Cardiovascular Disorders
Chapter 20
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Circulatory System
• Heart 4 chambers
– Right and left atria
superiorly
– Right and left ventricles
inferiorly
• Systole vs. diastole
• Valves
– Atrioventricular
– Semilunar
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Circulatory System (cont.)
• Pulmonary circuit
• Systemic circuit
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Circulatory System (cont.)
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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)
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Shock (cont.)
• Management:
– Activate EMS
– Maintain an open airway
– Control any bleeding
– Maintain body temperature
– Body position
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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
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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)
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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
Classification
Normal
SBP (mm Hg)*
DBP (mm HG)*
Lifestyle Modification
<120
and
<80
Encourage
Prehypertension
120-139
or
80-89
Yes
Stage 1 Hypertension
140-159
or
90-99
Yes
State 2 Hypertension
≥160
or
≥100
Yes
*Treatment determined by highest BP category.
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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
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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
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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
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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
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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)
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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
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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 lifethreatening arrhythmias
• Asymptomatic or symptoms common with viral
infections
• Cardiac symptoms
 Exercise intolerance, shortness of breath,
palpitations, and syncope may occur without
warning
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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
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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
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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
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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
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Sudden Cardiac Death (cont.)
• Participation
 Without evidence of aortic root dilation—
participation in moderate, low-static, and lowdynamic competitive activities
 With aortic root dilatation—only participate in
low-intensity physical activities
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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
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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
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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
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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
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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
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