DPT 611 Cardiovascular Rehabilitation Quiz

Course Information

• Course name: DPT 611 Cardiovascular Rehabilitation
• Course instructor: Lora Packel PT, PhD
• Course semester: Spring 2025
• FNIBBLE assignment due by the end of week 3

Cardiovascular Risk Factors, CV Anatomy & Physiology

• Learning Objectives for the module:
  • State the normal anatomy and physiology of the cardiovascular and lymphatic systems related to cardiovascular disease.
  • State risk factors for cardiovascular disease.
  • Interpret and categorize risk factors.
  • State fundamental principles in exercise physiology related to the cardiovascular system.
  • Define the movement system and use it to direct examinations of a mock patient with cardiovascular disease.

Cardiovascular Anatomy

•  Draw the heart (including valves) and the branches of the aorta with a classmate. 
• Do not draw coronary arteries yet.

Heart - Gross Anatomy

•  The base of the heart is the top portion tilted backward.
•  The apex of the heart is the bottom portion in the vicinity of the 5th intercostal space.
•  The heart is positioned two-thirds to the left of the breastbone (sternum).
•  Three layers: Epicardium (outermost layer), Myocardium (middle, muscular layer responsible for contraction), and Endocardium (innermost layer)
• Myocardial cell characteristics:
  • Automaticity: Ability to contract without a stimulus.
  • Rhythmicity: Ability to beat in a patterned manner.
  • Conductivity: Ability to transmit nerve impulses.

Aorta Branches

• Various arteries branch off the aorta, including the right and left common carotids, right and left subclavians, brachiocephalic, and coronary arteries (right and left).
• Other branches include the celiac trunk, superior mesenteric, renal, inferior mesenteric, and common iliac arteries.

Blood Flow and the Cardiac Cycle

• Pair with a classmate to discuss and draw the path of blood through the heart.
• Be prepared to report your findings.
• Do not look ahead to the next slides.

Heart Diagram

• Diagram showing blood flow through the heart, including the superior and inferior vena cava, right and left atria, right and left ventricles, pulmonary artery, pulmonary veins, aorta, and various heart valves (pulmonary, mitral, tricuspid, and aortic valves).
• Diagram provides a clear visual representation of blood flow direction.

Coronary Circulation

• Aortic sinuses of Valsalva give rise to the right and left coronary arteries.
•  Arteries are epicardial (on the heart surface) and have endocardial branches that nourish the myocardium.
•  Left main coronary artery branches into the left anterior descending (LAD) artery (feeds anterior left ventricle wall) and the left circumflex (LCX) artery (feeds left atrium, lateral, and posterior wall of the left ventricle).

Coronary Arteries

•  The right coronary artery (RCA) supplies blood to the right side of the heart, and in most people, it also supplies the sinoatrial (SA) and atrioventricular (AV) nodes.
• Arteries are compressed during systole; therefore the myocardium is perfused during diastole.
• Diastolic blood pressure determines coronary artery perfusion.
• Because of the high extraction/delivery rate of oxygen in the coronaries, the heart rate increases if it needs more oxygen.

Peripheral Arteries, Arterioles, Capillaries, Venules, Veins, and Lymphatics

• Arterial structure has three layers: intima (innermost), media (middle with contractile tissue for blood pressure regulation and oxygen delivery), and adventitia (outermost).
• Large arteries (e.g., aorta) have more elastic properties than smaller arterioles and capillaries which have more muscular properties.

Venules and Veins

• Veins carry deoxygenated blood back to the heart.
• Veins have valves to ensure one-way blood flow.
• Lymphatic vessels, with valves, carry excess fluid and proteins back to the heart.

Fundamentals of Cardiovascular Physiology

•  Concepts of neural and hormonal input, electrical system, mechanical system, pumping ability, relaxation ability, valve function, coronary artery function, lungs (gas exchange), hemoglobin function, peripheral artery function, and myoglobin function.

Cardiac Cycle

• Review of systole (contraction) and diastole (relaxation) phases of the cardiac cycle.
• Evaluation of AV valve and semilunar valve positions during ventricular systole.

Fundamentals of Cardiac Physiology

• Defining cardiac output (CO): The volume of blood pumped by the heart per minute.
• Defining stroke volume (SV): The amount of blood pumped per heartbeat.
• Defining ejection fraction (EF): The percentage of blood ejected from the left ventricle during each heartbeat.
• Preload and afterload are factors influencing cardiac performance.

Frank-Starling Principle

• Explanation of the relationship between preload and cardiac performance.
• A graphical representation showing that a greater ventricular end-diastolic volume increases stroke volume.

Peripheral Circulation

• Resistance in peripheral circulation impacts the heart's workload.
• Skeletal muscle function impacts blood flow during rest and activity.
• During activity, metabolism increases, triggering oxygen release from hemoglobin to myoglobin for muscle function.
• A-vO2 difference reveals oxygen use by the body.

Risk Factors for Heart Disease

• Review of risk factors for heart disease from exercise physiology.

• Normative values and recommended levels for assessment.

• Major risk factor categories: Hypertension (know the stages), High Cholesterol (total, HDL, LDL, triglycerides), Diabetes, Obesity and overweight (criteria review), Smoking.

• Additional risk factors outlined: Physical inactivity, Male gender (risk difference after 65), Hereditary and race (family history, ethnicity-specific risk factors), Age (older age increases risk), Stress, and Birth Control pills.

Diabetes and Heart Disease

• Full pathophysiology covered in separate medical management courses.
• Two main diabetes types: Type I (autoimmune) and Type II (acquired), both characterized by insulin resistance or absence.
• Insulin delivers glucose to cells for metabolism; without insulin, glucose builds up in the blood leading to potential circulatory and bodily system damage.
• Diabetes increases the risk (2x) for CAD, CVD, heart failure.
• Diabetes manifests in Macrovascular Changes, including hastened development of coronary artery disease, more widespread CAD in multiple vessels, and autonomic neuropathy (damage to nerves regulating heart and blood vessels).

Contributing Risk Factors

• Various factors can contribute to cardiovascular risk. Stress raises blood pressure and myocardial oxygen demand while increasing adrenaline. Birth control pills and alcohol can also influence cardiovascular health.

Test your knowledge on key concepts related to cardiovascular rehabilitation with the DPT 611 course. This quiz covers risk factors, heart anatomy, and physiological functions that contribute to heart health. Assess your understanding of important terms and their implications in heart disease prevention.