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Recent jogging-related sudden deaths rekindled the concern among health professionals as to the hazards of strenuous exercise. The purpose of this study was to evaluate the extent of rhythm disturbances and myocardial ischemia in older men and women during a typical strenuous jogging session. Twenty-two members of a local jogging club (11 men and 11 women) between the ages of 50 and 66 years participated in the study. The CardioData PR3/ST monitor was employed to record heart rate, rhythm disturbances, J point and ST slope during the course of the run. The men ran a 10 km run and the women a 6 km run at a competitive pace. The mean maximal heart rate during the run was 170 +/- 15 beats/min for the males and 176 +/- 14 beats/min for the females. The mean J point during the run was -3.39 +/- 1.21 mV for the males and -2.97 +/- 0.96 mV for the females. Females showed a significantly lower mean ST slope (3.95 +/- 0.91 mV) during the run than the males (5.56 +/- 1.37 mV, p < 0.05). A number of episodes of premature ventricular beats, both uni- and multifocal, were observed. Exercise testing of sufficient intensity is recommended to detect those persons susceptible to developing serious arrhythmias during strenuous exercise.

The CIS was undertaken with the aim to evaluate the effects of lipid modifications on angiographic progression and regression of CAD in patients with CAD and hypercholesterolemia. The design included a multicenter randomized, double-blind, parallel, placebo-controlled comparison, with target and safety limits for adjusting the trial medication depending on the LDL cholesterol level (LDL-C) achieved, i.e., up to 40 mg of simvastatin (S) or placebo (P) daily, add-on medication (up to 3 x 4 g Colestyramin), and diet counselling. Male patients, average age 49 (or = 56) years, were included with angiographic CAD and a screening total cholesterol of 207-350 mg/dl, who were not due to undergo coronary bypass surgery or PTCA, who did not suffer from serious other disease (e.g., diabetes mellitus), and who had not undergone coronary bypass surgery previously.All baseline variables were comparable in the treatment groups, with 129 patients taking S and 125 taking P. Of these 254 patients 217 had their final study visit and 207 underwent a second angiography after an average treatment time of 2.3 years under an average daily dose of 37 mg S. 205 pairs of films were available for analysis. Vital information was obtained of all patients until closure of the data bank, half a year after the last study angiography. Five deaths occurred within the study period, 12 through March 15, 1995 (S: 1/6, P: 4/6). 37 patients (S: 18, P: 19) discontinued trial drug and protocol. Concomitant CAD medication was comparable in both groups, except lipid-lowering add-on medication which was significantly higher in the P group (38% versus 13%). Significant changes in lipid levels, on treatment, were observed in the S group amounting to a mean difference in LDL-C of -35%, in Apo-Protein B (ApoB) of -30%, in VLDL-C of -37%, and in triglycerides (TG) of -27%, and in HDL-C of +6%, in comparison to the control group; these differences were even greater in 137 fully compliant patients: -41, -36, -39, -31, and +7%, respectively. Progression in the S group was significantly less, as defined by the two primary target criteria: 1) the minimum obstruction diameter (MOD), determined by quantitative coronary angiography (QCA), decreased about five times less in comparison to the control group (S: by -0.017; P: -0.0954 mm), and 2) the standardized visual global change score (GCS) deteriorated almost three times less in the S group (by +0.20) than in the P group (+0.58). Of the secondary target criteria, the mean lumen diameter (QCA) also developed a significant difference (S: -0.20; P: +0.23 mm; p = 0.0006) with a trend toward regression in the S group. The QCA-%-stenosis deteriorated three- to four-times less in the S group as compared to the control group (S: by 0.69%; P: by 2.73%; p = 0.0022), and the number of patients with angiographic progression was nearly halved (S: 30%; P: 56%; p0.0000). These differences were determined by intention to treat analysis (ITT), and they were obtained in spite of lipid lowering add-on medication in 38% of the P patients; they turned out to be more pronounced in 137 fully compliant patients, in an analysis "as treated". The mean decrease in LDL-C serum level caused by S was significantly correlated to the decrease in progression, and multivariate regression analysis of both treatment groups identified LDL-C (or ApoB) and TG as independent predictors of progression. Progression appeared to be most pronounced in low and medium sized lesions, and the beneficial effect of lipid intervention dominated in lesions with 12-56% QCA stenosis severity. A small fraction of patients who suffered from exercise-induced angina, with ST-segment-depression at the beginning of the study, experienced a significant improvement under S as compared to P treatment. Although the study was not designed to show differences in clinical events, the combined number of all major cardiovascular events tended to be less frequent in the S than in the C gr

