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H. RoSKAMM This International Symposium to be held on the occasion of the third anniversary of our institution and under the auspices of the European Society of Cardiology is entitled'Ventricular Function at Rest and During Exercise'. We have chosen the general term'ventricular function', because we want to include the different aspects of myocardial function like contrac­ tility, relaxation and compliance and their influence upon the overall pumping function of the heart. Heart failure at rest is a rather advanced outcome of a continuous spectrum of function disturbances. In order to grade these, it is reasonable to differentiate between pump function of the heart as a whole and muscle function of the myocardium. Compen­ satory factors like hypertrophy or the Frank-Starling mechanism may maintain the overall pump function of the ventricle, despite a defect in the underlying myocardial contractility. The time sequence of the func­ tional disturbances may be as follows (Fig. 1): EXERCISE £''-----,--------------, >-'5 ~, ~ ~, ~'~ I o u f--~__;_;IJ'_'_~''''• t REST II Fig. 1. Schematic presen­ REDUCTION OF CON REDUCTION OF CON PUMP FAILURE tation of time sequence of TRACTILITY RESERVE TRACTllITY. or REST progression in deteriortation _ TIME of ventricular function xvn The lower line represents contractility at rest, the upper one contrac­ tility during maximum exercise; the range between these two lines can be called contractility reserve.

On the occasion of the inauguration of the Department of Heart Surgery at the Rehabilitation Center in Bad Krozingen, we held under the aus­ pices of the European Society of Cardiology an International Symposium on March 17 to 18, 1978 with the topic:.'Coronary Heart Surgery - a Rehabilitation Measure'This book contains the papers given at that time. The editors of this book, together with the other members of the sci­ entific committee - H. Denolin from Brussels, Ch. Hahn from Geneva, and F. Loogen from DUsseldorf - aimed at selecting controversial top­ ics as well as speakers representing different viewpoints. Thus avoid­ ing portrayal of an image of a world of coronary bypass surgery in which all problems have found a solution. In keeping with the topic of the meeting, special emphasis was drawn to the long-term functional results of aortocoronary bypass surgery; symptomatic imprQvement be­ ing, in most patients, significant enough and lasting for at least some years, thus allowing the patients to return to work. However, a combination of social, economic, and psychological factors may hamper optimal rehabilitation, as can be seen from some of the following papers. The incorporation of heart surgery into a rehabilitation center - being the motif of this symposium - may hopefully stimulate a global approach to cardiac rehabilitation which includes surgical, medical, psychological, vocational, and social rehabilitation mea­ sures. Bad Krozingen, January 1979 H. Roskamm M. Schmuziger Table of Contents 1.

The papers presented in this book were held at the International Sympo­ sium on Myocardial Infarction at Young Age on January 30 and 31, 1981, in Bad Krozingen, FRG. The symposium was sponsored and supported by the European Society of Cardiology and the Pharma Schwarz Co. The scientific committee was composed of H. Denolin (Bruxelles), F. Loogen (Dusseldorf), E. Nussel (Heidelberg), J. Widimsky (Prague), M. Schmuziger (Bad Krozingen), and the editor of this book. To all of these, as well as to my co-workers, many thanks. Bad Krozingen, October 1981 H. ROSKAMM Contents Introduction H. ROSKAMM (With 6 Figures) Session 1 Epidemiology and Risk Factors The Epidemiology of Acute Myocardial Infarction in Young Age Groups G.LAMM........................ 5 Myocardial Infarction in Young Men in the Heidelberg Register Area E. NUSSEL, L. BUCHHOLZ, and R. SCHEIDT (With 4 Figures) 13 Coronary Artery Disease in Young Adults Under 35 Years Old: Risk Factors (Swiss Survey) P. MORET, F. GUTZWILLER, and B. JUNOD (With 1 Figure) 17 Myocardial Infarction Among Men Below Age 40 in Goteborg R. BERGSTRAND, A. VEDIN, C. WILHELMSSON, and L. WILHELMSEN (With 4 Figures)................... 23.. Myocardial Infarction at Young Age: Risk Factors and Natural History G. S. UHL and P. W. FARREL.............. 29.