• A symptom of coronary artery disease.
• Chest pain or discomfort that occurs when the heart muscle is not getting enough blood.
• Angina may feel like pressure or a squeezing pain in the chest.
• The pain also may occur in the shoulders, arms, neck, jaw, or back.
• It may feel like indigestion.

There are two forms of angina—stable or unstable:

• Stable angina happens during physical activity or under mental or emotional
• Unstable angina is chest pain that occurs even while at rest, without apparent
  • This type of angina is a medical emergency.

Exercise and/or Precautions

• Stop exercising immediately if you experience angina.
• Contact your physician if you experience chest pain, labored breathing, or extreme fatigue.
• Upper-body exercises may precipitate angina more readily than lower-body exercises because of a higher press or other cardiovascular complications following exercise.
• An extended warm-up and cool-down may reduce the risk of angina or other cardiovascular complications following
• If nitroglycerin has been prescribed, always carry it with you, especially during exercise.
• Avoid extreme weather conditions.

CDC

Medscape: Exercising With Angina: Prescription for Health

• This occurs when plaque builds up in the arteries that supply blood to the heart (called coronary arteries).
• Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood.
• Over time, plaque hardens and narrows your arteries.
  • This limits the flow of oxygen-rich blood to your organs and other parts of your body.
• Atherosclerosis can lead to serious problems, including heart attack, stroke, or even death.

Atherosclerosis-Related Diseases 

• Atherosclerosis can affect any artery in the body, including arteries in the heart, brain, arms, legs, pelvis, and kidneys
• Coronary Heart Disease / Coronary Artery Disease
• Peripheral Artery Disease
• Chronic Kidney Disease:
  • Can occur if plaque builds up in the renal arteries.
  • These arteries supply oxygen-rich blood to your kidneys.
  • Over time, chronic kidney disease causes a slow loss of kidney function.

NIH: What Is Atherosclerosis?

CDC: Other Conditions Related to Heart Disease

An aortic aneurysm is a balloon-like bulge in the aorta, the large artery that carries blood from the heart through the chest and torso.

• Aortic aneurysms work in two ways:
  • Dissection:
    • The force of blood pumping can split the layers of the artery wall, allowing blood to leak in between them.
    • This process is called a dissection.
  • Rupture:
    • The aneurysm can burst completely, causing bleeding inside the body.
  • Dissections and ruptures are the cause of most deaths from aortic aneurysms.

• Thoracic Aortic Aneurysms.
  • A thoracic aortic aneurysm occurs in the chest.
  • Men and women are equally likely to get thoracic aortic aneurysms, which become more common with increasing age.
  • Thoracic aortic aneurysms are usually caused by high blood pressure or sudden injury.
  • Sometimes people with inherited connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, get thoracic aortic aneurysms.
• Signs and symptoms of thoracic aortic aneurysm can include:
  • Sharp, sudden pain in the chest or upper back.
  • Shortness of breath.
  • Trouble breathing or swallowing.

• Abdominal Aortic Aneurysms
  • An abdominal aortic aneurysm occurs below the chest.
  • Abdominal aortic aneurysms happen more often than thoracic aortic aneurysms.
  • Abdominal aortic aneurysms are more common in men and among people aged 65 years and older.
  • Abdominal aortic aneurysms are less common among blacks compared with whites.
  • Abdominal aortic aneurysms are usually caused by atherosclerosis (hardened arteries), but infection or injury can also cause them.
  • Abdominal aortic aneurysms often do not have any symptoms.
• If an individual does have symptoms, they can include:
  • Throbbing or deep pain in your back or side.
  • Pain in the buttocks, groin, or

• Other Types of Aneurysms
• Aneurysms can occur in other parts of your body.
• A ruptured aneurysm in the brain can cause a stroke.
• Peripheral aneurysms—those found in arteries other than the aorta—can occur in the neck, in the groin, or behind the knees.
• These aneurysms are less likely to rupture or dissect than aortic aneurysms, but they can form blood clots.
• These clots can break away and block blood flow through the artery.

Risk Factors for Aortic Aneurysm

• Diseases that damage your heart and blood vessels also increase your risk for aortic aneurysm. These diseases include:
  • High blood
  • High
  • Atherosclerosis (hardened arteries).
  • Some inherited connective tissue disorders, such as Marfan syndrome and Ehlers- Danlos syndrome, can also increase your risk for aortic aneurysm.
    • Your family may also have a history of aortic aneurysms that can increase your risk.
  • Unhealthy behaviors can also increase your risk for aortic aneurysm, especially for people who have one of the diseases listed above.
  • Tobacco use is the most important behavior related to aortic aneurysm.
    • People who have a history of smoking are 3 to 5 times more likely to develop an abdominal aortic aneurysm.

Treating Aortic Aneurysm

• The two main treatments for aortic aneurysms are medicines and surgery.
• Medicines can lower blood pressure and reduce risk for an aortic aneurysm.
• Surgery can repair or replace the injured section of the aorta.

Exercise and/or Precautions –  Exercise with AAA (LiveStrong)

• The root problem with AAAs is a weak vessel wall combined with high blood pressure.
• If you have been diagnosed with this condition, or there is a family history of aneurysms and dissections, it is important to perform low intensity exercise to avoid increasing your blood pressure to dangerous levels.
• A 2003 study in “JAMA” recommends patients with known aneurysms to exercise with extreme caution.
• The study recommends limiting activities such as weightlifting because of the elevated risk of dissection.

What Are the Types of Exercise A Patient with Aortic Aneurysm Should Go for? – (E-Pain Assist)   

• The patient with aortic aneurysm should consult the doctor before starting with the exercise plan.
• In general, a patient with aortic aneurysm should keep the following points in mind while exercising-
  • Low Intensity: A patient with aortic aneurysm may go for any form of low intensity exercise that does not carry a risk of the blood pressure shooting high suddenly.
  • Walking: Brisk walking for 45 minutes to an hour is considered to be a good form of exercise for patients with aortic aneurysm.
    • It keeps the body active and does not carry the risk of having high blood pressure.
  • Yoga: The patient can go for yoga classes or aerobic exercises which are of characteristically low intensity to keep the body
• Stay Away from Weightlifting:
  • A patient having aortic aneurysm should stay away from weightlifting because it tends to create a pressure on aorta which is It may cause rupturing of the aneurysm.

CDC: Other Conditions Related to Heart Disease

E-Pain Assist: Can You Exercise If You Have An Aortic Aneurysm?

Exercise with AAA (LiveStrong)

• A type of arrhythmia that can cause rapid, irregular beating of the heart’s upper chambers.
• Blood may pool and clot inside the heart, increasing the risk for heart attack and stroke.