Background In several angiographic trials, HMG-CoA reductase inhibitors have shown a beneficial effect on the progression of coronary artery disease. Using 20 mg simvastatin day−1, a treatment period of up to 4 years was necessary to show a significant reduction in coronary artery disease progression. The question remains however, whether higher dosages of simvastatin would be more advantageous in respect to the magnitude of the effect and the required time interval to demonstrate treatment efficacy. Methods and results In the Coronary Intervention Study (CIS), a multicentre randomized double-blind placebo-controlled study, the effects of lipid-lowering therapy with simvastatin on progression of coronary artery disease in 254 men with documented coronary artery disease and hypercholesterolaemia were investigated. Following a period of lipid-lowering diet, treatment with 40 mg simvastatin or placebo was maintained for an average of 2·3 years. Two primary angiographic endpoints were chosen: the global change score (visual evaluation according to the method of Blankenhorn) and the per patient mean change of minimum lumen diameter (evaluated by the CAAS I system). The mean simvastatin dose was 34·5 mg day−1. In the placebo group, the serum lipids remained unchanged; in comparison to the placebo group the simvastatin group showed a 35% LDL-cholesterol decrease. Coronary angiography was repeated in 205 patients (81%) and 203 film pairs (80%) were evaluable by quantitative coronary angiography. In the simvastatin and placebo groups, the mean global change scores were +0·20 and +0·58 respectively, demonstrating a significantly slower progression of coronary artery disease in the treatment group ( P =0·02). The change in minimum lumen diameter assessed by computer-assisted quantitative evaluation with the CAAS I system was −0·02 mm in the simvastatin group and −0·10 mm in the placebo group ( P =0·002). In the simvastatin group, there was a significant correlation between the LDL cholesterol levels achieved therapeutically and the per patient mean loss of minimum lumen diameter (r=0·29; P =0·003). During the study period, there was no significant difference in the incidence of serious cardiac events (15 of 129 patients in the simvastatin group and 19 of 125 patients in the placebo group, ns). Conclusion Treatment with 40 mg simvastatin day−1 reduces serum cholesterol and slows the progression of coronary artery disease significantly within a short period of treatment time. In the treatment group, retardation of progression is inversely correlated to the LDL-cholesterol levels achieved.

A mechanical model for the quantitative investigation of the loss of performance of a ventricle caused by aneurysms of different sizes is described. The model permits an accurate simulation of the geometry of both the ventricle and the aneurysm, as well as the mechanical flow situation as expressed by the changing pattern of the intraventricular pressure. Investigations are limited to a determination of the loss of ventricular performance brought about by the dyskinetic motion of the aneurysm.

