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The antianginal effect of perhexiline was evaluated in a placebo-controlled double-blind study of 20 patients with stable angina pectoris. Only patients with documented myocardial infarction of more than 6 months' standing and with ST-segment depression on exercise were admitted to the study. Objective parameters of bicycle stress tests at a submaximum level of 50 watts and a maximum exercise level were evaluated. Subjective data such as nitroglycerin consumption and incidence of anginal attacks per week were obtained from the patients' self-maintained records. No negative chronotropic effect of perhexiline was found at rest. At a submaximum exercise level with unchanged double-product, a significantly lower heart rate (p less than 0.05) and a significant reduction in ST-segment depression were observed in comparison with the placebo. At maximum exercise level an increase in exercise tolerance of 8.1% and in aerobic capacity of 8.3% resulted in a significant increase in the double-product (p less than 0.01), with a shift in the blood pressure/heart rate ratio. Discontinuation of exercise occurred at the same heart rate, but at a markedly higher level of exercise attainment. Heart rate on exercise proved to be the most valuable parameter in this study for the evaluation of the aerobic capacity of the individual patient. Nitroglycerin consumption and frequency of anginal attacks per week were reduced, but were not of statistical significance. Side-effects occurred in 6 patients, but these did not require termination or reduction of medication. The selective effect on heart rate during exercise opens a new field of application for perhexiline in comparison with beta-blocking agents.

The antihypertensive effect of atenolol, a cardioselective beta-blocker, was examined in 8 patients with essential hypertension. The most important haemodynamic changes observed were a significant reduction in heart rate (reduction in maximum heart rate at the end of symptom-limited exercise by 23% p less than 0.01) and a moderate fall in systolic blood pressure (reduction at submaximum level of exercise by 22%, p less than 0.01). The antihypertensive effect was attributable in half the patients to a drop in peripheral vascular resistance and in the other half evenly to a predominant reduction in cardiac output or to a reduction in both parameters. In view of the compensatory rise in stroke volume a significant reduction in cardiac output was not found. Symptom-limited exercise tolerance was increased in all patients. These results lead to the conclusion that the antihypertensive action of the cardioselective beta-blocker, atenolol is based on a lowering of the increased peripheral vascular resistance and a reduction in cardiac output; the latter mechanism is predominantly found in patients with hyperkinetic features.

A special swimming programme was initiated during the course of rehabilitation of patients after myocardial infarction with additional disturbances of the musculoskeletal system. Allowance was made for aspects of individual training requirements. Patients were divided in two groups according initial values of physical working capacity: One group contained patients with less than 80% of the normal work capacity, the other those with borderline normal values. The first group showed an average increase of 35% in the initial values during a one-year period of swimming training once a week. The other group with practically normal initial values showed only a slight or negligible increase. Serum lipid levels were unchanged in both groups. No serious side effects were encountered in more than 3000 patients hours. However, no prediction of the risks of this type of training as compared to other forms of physical exercise in patients recovering from myocardial infarction can be made from this study.

The relationship between coronary disease and psychological factors is generally accepted. Numerous psychiatric studies have shown that there are typical basic personality features which predispose to heart disease. A personality inventory - the Freiburger Persönlichkeitsinventar (FPI) - was applied to a group of patients attending the Cardiology Clinic of the University of Vienna for a follow-up control examination after a heart attack. The results were compared with those of a control group (taken from the control population of the FPI). With respect to one personality dimension of the FPI, the so-called,,Nervositätsskala" (nervousness scale), significant differences were observed between the two groups. This scale includes so-called ,,psychosomatic" distrubances and disorders. According to these results,patients with coronary disease were more likely to experience such ,,psychosomatic distrubances" (as far as could be measured by this dimension of the FPI) than members of the control group. A comparison of patients graded according to the physical stamina level showed that those with a greatly-reduced work capacity as a consequence of myocardial infarction had a significantly higher score than patients whose work capacity was impaired to a lesser extent. This study introduces a new aspect in the relationship between coronary disease and personality dimensions.

Treatment of 12 hypertensive patients with a new imidazoline derivative, St 600 (1.5 to 12.0 mg daily over at least 7 days) resulted in a significant lowering of the blood pressure, mostly to normal values, parallelled by a reduced heart heart rate. A significant decrease in arterial resistance was observed at rest and during exercise in 6 of the patients, whereas a slight increase or no change was recorded in the remaining 6 patients. The changes in resistance in the pulmonary circulation were analogous to those in the systematic circulation for the 2 groups, respectively. The latter half of the patients displayed a decrease in stroke volume, cardiac index and oxygen consumption. No negative inotropic effect was observed.

The effects of high altitude (3000 m, low-pressure chamber) on maximum exercise and maximum oxygen uptake were studied in four normal subjects. In order to separate the effects of hypobaria and of hypoxia, exercise testing was performed under normoxic, hypobaric conditions and compared with the results under normoxic, normobaric conditions. There was no significant difference in performance, nor in the effects of exercise on the measured cardiovascular parameters.

Results of physical rehabilitation were studied in 2 groups of patients. Group A consisted of 16 men and at least 24 (mean 51.5) months had elapsed after myocardial infarction before they were entered into a training programme with supervised once-weekly classes in a school gymnasium. By contrast, the interval between infarction and onset of training was less than 12 (mean 7.0 months in the 21 patients of group B, who had exercise classes twice a week. Group A achieved an average increase in estimated aerobic capacity of 32% (p less than 0.001) in 10 months of training, group B of 33% (p less than 0.001) in 4.7 months. Further participation of group A for 26 more months resulted in an additional improvement of 11% (p less than 0.05). Differences between the groups in aerobic power and different methods of exercise testing and training are discussed. The results indicate that early physical training of groups of patients helps them to obtain a normal exercise capacity with a year after myocardial fixation. Without such intervention patients often remain restricted, but with supervised training their physical power may be improved significantly even if years have passed after the heart attack.