cardiovascular disorders

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Cardiovascular DisordersCardiovascular Disorders

Chapter 20


Circulatory SystemCirculatory System• Heart 4 chambers

– Right and left atria superiorly

– Right and left ventricles inferiorly

• Systole vs. diastole

• Valves

– Atrioventricular

– Semilunar


Circulatory System (cont.)Circulatory System (cont.)

• Pulmonary circuit

• Systemic circuit


Circulatory System (cont.)Circulatory System (cont.)


Blood and Lymph DisordersBlood 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)


Blood and Lymph Disorders (cont.)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


Blood and Lymph Disorders (cont.)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



• 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


Blood and Lymph Disorders (cont.)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


Blood and Lymph Disorders (cont.)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


Blood and Lymph Disorders (cont.)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


Blood and Lymph Disorders (cont.)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


Blood and Lymph Disorders (cont.)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



– 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


Blood and Lymph Disorders (cont.)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



– 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


SyncopeSyncope• 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


Syncope (cont.)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



• 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



• 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


ShockShock

• 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


Shock (cont.)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


Shock (cont.)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


Shock (cont.)Shock (cont.)

• Management:

– Activate EMS

– Maintain an open airway

– Control any bleeding

– Maintain body temperature

– Body position


Blood Pressure DisordersBlood 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


Blood Pressure Disorders (cont.)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)


Blood Pressure Disorders (cont.)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 SBP (mm Hg)* DBP (mm HG)* Lifestyle Modification

Normal <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.


Blood Pressure Disorders (cont.)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


Blood Pressure Disorders (cont.)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


Blood Pressure Disorders (cont.)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


Sudden Cardiac DeathSudden 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


Sudden Cardiac Death (cont.)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)


Sudden Cardiac Death (cont.)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


Sudden Cardiac Death (cont.)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



– 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



• 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


Sudden Cardiac Death (cont.)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


Sudden Cardiac Death (cont.)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



• 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



– Rare cardiac conditions

• Long QT syndrome; right ventricular dysplasia

Produce serious arrhythmias

• Congenital coronary artery anomalies

Decrease blood flow to heart


Noncardiac Causes of Sudden DeathNoncardiac 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


Noncardiac Causes of Sudden Death (cont.)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


Cardiovascular Preparticipation ScreeningCardiovascular 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


Cardiovascular Preparticipation Screening (cont.)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

cardiovascular disorders

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