In this paper, the shortterm influence of a lactovegetarian diet on selected laboratory parameters and motivation of patients in comparison to a conventional, fat-modified and cholesterol-lowered, omnivorous diet during a clinical rehabilitation treatment should be examined. During an average period of 24.2 days the total cholesterol and the LDL-cholesterol fell for a group of 151 patients who had volunteered to sustain a vegetarian diet for the duration of the clinical rehabilitation, significantly higher by a medium level of 31.1 mg/dl (12.5%) versus 16.9 mg/dl (7%) respectively 27.7 mg/dl (14.5%) versus 11.8 mg/dl (6.5%), as compared to a randomly selected control group of 151 patients. The reductions within the groups were also significant. All of the other laboratory parameters such as lipoprotein (a), fibrinogen, uric acid, triglycerides, and HDL-cholesterol did not exhibit any diet-related changes. The weight of the adipose patients could be reduced very significantly through a reduction diet consisting of lactovegetarian food by an average of 3.2 kg versus 1.6 kg (as in the case of the normal, omnivorous diet). All of the dependent values, i.e., circumference of abdomen and hip, and "body-mass-index" (BMI) showed the same highly significant differences. Even after 1 year approximately two-thirds of the patients of the vegetarian group chose the reduction of meat and meat-products in their diet, of which merely a small part, 5.3%, were faithful to the pure lactovegetarian food. Essentially, the favorable effects on the lipid values persisted. The positive effects on the lipid values, the weight, and the motivation of the group of patients with the lactovegetarian diet allow the general recommendation of this diet for heart patients in the course of their clinical rehabilitation.

Unter einer Myokardhypertrophie versteht man eine Zunahme der Muskelmasse des Herzens, die mit einer Gewichtsvermehrung einhergeht.

In einer fruheren Arbeit (Tammen et al. 2, 3) wurde 1984 uber den Langzeitverlauf bei Herzinfarktpatienten mit Belastungshypertonie berichtet (Abb. 1–3). Es wurden damals 83 Herzinfarktpatienten mit einer Belastungshypertonie 8 Jahre spater mit einer Kontrollgruppe von Herzinfarktpatienten ohne Belastungshypertonie hinsichtlich ihres Blutdruckverhalten in Ruhe und bei Belastung und hinsichtlich des klinischen Verlaufes verglichen. Es hatten dabei 62% der nachuntersuchten Belastungshypertoniker und 23% der Kontrollgruppe eine manifeste Hypertonie nach 8 Jahren entwickelt. Normotone Blutdruckwerte wiesen nach 8 Jahren 11% der Belastungshypertoniker und 56% der Kontrollgruppe auf. Die Sterblichkeit war mit 12% bei den Belastungshypertonikern und mit 17% bei den Normotonikern nicht sehr unterschiedlich. Die verstorbenen Belastungshypertoniker hatten aber die hochsten Belastungs-Blutdruckwerte.

Short stature in men has previously been associated with a higher risk of coronary heart disease. In order to further investigate this observation, the physical characteristics of 4470 German men admitted to the Klinik Roderbirken between 1978 and 1989 with a documented myocardial infarction and with a stenosis greater than or equal to 75% in at least one vessel were compared to those of 711 male controls. Results indicated that the myocardial infarct group was significantly shorter by 1.8 cm than the control group (p less than 0.001). However, discriminant function analysis indicated that height accounted for only 1% of the variance between the cardiac and control patients. Classification analysis further indicated that on the basis of height, the percentage of subjects correctly classified for grouping was no better than 54% for the myocardial infarct patients and 57% for the controls. It was concluded that height exerted a minimal influence on coronary heart disease in this population.

Short stature as an indicator of coronary disease in German men is described.A total of 4,524 patients investigated by coronary angiography (history of myocardial infarction and at least one vessel greater than or equal to 75% stenotic or occluded on angiography and, in addition corresponding levocardiographic changes) and 722 age-matched test subjects with unremarkable coronary angiographic findings were admitted to the study.The patients with coronary heart disease were, on average, 1.9 cm shorter than those with unremarkable blood vessels. This difference in height was found in particular in the age group between 40 and 60 years old. The reason for this is not known.

For some time, we have observed and reported on what appears to be a diurnal rhythm, or a temporal variation, with respect to episodes of angina pectoris and ST segment deviation during exercise stress tests when conducted at different times during the day (Henkels and Blumchen 1977; Henkels et al. 1977). Patients who were tested during the morning hours were more likely to develop angina, dyspnea, exhaustion, and ST segment depression, and at a lower threshold, than when tested during the late morning or afternoon.