A-fib Symptoms:

• Some people who have A-Fib do not know they have it and don’t have any symptoms. Others may experience one or more of the following symptoms:
  • Irregular heartbeat
  • Heart palpitations (rapid, fluttering, or pounding)
  • Lightheadedness
  • Extreme fatigue
  • Shortness of breath
  • Chest pain

• A-fib increases a person’s risk for stroke by four to five times compared with stroke risk for people who do not have A-fib.
• Strokes caused by complications from A-fib tend to be more severe than strokes with other underlying causes.
• A-fib causes 15%–20% of ischemic strokes, which occur when blood flow to the brain is blocked by a clot or by fatty deposits called plaque in the blood vessel lining.

Treatment for A-fib can include:

• Medications to control the heart’s rhythm and rate.
• Blood-thinning medication to prevent blood clots from forming and reduce stroke risk.
• Surgery.

Exercise and/or Precautions

Exercises to avoid with A-fib (HealthLine (HL) and Everyday Health (EH))

• If you have not exercised in a while, you don’t want to start with intense, high- impact exercise.
  • When you exercise with A-fib, you may want to start with short intervals of low-impact exercise.
  • Then you can gradually increase the length and intensity of your workouts. (HL)
• Try to avoid activities with a higher risk of causing injury, such as skiing or outdoor biking.
  • Many blood thinner medications used to treat A-fib may make you bleed more heavily when you’re injured. (HL)
• If you plan to lift weights, talk to your doctor or a physical therapist about how much weight is safe for you to lift.
  • Lifting too much can put a lot of strain on your (HL)
• Do not overheat.
  • Some medications used to treat atrial fibrillation can lower your blood pressure, making you more sensitive to heat.
  • Protect yourself by taking frequent breaks, drinking water, and paying attention to how you feel.
  • If you ever feel dizzy or lightheaded during exercise, stop right away and cool (EH)
• Use an alternative method of heart rate monitoring.
  • Because atrial fibrillation medications can slow down your pulse, checking your heart rate during exercise may not be effective,
  • Stevens says. Instead, for heart health and exercise safety, she recommends that you push yourself until your level of exertion is “somewhat hard” but you can still speak a full sentence without gasping.
  • “When people push to where they’re working ‘somewhat hard,’ it usually corresponds to their target heart rate,” she says. (EH)

Beta Blockers and Exercise (Living with Atrial Fibrillation)

• A-fib patients taking beta blockers must be aware that beta blockers naturally slow their heart rate.
• Your heart may not beat as fast even during exercise.
  • As a result, checking or monitoring your heart rate while on these drugs may not be effective.
• A better guide in that situation is to listen to your body.
• If you cannot speak a full sentence without gasping for air, you’re pushing too hard.
• You want to exercise to the point where you’re tired and slightly winded, but can still talk without gasping for air.

CDC: What is atrial fibrillation? 

 Everyday Health (EH): Safe Exercises When You Have Atrial Fibrillation

HealthLine (HL): Side effects of exercising with atrial fibrillation 

Living with Atrial Fibrillation: Can I Exercise with Atrial Fibrillation?

• Occurs when the heart muscle becomes enlarged or stiff.
• This can lead to inadequate heart pumping (or weak heart pump) or other problems.
• Cardiomyopathy has many causes, including family history of the disease, prior heart attacks, uncontrolled high blood pressure, and viral or bacterial infections.
• When cardiomyopathy occurs, the normal muscle in the heart can thicken, stiffen, thin out, or fill with substances the body produces that do not belong in the heart muscle.
  • As a result, the heart muscle’s ability to pump blood is reduced, which can lead to irregular heartbeats, the backup of blood into the lungs or rest of the body, and heart failure.
• Cardiomyopathy can be acquired—developed because of another disease, condition, or factor—or inherited.
  • The cause is not always known.

• The main types of cardiomyopathies include the following:
  • Dilated: where one of the pumping chambers (ventricles) of the heart is enlarged.
    • This is more common in males and is the most common form of cardiomyopathy in children.
    • It can occur at any age and may or may not be inherited.
  • Hypertrophic: where the heart muscle is thickened.
    • This often presents in childhood or early adulthood and can cause sudden death in adolescents and young adult athletes.
    • It is often an inherited condition, and a person may not have any symptoms.
    • If there is a family history of this, other family members can be tested and adjust their activities to reduce the risk of sudden death.
  • Arrhythmogenic: where the disease causes irregular heartbeats or rhythms.
    • This is often inherited and more common in males.
  • Restrictive: where heart muscle is stiff or scarred, or both.
    • It can occur with amyloidosis or hemochromatosis, and other conditions.
    • This is the least common type.

Some people who have cardiomyopathy never have symptoms, while others may show signs as the disease progresses. These might include the following:

• Shortness of breath or trouble breathing.
• Swelling in the ankles and legs.
• Irregular heartbeat or palpitations.
• Syncope, the medical term for fainting or briefly passing out.

Treatment and Prevention

• The goal of treatment is to slow down the disease, control symptoms, and prevent sudden death.
• If you are diagnosed with cardiomyopathy, your doctor may tell you to change your diet and physical activity, reduce stress, avoid alcohol and other drugs, and take medicines.
• Your doctor may also treat you for the conditions that led to cardiomyopathy, if they exist, or recommend surgery.
• Treatment also depends on which type of cardiomyopathy you have.
• Genetic or inherited types of cardiomyopathies cannot be prevented but adopting or following a healthier lifestyle can help control symptoms and complications.
• If you have an underlying disease or condition that can cause cardiomyopathy, early treatment of that condition can help prevent the disease from developing.

Exercise and/or Precautions (Cardiomyopathy UK) Exercise and breathing difficulties.

• How much your condition affects your ability to do physical activity is sometimes classified by the ‘New York Heart Association classification of heart failure’.
  • This looks at difficulty in breathing during different levels of activity for people with heart failure (where the heart is unable to meet the normal demands of the body).
• Class I (unaffected): no limitations to activities.
  • Ordinary activity doesn’t cause symptoms.
• Class II (mildly affected): some limitation in activity.
  • Moderately strenuous activity (such as walking up several flights of stairs) causes some symptoms such as tiredness, palpitations, and breathlessness.
• Class III (moderately affected): more limited activity than class II.
  • Symptoms happen at low levels of activity (such as walking on a flat surface).
• Class IV (severely affected): very limited activity as symptoms happen with all physical activity, and the person is breathless even when resting.

Exercise and different types of cardiomyopathies:

Intensive or competitive exercise is not recommended for anyone with cardiomopathy.

