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The purpose of this study was to determine (1) if there is a relationship between the changes in the plasma levels of atrial natriuretic peptide (ANP) and plasma renin activity (PRA) as rats compensated from 3 days to 6 weeks after coronary ligation and (2) if these changes are related to myocardial infarction (MI) size. Arterial blood was drawn twice from 34 conscious rats (control, n = 10; small MI, n = 10; large MI, n = 14). Histologic MI size correlated better with ANP 3 days (r = .72, P < .001) than with ANP 6 weeks after MI (r = .39, P = .021). The reverse was true for an electrocardiographic index of MI size that used the sum of the Q waves minus the sum of the R waves in leads I, aVL, and V5. Atrial natriuretic peptide at 3 days was increased in both MI groups and was highest in the large MI group (control, 25.6; small MI, 41.0; large MI, 58.6 pM). Atrial natriuretic peptide decreased significantly from 3 days to 6 weeks in the large MI group and normalized in the small MI group (control, 25.0; small MI, 26.4; large MI, 44.4 pM). Plasma renin activity was not elevated at either time. However, the change in ANP from 3 days to 6 weeks in the MI rats was negatively related to the change in PRA (r = .48, P = .016). Atrial natriuretic peptide levels early after MI may be a good predictor of infarct size. The pattern of ANP and PRA changing in opposite directions over time suggest a counterregulatory link between these two systems.

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.

Correlations between scales and items of the "MPFH", and physical performance of MI-patients, lead us to conclude that the self-perception of decreased physical performance after MI is often generalized and thus leads to a decrease in self-esteem, often connected with feelings of social isolation. This pattern of reaction can in itself be a new risk factor during rehabilitation. Psychological rehabilitation must therefore focus on both: 1. trying to find a meaningful balance between moderate increase in physical performance and psychological adaptation to the reduction in performance, and 2. trying to reduce the feeling of social isolation which comes along with decreased physical performance.

Data of 253 patients with acute myocardial infarction (data collected from primary hospital, from the rehabilitation center-- R.C.-- and from a questionnaire dealing with the individual problems of the rehabilitation period; response rate 77%) were correlated in order to derive criteria for the estimation of the success of rehabilitation. It could be shown that the increase in physical performance and the clinical judgement in the R.C. are well paralleled by the further course of the rehabilitation period (return to work etc.). On the other hand it seemed difficult to predict rehabilitative results from the hospital data alone. It was only shown that the severity of the disease had a major influence upon rate of and interval, before return to work.

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.

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.

The spatial loop of the heart vector can be projected on the Aitoff projection of the globe. The complete information that is contained in the orthogonal leads in displayed on a single graph when the vector magnitudes are indicated by the diameter of circles drawn around the vector projection in short time intervals (spherocardiogram). Diagnostic vector- and polarcardiographic criteria were applied to the spherocardiograms of 68 survivors of inferior myocardial infarction and 30 healthy men. Sensitivity increased from 65% (standard 12-lead ECG) to 87% (VCG criteria) (P less than 0.001) to 94% (VCG and PCG criteria combined), with no false-positive diagnoses. The spherocardiogram can be obtained by use of an "intelligent plotter." In contrast to the vectorcardiogram (VCG) and the polarcardiogram (PCG), it permits the direct visual study of the spatial direction and the spatial magnitude of the heart vector and of their sequential changes during the heart cycle.

For determination of the individual rehabilitation potential in patients after myocardial infarction, factors were extracted which are of importance for exercise capacity and its influence upon rehabilitation measures. Further results of exercise tests were correlated with psychological tests (Freiburg-personality-inventory) and the results of a patients' questionnaire for individual self-assessment, with concerning restitution by means of rehabilitation measures. 147 patients were admitted to a controlled rehabilitation program 10 weeks after myocardial infarction or later. Mean increase of exercise capacity after one year of rehabilitation was 21.6% of the initial test. Significantly greater increases of exercise capacity were achieved in patients with regular attendance particularly in younger patients in comparison with older patients. As evidenced by ergometric test data initially low maximal heart rate, low increase of heart rate, low exercise capacity and low double product were correlated with greater increase of exercise capacity. Patients with anterior-wall myocardial infarction tended to increased exercise capacity more. A relation between "psychosomatic disturbance" at onset of rehabilitation and a greater increase of exercise capacity could be determined as a trend. Connections between psychosocial factors and determinants of exercise capacity in influencing the rehabilitation potential are discussed.

In 147 patients exercise tests were performed at the beginning and after 1 year of an ambulatory rehabilitation program. Measurements of both tests and the degree of functional improvement were correlated with patients' characteristics, the results of a psychological analysis using the Freiburger Personality Inventory and a patient's questionnaire for self-assessment. Among the major determinants for functional improvement were age, location of the infarct, rate of participation and greater initial functional impairment. High degree of psychosomatic impairment accompanied low levels of exercise capacity, the patients' self-assessment showed no correlation with exercise performance.

This report concerns a model for multifactorial rehabilitation after myocardial infarction (MI), with minimum requirements of personnel, space and equipment. Groups of patients are treated twice weekly, in a gymnasium of a school. Survivors of MI increased their exercise capacity from 77% to 93% of sex- and age adjusted normal within 3 to 6 months of therapy (mean values, P less than 0.001). A similar improvement was observed regardless of whether exercise training was started soon (less than 6 months) or late (greater than 12 months) after MI, indicating that exercise capacity increased with training, but was not dependent on time alone. The majority of 87 patients who answered a questionnaire, indicated that in their opinion a strictly organized program requiring a regular attendance was important for the rehabilitation and 89% thought that their participation had resulted in physical and psychological benefits. Two groups of survivors of MI were compared by use of the "Freiburger personality inventory" (FPI). Patients who were more physically impaired, showed a greater degree of a sort of psychosomatic disorder as indicated by the ratings of scale 1 of the FPI. The described program has proved successful, as it resulted in an increase of exercise capacity. This may have a favorable influence on a sort of psychosomatic disorder encountered in patients with healed MI. Beneficial physical and psychological effects were reported by the participants.