BACKGROUND This study was designed to determine the controlled effects of a short-term exercise rehabilitation program on patients with moderate-to-severe left ventricular dysfunction after a recent myocardial infarction. METHODS AND RESULTS Thirty-nine male patients 51 +/- 8 years old with a large anterior myocardial infarction less than 10 weeks old were recruited for the study. The patients were randomly assigned to either one of two training or control groups on the basis of their resting ejection fraction: training, less than 30%; control, less than 30%; training, 31-50%; or control, 31-50%. Patients were evaluated for filling pressures, radionuclide ventriculography, heart volume, echocardiography, and work capacity. Patients who underwent training participated in an intensive 4-week in-hospital exercise program, whereas the control patients were restricted to a minimal activity program. Results indicated that there were no significant improvements in resting, submaximal, and maximal hemodynamic measurements as a result of the program. Mean work capacity and peak oxygen consumption improved significantly in the less-than-30% training group but was accompanied by a significant increase in mean pulmonary wedge pressure. Resting ejection fraction improved markedly in both less-than-30% training and control patients, but ejection fraction measures were not associated with work capacity. Training did not cause further deterioration in ventricular function. CONCLUSIONS It was concluded that in the present study, exercise training had little or no effect on hemodynamic measurements and that the training effects achieved in patients with left ventricular dysfunction are most likely due to corrected impaired vasodilation, not necessarily to cardiac function. The importance of using a control group in this type of study and the wide interindividual variations in training responses are emphasized.

The effect of tennis play on blood pressure, heart rate response, and rhythm disturbances was evaluated in 21 men 39 to 61 years of age (M = 49.5 +/- 6.7 yrs). A Holter monitor was utilized for continuous ECG recording during tennis play and a portable ambulatory blood pressure recorder (Spacelabs) was used to measure blood pressures and heart rates periodically during tennis matches. The results indicated that blood pressure response to tennis (singles), although an activity of moderate aerobic intensity, can exert significant increases in systolic and diastolic blood pressure even in those persons who are normotensive at rest. Excessive body weight, and particularly abdominal deposition, appears associated with an increase in diastolic blood pressure to exercise. Few heart rhythm disturbances of consequence were uncovered. A simple submaximal step test such as the Canadian Aerobic Fitness Test, with ECG monitoring, could assist in detecting those individuals susceptible to an exaggerated blood pressure response and to heart rhythm disturbances at exercise.

Thirty-nine male patients (average age 50.8 years +/- 8.4 years) with a large anterior myocardial infarction (average 45.6 days +/- 10.5 days ago) and with moderate to severe left-ventricular dysfunction (RNVA EF less than 50%) participated in the study. The patients were randomly assigned to either a training group or to a control group. They were also subdivided into training/control groups (EF less than 30% and EF = 30-50%). The training program consisted of three to four sessions per day, 5 days a week, at an intensity of up to 1 W/kg body wt. (approximately 4-5 METS). The following evaluations were recorded prior to and following the 4-week training program: relative heart volume (x-ray), echocardiographic data (enddiastolic diameter, ES-distance, and shortening fraction), and exercise stress test (work capacity, heart rate). Filling pressures, cardiac outpout, and stroke volume index were calculated from right-heart catheterization (Swan-Ganz) at rest and during exercise. Results indicate that there were no significant changes in relative heart volume, end-diastolic volume, ES-distance, resting heart rate, PCP at rest, and ejection fraction during exercise as a result of the training program. Shortening fraction showed a tendency to improve (not significant). Work capacity increased by 15 W (p less than 0.05) in the training group and by 28 W (1.5 METS, p less than 0.05) in the EF less than 30% training-group as compared with the control group. Cardiac output at rest decreased by 10% (p less than 0.05). Stroke-volume index increased in the EF greater than 30% training-group, while heart rate was reduced.(ABSTRACT TRUNCATED AT 250 WORDS)

One metabolic equivalent (MET) is defined as the amount of oxygen consumed while sitting at rest and is equal to 3.5 ml O2 per kg body weight x min. The MET concept represents a simple, practical, and easily understood procedure for expressing the energy cost of physical activities as a multiple of the resting metabolic rate. The energy cost of an activity can be determined by dividing the relative oxygen cost of the activity (ml O2/kg/min) x by 3.5. This article summarizes and presents energy expenditure values for numerous household and recreational activities in both METS and watts units. Also, the intensity levels (in METS) for selected exercise protocols are compared stage by stage. In spite of its limitations, the MET concept provides a convenient method to describe the functional capacity or exercise tolerance of an individual as determined from progressive exercise testing and to define a repertoire of physical activities in which a person may participate safely, without exceeding a prescribed intensity level.