• Arrhythmic cardiomyopathy (or arrhythmogenic right ventricular cardiomyopathy or ARVC) – some types of exercise make this condition worse and can increase arrhythmias and symptoms of heart failure in some people.
  • Exercise for people with this condition needs to be considered carefully and specifically individualized, as it can be dangerous in people whose condition is unstable.
• Dilated cardiomyopathy (DCM) – for people who are on medication, with stable symptoms and who do not have heart failure or arrhythmias, exercise can be important. It can help to improve symptoms and is not likely to affect the underlying condition.
  • How much exercise to do depends on the person’s symptoms.
• Hypertrophic cardiomyopathy (HCM) – it is not clear whether it can increase the thickening of the heart, and in some people it can cause arrhythmias.
  • If an arrhythmia is picked up during an exercise test during diagnosis, the person may be considered for an ICD (to control any future arrhythmias).

Exercising with an ICD (implantable cardioverter defibrillator).

Some people are concerned that a change in their heart rate due to exercise could cause their ICD to give them a shock. Generally, people with an ICD can exercise, and an ICD is no more likely to give a shock during exercise than at any other time.

• ICDs should give a shock when they detect abnormal, dangerous, heart rhythms (arrhythmias).
  • These arrhythmias are usually faster (higher heart rate) than what happens during normal exercise.
  • An exercise test may be helpful to program the ICD to check that it recognizes the person’s normal heart rate and only gives a shock at the appropriate time.
• ICDs are made up of a generator (which generates the shock if it is needed), a battery (to power the device) and leads (wires that connect the ICD to the heart).
  • For many people, after they have recovered from having it implanted, their ICD does not limit their physical movement.
  • However, for some over-stretching the arm and shoulder could affect the leads.
    • This may limit their movement and affect what exercise is suitable. This is something that they can discuss with their doctor.
• For some people, doing regular exercise might help to reduce the risk of arrhythmias.
  • For anyone with an ICD, it is a good idea to warm up before, and to cool down after exercise.
  • This helps to ensure that their heart rate increases and decreases gradually.
  • This also reduces the risk of arrhythmias.

Cardiomyopathy UK

CDC: Cardiomyopathy

• Cholesterol travels through the blood on proteins called “lipoproteins.”
• Two types of lipoproteins carry cholesterol throughout the body:
  • LDL (low-density lipoprotein), sometimes called “bad” cholesterol, makes up most of your body’s cholesterol.
    • High levels of LDL cholesterol raise your risk for heart disease and stroke.
  • HDL (high-density lipoprotein), or “good” cholesterol, absorbs cholesterol and carries it back to the liver.
  • The liver then flushes it from the body. High levels of HDL cholesterol can lower your risk for heart disease and stroke.
• When your body has too much LDL cholesterol, the LDL cholesterol can build up on the walls of your blood vessels.
  • This buildup is called “plaque.”
  • As your blood vessels build up plaque over time, the insides of the vessels narrow.
  • This narrowing blocks blood flow to and from your heart and other organs.
  • When blood flow to the heart is blocked, it can cause angina (chest pain) or a heart attack.
• Overweight and obesity raise levels of LDL (“bad”) cholesterol.
  • Excess body fat affects how your body uses cholesterol and slows down your body’s ability to remove LDL cholesterol from your blood.
  • The combination raises your risk of heart disease and stroke.

There are two sources of cholesterol: Cholesterol made by the body and dietary cholesterol.

• Cholesterol is made in your liver.
  • Your body uses cholesterol to make hormones and digest fatty
  • Your body makes all the cholesterol it needs.
• Dietary cholesterol is in animal foods, such as egg yolks, fatty meats, and regular cheese.
  • In general, foods that are high in dietary cholesterol are also high in saturated fat.

Lowering Your Risk

• If you have high LDL cholesterol levels, your health care team may recommend cholesterol-lowering medicine and lifestyle changes to lower your risk for heart disease and stroke.
• If you have low HDL cholesterol levels, talk to your doctor about lifestyle changes that may help raise your levels.
• Your body makes all of the cholesterol it needs, so you do not need to obtain cholesterol through foods.
• Eating lots of foods high in saturated fat and trans fat may contribute to high cholesterol and related conditions, such as heart disease.

What you can do:

• Limit foods high in saturated fat.
  • Saturated fats come from animal products (such as cheese, fatty meats, and dairy desserts) and tropical oils (such as palm oil).
  • Foods that are higher in saturated fat may be high in cholesterol.
• Choose foods that are low in saturated fat, trans fat, sodium (salt), and added sugars.
  • These foods include lean meats; seafood; fat-free or low-fat milk, cheese, and yogurt; whole grains; and fruits and vegetables.
• Eat foods naturally high in fiber, such as oatmeal and beans (black, pinto, kidney, Lima, and others) and unsaturated fats, which can be found in avocado, vegetable oils like olive oil and nuts).
  • These foods may help prevent and manage high levels of low-density lipoprotein (LDL, or “bad”) cholesterol and triglycerides while increasing high-density lipoprotein (HDL, or “good”) cholesterol levels.
• Physical activity can help you maintain a healthy weight and lower your cholesterol and blood pressure levels.
• Smoking damages your blood vessels, speeds up the hardening of the arteries, and greatly increases your risk for heart disease.
  • If you don’t smoke, don’t start.
  • If you do smoke, quitting will lower your risk for heart disease.
  • Too much alcohol can raise cholesterol levels and the levels of triglycerides, a type of fat in the blood. Avoid drinking too much alcohol.
  • Men should have no more than two drinks per day, and women should have no more than one.

Types of Cholesterol-lowering Medicine

Several types of medicines help lower LDL cholesterol. 

Type of Medicine

• Statin drugs lower LDL cholesterol by slowing down the liver’s production of cholesterol.
  • They also increase the liver’s ability to remove LDL cholesterol that is already in the blood.
• Bile acid sequestrants help remove cholesterol from the blood stream by removing bile acids.
  • The body needs bile acids and makes them by breaking down LDL cholesterol.
• Niacin or nicotinic acid. Niacin is a B vitamin that can improve all lipoprotein levels.
  • Nicotinic acid raises high-density lipoprotein (HDL) cholesterol levels while lowering total cholesterol, LDL cholesterol, and triglyceride levels.
• Fibrates mainly lower  triglycerides.
• Injectable medicine. A newer type of medicine called PCSK9 inhibitors lowers cholesterol.
  • These medicines are primarily used in people who have familial hypercholesterolemia, a genetic condition that causes very high levels of LDL cholesterol.
• All drugs may have side effects, so talk with your health care team, including your pharmacist, on a regular basis.
• Once your cholesterol levels have improved, your health care team will monitor them to ensure they stay in a healthy range.

