wall Can lead to electrical problems and abnormal rhythms Usually undetected in PPE Exam should include thorough cardiac hx and cardiac exam Prodromal symptoms (refer to a physician)

33. Sudden Cardiac Death (cont.) • Mitral valve prolapse • Redundant tissue is found on one or both leaflets of the mitral valve • During a ventricular contraction, part of the redundant tissue pushes back beyond the normal limit • Produces an abnormal sound followed by a systolic murmur as blood is regurgitated back through the mitral valve into the left atrium

34. Sudden Cardiac Death (cont.) Myocarditis Inflammatory condition of muscular walls of the heart from a bacterial or viral infection Can result in electrical instability and life-threatening arrhythmias Asymptomatic or symptoms common with viral infections Cardiac symptoms Exercise intolerance, shortness of breath, palpitations, and syncope may occur without warning

35. Sudden Cardiac Death (cont.) Acquired valvular heart disease Defect or insufficiency in a heart valve Valvular stenosis A narrowing of the orifice around the cardiac valves Regurgitation Backward flow of blood

36. Sudden Cardiac Death (cont.) • Named according to affected valve (e.g., mitral valve, aortic valve, tricuspid valve) • Normally detected in PPE • Mild or moderate asymptomatic aortic stenosis with history of supraventricular tachycardia or ventricular arrhythmias at rest • Only participate in low-intensity competitive sports • Severe aortic stenosis or symptomatic, moderate stenosis • Should not engage in any competitive sport

37. Sudden Cardiac Death (cont.) Coronary artery disease Excessive buildup of cholesterol within coronary arteries Narrows diameter of arteries and impedes blood flow Common symptom—angina or chest pain during physical exertion ACSM List of risk factors for CAD (refer to Table 20.3) Use to identify individuals at risk and who warrant additional testing before beginning an exercise program

38. Sudden Cardiac Death (cont.) Marfan’s syndrome Inherited connective tissue disorder affecting many organs, but commonly resulting in dilation and weakening of thoracic aorta Distinct physical features Screening Musculoskeletal and eye examination Echocardiogram to determine abnormalities of the aorta

39. Sudden Cardiac Death (cont.) • Participation • Without evidence of aortic root dilation—participation in moderate, low-static, and low-dynamic competitive activities • With aortic root dilatation—only participate in low-intensity physical activities

40. Sudden Cardiac Death (cont.) Rare cardiac conditions Long QT syndrome; right ventricular dysplasia Produce serious arrhythmias Congenital coronary artery anomalies Decrease blood flow to heart

41. Noncardiac Causes of Sudden Death Commotio cordis Cardiac arrest from a low-impact blunt blow to the chest Conduction abnormalities Usually a fatal event; key—prevention Substance abuse Amphetamines CNS stimulants—↑ heart rate, respiration rate, and BP

42. Noncardiac Causes of Sudden Death (cont.) • Cocaine • Constricts coronary arteries; known to lead to myocardial infarction in those with and without coronary artery disease • Anabolic steroids • Documented cases, but direct relationship has not been established • Erythropoietin • Used as an ergogenic aid for endurance athletes • Can ↑ blood volume and viscosity → ↓ circulation, thrombosis, and myocardial infarction; lead to SCD

43. Cardiovascular Preparticipation Screening Standard screening approach 6–8 weeks before start of season AHA consensus statement (2007) (Refer to Box 20.6) Medical history Physical examination Precordial auscultation to identify heart murmurs Assessment of femoral artery pulses Checking for signs of Marfan’s syndrome Measuring brachial blood pressure

44. Cardiovascular Preparticipation Screening (cont.) • Referral to a cardiologist • More extensive screening • Clearance for participation • must be resolved on an individual basis under the Americans with Disabilities Act of 1990, the Rehabilitation Act of 1973, and similar state statutes prohibiting unjustified discrimination against the physically impaired