Thirty patients with a first nontransmural myocardial infarction (MI) were examined retrospectively. The patients had been treated either surgically or conservatively on the basis of the clinical and morphological findings. Three years following infarction, 28 of the 30 patients were still alive (93.3%). 10 of the 13 patients with one vessel disease and 7 of the 17 patients with two or three vessel disease were gainfully employed. The unfavorable natural course of nontransmural myocardial infarction favors an aggressive diagnostic and therapeutic approach since the survival rate of these patients is only 60 to 70% after three years. The results of this study demonstrates convincingly the economic and social benefits of our diagnostic and therapeutical interventions.

We suspected there could be different social, psychological, and medical problems for women after a first myocardial infarction than those affecting men. 140 women (56.4 +/- 7 years) were interviewed by questionnaire 32 +/- 8.7 months after myocardial infarction; 83% (n = 119) responded (8.8% of the sample group had died), 12% suffered a reinfarction, and 11% underwent aortocoronary bypass surgery. For 84% of those responding it was harder to do their housework after myocardial infarction, but 73% did it without help. 51.5% showed a mood change that included increasing depression, anxiousness, and insecurity. In 12.5% of the women their relationship with their husband was adversely affected; in 6.6% their relationship with their children worsened. 83% (n = 89) saw their infarction as a result of stress. 45% could not relieve their stress after 32 months. A subjective feeling of stress decrease in 54% was achieved with a quieter life, in 39.5% by resigning their jobs, and in 6.5% by the death of the husband. Concerning somatic risk factors 74% of the smokers stopped smoking; oral contraceptives were discontinued in all cases. 90.5% (n = 97) of the women said they had their serum lipid values checked regularly, but these were only under control in 35%. We conclude the rehabilitation process does not end when patients leave a rehabilitation clinic. Patients should acquire household help, and their family situation should be discussed during their stay in the rehabilitation clinic. Concerning the somatic risk factors, women who survive myocardial infarction require better care and information.

This paper describes the long-term effect of conservative, interventional and surgical treatment in coronary heart disease on the prognosis and on the quality of life. It is difficult to decide if prognosis or quality of life is more influenced by the different therapeutic measures.

It is more or less taken for granted that exercise training not only affects the somatic but also the emotional state of patients with heart disorders in a positive way (Halhuber 1980; Riedel 1987). Controlled studies scarcely exist, however. Also, there seems to be little agreement in the results referring to this topic, nor are these results as positive as supposed. Knobloch (1985) found in a 2-year follow-up study that even those patients who were sportive and participated in a regular exercise training group showed an increase of “social anxiety”, “sensitivity concerning feelings of pain” and “sorrow concerning health.”