Who Needs Cholesterol-lowering Medicine?

• Your treatment plan for high cholesterol will depend on your current cholesterol levels and your risk of heart disease and stroke.
• Your risk for heart disease and stroke depends on other risk factors, including high blood pressure and high blood pressure treatment, smoking status, age, high-density lipoprotein cholesterol level, total cholesterol level, diabetes, family history, and whether you have already had a heart attack or stroke.
• Your health care provider may prescribe medicine if:
  • You have already had a heart attack or stroke, or you have peripheral arterial disease.
  • Your LDL cholesterol level is 190 mg/dL or higher.
  • You are 40–75 years old with diabetes and an LDL cholesterol level of 70 mg/dL or higher.
    • You are 40–75 years old with a high risk of developing heart disease or stroke and an LDL cholesterol level of 70 mg/dL or higher.

  TRIGLYCERIDES (High Blood) -aka Hypertriglyceridemia, Dyslipidemia, Lipid Disorder

• High blood triglycerides are a type of lipid disorder, or dyslipidemia.
• This condition may occur on its own, with other lipid disorders such as high blood cholesterol or low HDL cholesterol, or as part of metabolic syndrome.
• Certain medical conditions, genetics, lifestyle habits, and some medicines are all risk factors for high blood triglycerides.
• Medical conditions that may increase blood triglyceride levels include thyroid disease, diabetes, liver and kidney diseases, and overweight and obesity.
• Sometimes the gene you inherited can cause high blood triglyceride levels.
• Being physically inactive, eating foods that are high in fat and sugar, or drinking too much alcohol may increase blood triglycerides.
• Some medicines used to treat breast cancer, high blood pressure, HIV, and other conditions may also increase triglyceride levels in the blood.

High blood triglycerides usually do not cause any symptoms.

• Untreated or uncontrolled high blood triglyceride levels may increase your risk of serious complications such as coronary heart disease and stroke.
• Very high blood triglycerides can increase the risk of acute pancreatitis, which is inflammation of the pancreas that causes severe pain in the abdomen.
• Based on your risk factors and your personal and family health histories, your doctor may recommend testing you for high blood triglycerides with a routine blood test called a lipid panel.
  • A lipid panel measures the total cholesterol, HDL cholesterol, LDL cholesterol, and triglyceride levels in your blood.
  • Your doctor may diagnose you with high blood triglycerides if your fasting blood triglyceride levels are consistently 150 milligrams per deciliter (mg/dL) or higher.
  • Normal fasting blood triglyceride levels are less than 75 mg/dL for children under the age of 10 and less than 90 mg/dL for children aged 10 and older and  adults.
• If you are diagnosed with high blood triglycerides, your doctor may first recommend that you adopt heart-healthy lifestyle changes, such as healthy eating, which includes limiting alcohol, added sugars, and foods high in saturated or trans fats; getting regular physical activity; quitting smoking; and aiming for a healthy weight.
• Your doctor may also prescribe medicines such as fibrates, omega-3 fatty acids, nicotinic acid, or statins to control or lower your triglyceride levels

CDC  Cholesterol

NIH Triglycerides

• Often called congestive heart failure because of fluid buildup in the lungs, liver, gastrointestinal tract, and the arms and legs.
• Heart failure is a serious condition that occurs when the heart cannot pump enough blood to meet the body’s needs.
• It does not mean that  the heart has stopped but that muscle is too weak to pump enough blood.
• The majority of heart failure cases are chronic or long-term heart failures.

The only cure for heart failure is a heart transplant. However, heart failure can be managed with medications or medical procedures.

• Conditions that damage or overwork the heart muscle can cause heart failure.
  • Over time, the heart weakens.
• It is not able to fill with and/or pump blood as well as it should.
• As the heart weakens, certain proteins and substances might be released into the blood.
  • These substances have a toxic effect on the heart and blood flow, and they worsen heart failure.

Causes of heart failure include:

• • Coronary heart disease
  • Diabetes
  • High blood pressure
  • Other heart conditions or diseases
    • Congenital heart defects. Problems with the heart’s structure are present at
    • Heart valve disease. Occurs if one or more of your heart valves does not work properly, which can be present at birth or caused by infection, other heart conditions, and age.

Common symptoms of heart failure include:

• Shortness of breath during daily activities.
• Having trouble breathing when lying down.
• Weight gain with swelling in the feet, legs, ankles, or stomach.
• Generally feeling tired or weak.
  • All these symptoms are the result of fluid buildup in your body.
  • When symptoms start, you may feel tired and short of breath after routine physical effort, like climbing stairs.
  • As your heart grows weaker, symptoms get worse.
  • You may begin to feel tired and short of breath after getting dressed or walking across the room.
  • Some people have shortness of breath while lying flat.
  • Fluid buildup from heart failure also causes weight gain, frequent urination, and a cough that is worse at night and when you’re lying down.
    • This cough may be a sign of acute pulmonary edema.
    • This is a condition in which too much fluid builds up in your lungs.
    • The condition requires emergency treatment.

Treating Heart Failure

• Early diagnosis and treatment can improve quality and length of life for people who have heart failure.
• Treatment usually involves taking medications, reducing sodium in the diet, and getting daily physical activity.
• People with heart failure also track their symptoms each day so that they can discuss these symptoms with their health care team.

Exercise and/or Precautions – AUSmed (unless specified Doctor’s Handbook (DH)

• Specific contraindications to exercise in patients with CHF include new onset atrial fibrillation, obstructive valvular disease, especially aortic stenosis, or active myocarditis (either viral or autoimmune). (DH)
• CHF patients with diastolic and systolic dysfunction should refrain from (DH)
• Recent studies show – if cardiac exercise is properly administered and supervised – a huge spectrum of patients with HF can safely participate, including patients with both systolic and diastolic dysfunction, atrial fibrillation, pacemakers, implantable cardioversion devices, and post-cardiac  transplantation.
• Patients who are unstable or decompensated should not participate in exercise until stable; in fact, some programs will not permit patients to exercise until they have been stable for 3 months or more.
• No matter the official diagnoses, no HF patient is considered appropriate for exercise training until they are evaluated and assessed for current physical status, medical regime, and exercise tolerance.
• Patients should undergo an assessment with particular attention paid to signs or symptoms related to heart failure, such as the presence of new heart sounds, lung crackles, weight gain, or edema.