The Coronary Intervention Study, CIS, is a multicentre, randomized, doubleblind. placebo-controlled study to investigate the effects of lipid-modifying therapy on progression in 254 men with documented coronary artery disease (CAD) and hypercholesterolemia. Entry criteria were the presence of at least 3 coronary stenoses of ≥25% and a mean serum total cholesterol (C) of : ≥207 mg/dl after diet. Treatment with up to 40 mg simvastatin (S) or placebo (P) o.d. included diet and — as a reserve medication: — colestyramine, and was pursued for 2.3 years (S/P: 865/835 days). The two treatment groups (see below) were comparable with respect to baseline variables, e.g. average age (49.9/49.1 y), height(175.4/175.2 cm), weight(80.1/80 kg), blood pressure (123,5/79.8 vs. 123.1/78.6 mmHg), diastolic hypertension ≥90 mmHg (9.6/9.1%), fasting serum glucose ≥120 mg/dl (2.9/5.1%), family history (47.1/48.0%), smoking (83.6/85.9), ventricular score (1.0/0.9), coronary score (2.12/1.93 — vessel-disease), and lipid values, with a baseline LDL-C of 163.8/166.7 mg/dl. Treatment resulted in significant changes of serum lipids with a decrease of LDL-C by 33% and -1.5% in the Sand P group, respectively. 204 (81; 104/100) patients had a second angiography. Two primary end points were chosen: — the within-patient change in minimum diameter avenged over all assessable coronary segments (“ΔminD”, determined by quantitative analysis using the CAAS system), and—the visual Global Change Score (“GCS”, Blankenhorn), and calculated according to Bonferroni-Holme on a multiple significance level of 5%. The detailed results will be presented. Supported by MSD Sharp and Dohme, Munich, Germany.

UNLABELLED The CIS was undertaken with the aim to evaluate the effects of lipid modifications on angiographic progression and regression of CAD in patients with CAD and hypercholesterolemia. The design included a multicenter randomized, double-blind, parallel, placebo-controlled comparison, with target and safety limits for adjusting the trial medication depending on the LDL cholesterol level (LDL-C) achieved, i.e., up to 40 mg of simvastatin (S) or placebo (P) daily, add-on medication (up to 3 x 4 g Colestyramin), and diet counselling. Male patients, average age 49 (< or = 56) years, were included with angiographic CAD and a screening total cholesterol of 207-350 mg/dl, who were not due to undergo coronary bypass surgery or PTCA, who did not suffer from serious other disease (e.g., diabetes mellitus), and who had not undergone coronary bypass surgery previously. RESULTS All baseline variables were comparable in the treatment groups, with 129 patients taking S and 125 taking P. Of these 254 patients 217 had their final study visit and 207 underwent a second angiography after an average treatment time of 2.3 years under an average daily dose of 37 mg S. 205 pairs of films were available for analysis. Vital information was obtained of all patients until closure of the data bank, half a year after the last study angiography. Five deaths occurred within the study period, 12 through March 15, 1995 (S: 1/6, P: 4/6). 37 patients (S: 18, P: 19) discontinued trial drug and protocol. Concomitant CAD medication was comparable in both groups, except lipid-lowering add-on medication which was significantly higher in the P group (38% versus 13%). Significant changes in lipid levels, on treatment, were observed in the S group amounting to a mean difference in LDL-C of -35%, in Apo-Protein B (ApoB) of -30%, in VLDL-C of -37%, and in triglycerides (TG) of -27%, and in HDL-C of +6%, in comparison to the control group; these differences were even greater in 137 fully compliant patients: -41, -36, -39, -31, and +7%, respectively. Progression in the S group was significantly less, as defined by the two primary target criteria: 1) the minimum obstruction diameter (MOD), determined by quantitative coronary angiography (QCA), decreased about five times less in comparison to the control group (S: by -0.017; P: -0.0954 mm), and 2) the standardized visual global change score (GCS) deteriorated almost three times less in the S group (by +0.20) than in the P group (+0.58). Of the secondary target criteria, the mean lumen diameter (QCA) also developed a significant difference (S: -0.20; P: +0.23 mm; p = 0.0006) with a trend toward regression in the S group. The QCA-%-stenosis deteriorated three- to four-times less in the S group as compared to the control group (S: by 0.69%; P: by 2.73%; p = 0.0022), and the number of patients with angiographic progression was nearly halved (S: 30%; P: 56%; p < 0.0000). These differences were determined by intention to treat analysis (ITT), and they were obtained in spite of lipid lowering add-on medication in 38% of the P patients; they turned out to be more pronounced in 137 fully compliant patients, in an analysis "as treated". The mean decrease in LDL-C serum level caused by S was significantly correlated to the decrease in progression, and multivariate regression analysis of both treatment groups identified LDL-C (or ApoB) and TG as independent predictors of progression. Progression appeared to be most pronounced in low and medium sized lesions, and the beneficial effect of lipid intervention dominated in lesions with 12-56% QCA stenosis severity. A small fraction of patients who suffered from exercise-induced angina, with ST-segment-depression at the beginning of the study, experienced a significant improvement under S as compared to P treatment. Although the study was not designed to show differences in clinical events, the combined number of all major cardiovascular events tended to be less frequent in the S than in the C gr