Chronic Heart Failure and Exercise Red Flags

Signs and symptoms during exercise include:

• Hypotension (typically after exercise)
• Arrhythmias (both atrial and ventricular)
• A general worsening of CHF symptoms (dyspnea, swelling)
• Many patients with CHF already experience vacillating levels of symptoms from day to day; when this is the case, it is harder to determine if any decline in status is due to the exercise program or the disease

Unstable symptoms may include:

• Dyspnea: at rest/orthopnea (change from baseline), sudden onset of shortness of breath (SOB), worsening SOB, exertional dyspnea, gasping
• Arterial oxygen saturation (SaO2) less than 90%
• Coughing up pink/frothy sputum
• Dizziness or syncope
• Chest pain
• Systolic blood pressure (BP) less than 80 to 90mmHg and symptomatic
• Evidence of hypoperfusion (cyanosis, decreased level of consciousness)

Why is the CHF patient a special risk?

• The body reacts differently to exertion and do not experience the normal physiological and compensatory responses that are commonly seen during an exercise session.
• Multiple medications, including beta blockers, ACE inhibitors and diuretics, all of which dramatically alter how the heart responds to exercise stimuli.
• Pacemaker, implantable defibrillator or other device may alter the capacity to respond to exeercise.
• Patients who have developed heart failure typically have a history of hypertension, coronary artery disease and/or diabetes.
  • Each of these comorbidities brings its own special needs to the exercise table.

NIH– Heart Failure

AUSmed

Doctor’s Handbook (DH)

• Coronary artery disease (CAD) is the main cause of heart attack.
• A heart attack happens when the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart cannot get oxygen.
• If blood flow is not restored quickly, the section of heart muscle begins to die.
• A less common cause is a severe spasm, or sudden contraction, of a coronary artery that can stop blood flow to the heart muscle.
• Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies.
  • In one study, for example, one-third of the patients who had heart attacks had no chest pain.
  • These patients were more likely to be older, female, or diabetic.
• The symptoms of a heart attack can vary from person to person.
• Some people can have few symptoms and are surprised to learn they have had a heart attack.
• If you have already had a heart attack, your symptoms may not be the same for another one.

It is important for you to know the most common symptoms of a heart attack and remember these facts:

• Heart attacks can start slowly and cause only mild pain or discomfort.
  • Symptoms can be mild or more intense and sudden.
  • Symptoms also may come and go over several hours.
• People who have high blood sugar (diabetes) may have no symptoms or very mild ones.
• The most common symptom, in both men and women, is chest pain or discomfort.
• Women are somewhat more likely to have shortness of breath, nausea and vomiting, unusual tiredness (sometimes for days), and pain in the back, shoulders, and jaw.
• Some people do not have symptoms at all.
  • Heart attacks that occur without any symptoms or with very mild symptoms are called silent heart attacks.

Most Common Symptoms

• Chest pain or discomfort.
  • Most heart attacks involve discomfort in the center or left side of the chest.
  • The discomfort usually lasts for more than a few minutes or goes away and comes back.
  • It can feel like pressure, squeezing, fullness, or pain.
  • It also can feel like heartburn or indigestion.
  • The feeling can be mild or severe.
• Upper body discomfort.
  • You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach (above the belly button).
• Shortness of breath.
  • This may be your only symptom, or it may occur before or along with chest pain or discomfort.
  • It can occur when you are resting or doing a little bit of physical activity.
• The symptoms of angina can be similar to the symptoms of a heart attack.
  • Angina is chest pain that occurs in people who have coronary heart disease, usually when they are active.
  • Angina pain usually lasts for only a few minutes and goes away with rest.
• Chest pain or discomfort that doesn’t go away or changes from its usual pattern (for example, occurs more often or while you’re resting) can be a sign of a heart attack.
• If you have had a heart attack, your heart may be damaged.
  • This could affect your heart’s rhythm, pumping action, and blood circulation.
  • You also may be at risk for another heart attack or conditions such as stroke, kidney disorders, and peripheral arterial disease (PAD).

You can lower your chances of having future health problems following a heart attack with these steps:

• Physical Activity
  • Talk to your health care team about the things you do each day in your life and work.
  • Your doctor may want you to limit work, travel, or sexual activity for some time after a heart attack.
• Lifestyle Changes
  • Eating a healthier diet, increasing physical activity, quitting smoking, and managing stress—in addition to taking prescribed medications—can help improve your heart health and quality of life.
• Ask your health care team about attending a program called cardiac rehabilitation to help you make these lifestyle

Exercise and/or Precautions (Cleveland Clinic)

• After a heart attack it is important to begin a regular activity program to help reduce the chance of having additional heart problems.
• Your doctor will let you know when it is the right time to begin an exercise program.
• Most patients are given a prescription for Cardiac Rehabilitation.
  • Patients who join cardiac rehabilitation programs have a faster and safer recovery and better outcomes after a heart attack.
• It is important to follow your cardiac rehabilitation team’s instructions for activity.

Everyone recovers at a different pace. This may be related to your activity level before your heart attack or the amount of damage to your heart muscle. It may take many months to develop the optimal exercise program.

Here are some general guidelines from our cardiac rehabilitation staff to get started.

• Enroll in an outpatient cardiac rehab program to assist with developing the best exercise program and assisting with lifestyle changes such as heart healthy diet, quitting smoking, weight loss and stress management.
  • Cardiac rehabilitation is covered by most insurance companies for patients after a heart attack.
• Returning to exercise after a heart attack or beginning a new exercise program can be challenging or anxiety provoking.
  • Starting will small amounts and steadily building your program over time will help to set you up for success.
  • A cardiac rehabilitation program will provide you with the support you need to get on a heart healthy path.
• Start slowly and gradually increase your walking pace over 3 minutes until the activity feels moderate (slightly increased breathing but should still be able to talk with someone).
  • If you feel too short of breath, slow down your walking pace.
• Walk at a moderate pace for about 10 minutes the first time and each day try to add one or two minutes.
  • By the end of a month, aim for walking 30 minutes most days of the week.
• Remember to cool down at the end of your exercise by gradually walking slower for the last 3 minutes of your exercise.
• If walking outside, walk with someone or in short distances close to home so you do not get too far away and have a hard time walking home.
• Chose an activity that you enjoy such as walking (outside or on a treadmill), stationary cycling, rowing, or water aerobics.
• Ask your doctor before lifting weights.
• Exercise should be done regularly to gain the benefits; national guidelines suggest most days of the week if not every day.
• Try to exercise at the same time every day to establish a habit and to minimize any variables that may impact your exercise (timing of meals, medications, work schedule, etc.)
• If you notice any symptoms such as excessive shortness of breath, chest discomfort, palpitations that do not go away or increasing fatigue, stop your exercise and notify your doctor.
• After a heart attack many things may have changed including energy level and
  • These may affect your exercise tolerance; keep your exercise expectations day to day as you go through the healing process.

CDC: Heart Attack Symptoms, Risk, and Recovery 

Cleveland Clinic: Exercise & Activity After a Heart Attack

NIH – What Is a Heart Attack?

• High blood pressure usually has no warning signs or symptoms, so many people don’t realize they have it.
• There is only one way to know whether you have high blood pressure: Have a doctor or other health professional measure it.
  • Measuring your blood pressure is quick and painless.

Rates of High Blood Pressure Control Vary by Sex and Race
Uncontrolled high blood pressure is common; however, certain groups of people are more likely to have control over their high blood pressure than others.

• A greater percentage of men (50%) have high blood pressure than women (44%).
• High blood pressure is more common in non-Hispanic black adults (56%) than in non-Hispanic white adults (48%), non-Hispanic Asian adults (46%), or Hispanic adults (39%).
• Among those recommended to take blood pressure medication, blood pressure control is higher among non-Hispanic white adults (32%) than in non-Hispanic black adults (25%), non-Hispanic Asian adults (19%), or Hispanic adults (25%).3

What Blood Pressure Numbers Mean?

• Blood pressure is measured using two numbers.
  • The first number, called systolic blood pressure, represents the pressure in your blood vessels when your heart beats.
  • The second number, called diastolic blood pressure, represents the pressure in your blood vessels when your heart rests between beats.
• Blood pressure is measured in millimeters of mercury (mmHg).

The chart below shows normal, at-risk, and high blood pressure levels.

• A blood pressure less than 120/80 mmHg is normal.
• A blood pressure of 140/90 mmHg or more is too high.
• People with levels from 120/80 mmHg to 139/89 mmHg have a condition called pre-hypertension, which means they are at high risk for high blood pressure.

Blood Pressure Levels

• Normal
  • systolic: less than 120 mmHg
  • diastolic: less than 80mmHg
• At Risk / Elevated (pre-hypertension)
  • systolic: 120–139 mmHg
  • diastolic: 80–89 mmHg
• High / Hypertension – Stage 1 
  • systolic: 130-139 mmHg
  • diastolic: 80-89 mmHg 
• High / Hypertension – Stage 2
  • systolic: ≥140 mmHg
  • diastolic: ≥90 mmHg

It is important to have regular blood pressure readings taken and to know your numbers, because high blood pressure usually does not cause symptoms until serious complications occur.

Undiagnosed or uncontrolled high blood pressure can cause the following complications:

• Aneurysms
• Chronic kidney disease
• Eye damage
• Heart attack
• Heart failure
• Peripheral artery disease
• Stroke
• Vascular dementia

Controlling High Blood Pressure

Keeping your blood pressure levels in a healthy range usually involves:

• Taking medications
• Heart-healthy eating
• Reducing sodium in the diet
• Getting daily physical activity
• Quitting smoking.

CDC – Facts About Hypertension

CDC – Pulmonary Hypertension

MedlinePlus: High Blood Pressure

• Hypotension is abnormally low blood pressure.
• Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood.
• Blood pressure is measured as systolic and diastolic pressures.
  • “Systolic” refers to blood pressure when the heart beats while pumping blood.
  • “Diastolic” refers to blood pressure when the heart is at rest between beats.
• You most often will see blood pressure numbers written with the systolic number above or before the diastolic number, such as 120/80 mmHg. (The mmHg is millimeters of mercury—the units used to measure blood )
• Normal blood pressure in adults is lower than 120/80 mmHg. Hypotension is blood pressure that’s lower than 90/60 mmHg.

There are several types of hypotension.

• People who always have low blood pressure have chronic asymptomatic hypotension.
• They usually have no signs or symptoms and need no treatment.
• Their low blood pressure is normal for them.
• The three main types of this kind of hypotension are orthostatic hypotension, neurally mediated hypotension, and severe hypotension linked to shock.

Orthostatic Hypotension.

• The signs and symptoms of orthostatic hypotension and neurally mediated hypotension (NMH) are similar. They include:
  • Dizziness or light-headedness
  • Blurry vision
  • Confusion
  • Weakness
  • Fatigue (feeling tired)
  • Nausea (feeling sick to your stomach)

• This type of hypotension occurs when standing up from a sitting or lying down position.
  • You may feel dizzy or light-headed, or you may even faint.
• Orthostatic hypotension occurs if your body isn’t able to adjust blood pressure and blood flow fast enough for the change in position.
  • The drop in blood pressure usually lasts only for a few seconds or minutes after you stand up.
  • You may need to sit or lie down for a short time while your blood pressure returns to normal.
• Orthostatic hypotension can occur in all age groups.
  • However, it is more common in older adults, especially those who are frail or in poor health.
  • This type of hypotension can be a symptom of another medical condition.
  • Thus, treatment often focuses on treating underlying conditions.
• Some people also have high blood pressure when lying
• A form of orthostatic hypotension called postprandial hypotension is a sudden drop in blood pressure after a meal.
• This type of hypotension mostly affects older adults.
• People who have high blood pressure or a central nervous system disorder, such as Parkinson’s disease, also are at increased risk for postprandial hypotension.

Neurally Mediated Hypotension

• See Orthostatic above for signs and symptoms.
• With neurally mediated hypotension (NMH), blood pressure drops after you’ve been standing for a long time.
  • You may feel dizzy, faint, or sick to the stomach as a result. NMH also can occur as the result of an unpleasant, upsetting, or scary situations.
• NMH affects children and young adults more often than people in other age groups. Children often outgrow

Severe Hypotension Linked to Shock

• Shock is a life-threatening condition in which blood pressure drops so low that the brain, kidneys, and other vital organs can’t get enough blood to work well.
• Blood pressure drops much lower in shock than in other types of hypotension.
• Many factors can cause shock.
  • Examples include major blood loss, certain severe infections, severe burns and allergic reactions, and poisoning.
• Shock can be fatal if it’s not treated right away.
• Signs and Symptoms
  • In shock, not enough blood and oxygen flow to the body’s major organs, including the brain.
  • The early signs and symptoms of reduced blood flow to the brain include light-headedness, sleepiness, and confusion.
  • In the earliest stages of shock, it may be hard to detect any signs or symptoms.
    • In older people, the first symptom may only be confusion.
  • Over time, as shock worsens, a person won’t be able to sit up without passing out.
  • If the shock continues, the person will lose consciousness.
  • Other symptoms of shock vary, depending on what’s causing the shock.
  • When low blood volume (from major blood loss, for example) or poor pumping action in the heart (from heart failure, for example) causes shock:
    • • The skin becomes cold and sweaty.
      • It often looks blue or pale.
      • If pressed, the color returns to normal more slowly than usual.
      • A bluish network of lines appears under the
  • The pulse becomes weak and rapid.
  • The person begins to breathe very quickly.
  • When extreme relaxation of blood vessels causes shock (such as in vasodilatory shock), a person feels warm and flushed at first.
    • Later, the skin becomes cold and sweaty, and the person feels very sleepy.
  • Shock is an emergency and must be treated right away.
    • If a person has signs or symptoms of shock, call 9–1–1.

Living with Hypotension

• Doctors can successfully treat hypotension.
  • Many people who had the condition and were successfully treated live normal, healthy lives.
• If you have hypotension, you can take steps to prevent or limit symptoms, such as dizzy spells and fainting.
• If you have orthostatic hypotension, get up slowly after sitting or lying down, or move your legs before changing your position.
• Eat small, low-carbohydrate meals if you have postprandial hypotension (a form of orthostatic hypotension).
• If you have neurally mediated hypotension, try not to stand for long periods.
  • If you do have to stand for a long time, move around and wear compression stockings.
  • These stockings apply pressure to your lower legs.
  • The pressure helps move blood throughout your body.
• Drink plenty of fluids, such as water or sport drinks that contain nutrients like sodium and potassium.
• Also, try to avoid unpleasant, upsetting, or scary situations.
• Learn to recognize symptoms and take action to raise your blood pressure.
• Ask your doctor about learning how to measure your own blood pressure.
  • This will help you find out what a normal blood pressure reading is for you.
  • Keeping a record of blood pressure readings done by health providers also can help you learn more about your blood pressure.
• Severe hypotension linked to shock is an emergency.
  • Shock can lead to death if it’s not treated right away.
  • If you see someone having signs or symptoms of shock, call 9–1–1.
  • Signs and symptoms of shock include light-headedness, sleepiness, and confusion.
  • Over time, as shock worsens, a person won’t be able to sit up without passing out.
  • If the shock continues, the person can lose consciousness.
  • Other signs and symptoms of shock include cold and sweaty skin, a weak and rapid pulse, and rapid breathing.

NIH: Low Blood Pressure

See Cardiomyopathy for Exercise and/or Precautions

• An implantable cardioverter defibrillator (ICD) is a small device that your doctor can put into your chest to help regulate an irregular heart rhythm, or an arrhythmia.
• Although it is smaller than a deck of cards, the ICD contains a battery and a small computer that monitors your heart rate.
• The computer delivers small electrical shocks to your heart at certain moments.
  • This helps control your heart rate.
• Doctors most commonly implant ICDs in people who have life-threatening arrhythmias and who are at risk for sudden cardiac arrest, a condition in which the heart stops beating.
• Arrhythmias can be congenital (something you were born with) or a symptom of heart disease.

You might benefit from an ICD if you have:

• A very fast and dangerous heart rhythm called ventricular tachycardia.
• Erratic pumping, which is referred to as quivering or ventricular fibrillation.
• A heart weakened by a history of heart disease or a previous heart attack.
• An enlarged or thickened heart muscle, which is called dilated, or hypertrophic cardiomyopathy,
• Congenital heart defects, such as long QT syndrome, which causes heart quivering.
• Heart failure.

An ICD can also deliver up to four types of electrical signals to your heart:

• Cardioversion gives a strong electrical signal that can feel like a thump to your chest.
  • It resets heart rhythms to normal when it detects a very fast heart rate.
• Defibrillation sends a very strong electrical signal that restarts your heart.
  • The sensation is painful and can knock you off your feet but lasts only a second.
• Antitachycardia pacing provides a low-energy pulse meant to reset a rapid heartbeat.
  • Typically, you feel nothing when the pulse occurs. However, you may sense a small flutter in your chest.
• Bradycardia pacing restores to normal speed a heartbeat that is too slow.
  • In this situation, the ICD works like a pacemaker.
  • People with ICDs usually have hearts that beat too fast.
  • However, defibrillation can sometimes cause the heart to slow down to a dangerous level.
  • Bradycardia pacing returns the rhythm to normal.

Certain objects can interfere with your device’s performance, so you will need to avoid them.

• security systems
• certain medical equipment, like MRI machines
• power generators

Although the risk is low, people should also keep any consumer electronic devices that may create magnetic interference, including cell phones and smart watches, at least 6 inches away from implanted medical devices. This especially applies to pacemakers and cardiac defibrillators.

Healthline: What are Implantable Cardioverter Defibrillator (ICD)?

• A pacemaker is a small device that is placed in the chest or abdomen to help control abnormal heart rhythms.
• This device uses electrical pulses to prompt the heart to beat at a normal rate.
• Used to treat arrhythmias.
  • During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.
    • A heartbeat that is too fast is called tachycardia.
    • A heartbeat that is too slow is called bradycardia.
• During an arrhythmia, the heart may not be able to pump enough blood to the body.
  • This can cause symptoms such as fatigue (tiredness), shortness of breath, or fainting.
• Severe arrhythmias can damage the body’s vital organs and may even cause loss of consciousness or death.
• A pacemaker can relieve some arrhythmia symptoms, such as fatigue and fainting.
• A pacemaker also can help a person who has abnormal heart rhythms resume a more active lifestyle.

Once you have a pacemaker, you must avoid close or prolonged contact with electrical devices or devices that have strong magnetic fields.

Devices that can interfere with a pacemaker include:

• Cell phones and MP3 players (for example, iPods)
• Household appliances, such as microwave ovens
• High-tension wires
• Metal detectors
• Industrial welders
• Electrical generators

These devices can disrupt the electrical signaling of your pacemaker and stop it from working properly.

• You may not be able to tell whether your pacemaker has been affected.
• How likely a device is to disrupt your pacemaker depends on how long you are exposed to it and how close it is to your pacemaker.
• To be safe, some experts recommend not putting your cell phone or MP3 player in a shirt pocket over your pacemaker (if the devices are turned on).
• You may want to hold your cell phone up to the ear that is opposite the site where your pacemaker is implanted.
• If you strap your MP3 player to your arm while listening to it, put it on the arm that is farther from your pacemaker.
• You can still use household appliances, but avoid close and prolonged exposure, as it may interfere with your pacemaker.
• You can walk through security system metal detectors at your normal pace.
  • Security staff can check you with a metal detector wand as long as it isn’t held for too long over your pacemaker site.
  • You should avoid sitting or standing close to a security system metal edtector.
  • Notify security staff if you have a pacemaker.
• Also, stay at least 2 feet away from industrial welders and electrical

Some medical procedures can disrupt your pacemaker. These procedures include:

• Magnetic resonance imaging, or MRI
• Shock-wave lithotripsy to get rid of kidney stones.
• Electrocauterization to stop bleeding during surgery.

Let all your doctors, dentists, and medical technicians know that you have a pacemaker.

• Your doctor can give you a card that states what kind of pacemaker you have.
• Carry this card in your wallet.
• You may want to wear a medical ID bracelet or necklace that states that you have a pacemaker.

Exercise and/or Precautions

• In most cases, having a pacemaker will not limit you from doing sports and exercise, including strenuous activities.
• Although there are not many limitations on exercise after a pacemaker, there are some, particularly in the first months after implantation.
  • According to Arrythmia.org, you should avoid exercises like golf, swimming, tennis, or other exercises involving extensive range of motion in the shoulders during the first six weeks after surgery.
  • You should also avoid heavy lifting during this time.
• According to Cardiac Athletes.org, contact sports are not suitable for a person with a pacemaker, as these sports may damage your pacemaker.
• You should also take care, even after six weeks, when doing exercises requiring shoulder motion, as these may cause you to crush the pacemaker wire between your first rib and clavicle. (LiveStrong)

NIH – What are Pacemakers

LiveStrong –Exercises with a Pacemaker

• You may feel palpitations in your chest, throat, or neck during activity or when you are sitting still or lying down.
• Strong emotions, physical activity, some medicines, caffeine, alcohol, nicotine, or illegal drugs may cause palpitations.
• Medical conditions such as thyroid disease, low blood sugar, anemia, and low blood pressure also may cause palpitations.
• Heart palpitations may be a sign or symptom of arrhythmia, an irregular heartbeat, or other heart conditions such as heart attack, heart failure, heart valve disease, or cardiomyopathy.

• Although palpitations are very common and usually harmless, they can be frightening when they happen and may cause anxiety.
• • Most go away on their own.
  • To prevent palpitations, you can try to avoid things that trigger them, such as stress, alcohol, or caffeine.
  • You also may prevent palpitations by treating any other medical condition that may be causing them.
• Palpitations may be a sign of more serious heart problems.
  • You should seek medical attention immediately if you have palpitations and feel dizzy or confused, have trouble breathing, thinking you may faint, or have pain or tightness in your chest.

NIH: What Is an Arrhythmia?

AKA

• Atherosclerotic peripheral arterial disease
• Claudication
• Hardening of the arteries
• Leg cramps from poor circulation
• Peripheral arterial disease
• Peripheral vascular disease
• Poor circulation
• Vascular disease

Occurs when the arteries that supply blood to the arms and legs (the periphery) become narrow or stiff.

• PAD usually results from atherosclerosis, the buildup of plaque and narrowing of the arteries.
• With this condition, blood flow and oxygen to the arm and leg muscles are low or even fully blocked.
• Signs and symptoms include leg pain, numbness, and swelling in the ankles and feet.
• Blocked blood flow to your legs can cause pain and numbness. It also can raise your risk of getting an infection in the affected limbs. Your body may have a hard time fighting the infection.
• If severe enough, blocked blood flow can cause gangrene (tissue death). In very serious cases, this can lead to leg amputation.
• If you have leg pain when you walk or climb stairs, talk with your doctor. Sometimes older people think that leg pain is just a symptom of aging. However, the cause of the pain could be PAD. Tell your doctor if you are feeling pain in your legs and discuss whether you should be tested for PAD.
• Smoking is the main risk factor for PAD. If you smoke or have a history of smoking, your risk of PAD increases. Other factors, such as age and having certain diseases or conditions, also increase your risk of PAD.

The most common cause of peripheral artery disease (PAD.) is atherosclerosis.

• The disease may start if certain factors damage the inner layers of the arteries. These factors include:
  • Smoking
  • High amounts of certain fats and cholesterol in the blood
  • High blood pressure
  • High amounts of sugar in the blood due to insulin resistance or diabetes

• When damage occurs, your body starts a healing process. The healing may cause plaque to build up where the arteries are damaged.
• Eventually, a section of plaque can rupture (break open), causing a blood clot to form at the site.
• The buildup of plaque or blood clots can severely narrow or block the arteries and limit the flow of oxygen-rich blood to your body.

Presentation/signs and symptoms

Patients might present with a history of chronic and reproducible activity-related IC

• Described as burning, heaviness/deep fatigue, and/or cramping in the legs
• Onset often begins in the calf muscles
• Bilateral or unilateral
• Pain might extend to proximal leg muscles (thigh and buttock) in severe cases
• Pain is relieved by slowing or stopping the activity
• Only present in 10% of patients with PAD; in fact, the American Heart Association estimates that 75% of the 8-12 million Americans with PAD are asymptomatic
• The intensity of IC pain typically increases with the intensity/speed and distance of leg exercise such as walking or cycling
• Weak lower extremity pulses and ABI≤90
• Bruit (i.e., vascular sound heard through auscultation when blood flow is abnormal) might be present over carotid arteries, abdominal aorta, and iliac and femoral arteries
• Patient might also present with resting leg pain, non-healing wounds, and impotence/erectile dysfunction.

Living With Peripheral Artery Disease Symptoms

• If you have PAD., you may feel pain in your calf or thigh muscles after walking.
  • Try to take a break and allow the pain to ease before walking again.
  • Over time, this may increase the distance that you can walk without pain.
• Talk with your doctor about taking part in a supervised exercise program.
  • This type of program has been shown to reduce PAD symptoms.
• Check your feet and toes regularly for sores or possible infections.
  • Wear comfortable shoes that fit well.
  • Maintain good foot hygiene and have professional medical treatment for corns, bunions, or calluses.

Exercise and/or Precautions

Overall Contraindications/Precautions

• Obtain physician clearance for patient to participate in individualized exercise training program; adhere to any parameters set by the physician for vitals and exercise intensity.
• Deep vein thrombosis (DVT) with or without critical limb ischemia contraindicates exercise.
• Acute limb ischemia is a medical emergency and any patient suspected of having this (see symptoms listed above, under Description) should be immediately referred to emergency services.
• Ischemic leg pain at rest is a relative contraindication to exercise.
  • However, critical limb ischemia should be immediately ruled out (especially in patients with diabetes, neuropathy, chronic renal failure, or limb infection) as risk of amputation is high.
• Multiple precautions might be warranted depending on any existing comorbidities, scope of disabilities, and weight-bearing restrictions from physician.

AHA – Exercise Rehabilitation in Peripheral Artery Disease

American Heart Association: Supervised Exercise Therapy for PAD

NIH: What Is Peripheral Artery Disease?

Cinahl Information Systems – Peripheral Artery Disease and Exercise