ZusammenfassungDreyfuss et al. berichteten über Untersuchungen an 49 Patienten, von denen 23 einen Herzinfarkt erlitten hatten. Sie verabreichten oral zwischen 50 und 200 μCi Na131 J. Bei den Infarktpatienten waren am 1., 2., 6., 7. Tag nach der Injektion höhere präkordial gemessene Aktivitäten feststellbar (verglichen mit den Aktivitäten über der rechten Lunge), als bei den nicht herzkranken Kontroll-patienten. Die Autoren folgerten daraus, daß der geschädigte Herzmuskelbereich oder das ihn umgebende Gewebe Radiojod anhäuft.In der vorliegenden Arbeit wurde die Aussagekraft dieser Methode überprüft.Es wurde bei 9 Infarktpatienten, bei 9 herzgesunden Studenten, bei 7 Patienten mit Koronarinsuffizienz und bei 17 herzgesunden Patienten (diese Patienten litten vorwiegend unter peripher arterieller Verschlußkrankheit) 20 mCi Na131J intravenös injiziert.Danach wurde die Anhäufung von Na131J präkordial und über der rechten Thoraxhälfte über mehrere Tage verfolgt.Im Vergleich mit den Normalpersonen fanden wir bei den Infarktpatienten keine erhöhte präkordiale Aktivität. Der Quotient aus präkordialer und präpulmonaler Impulsrate (bis zur 35. Stunde nach der Injektion statistisch untersucht) eignet sich nicht für eine Differenzierung von Infarktpatienten und Herzgesunden.Es wird diskutiert, wieweit geringe methodische Unterschiede für die unterschiedlichen Resultate verantwortlich gemacht werden können.

Fifteen subjects with arteriosclerosis obliterans underwent an individualized physical training program for an average of 5.5 months. Each month the following measurements were obtained: venous occlus

It was studied development of Subclavian Steal Syndrome in 27 patients postoperatively and spontaneously over a period of 3 years. It was seen a high quote of spontaneous recovery of cerebral symptoms, on the other side there was a lack of complete remissions of cerebral symptoms after vascular operation. Vascular operation is only indicated in syncopal and severe ischemic brachial symptoms.

We examined 221 patients with postmyocardial infarctions 8 weeks after MI using radionuclide ventriculography (RNVA) at rest (EFR) and during supine submaximal exercise (delta EF). Mortality rates were evaluated 2 1/2 and 3 1/2 years later by interviewing patients and/or their homephysicians. Sixteen patients were dead (6.7%) 2 1/2 years after MI, 28 (12.7%) were dead after 3 1/2 years. Thirty percent of patients with a resting EF less than 30% had died 2 1/2 years after MI, and 40% were dead within 3 1/2 years. The mortality rate was significantly higher than in patients who had EF greater than or equal to 30% 8 weeks after MI. Patients with a decrease of delta EF (greater than or equal to 5%) showed a 2 1/2 year mortality of 10.8% and after 3 1/2 years of 18.5%. Mortality was significantly higher in patients with decreasing EF during exercise than in those who increased their EF during exercise. This prognostic value of EFR and delta EF was compared with other parameters (angina pectoris, ECG at rest and during exercise, heart volume, Holter ECG, floating catheter PCP [rest and exercise], coronary angiography). Radionuclide ventriculography at rest and during exercise showed a tendency to be the best determining factor for prognosis, and is therefore recommended to determine prognosis in post-MI patients.

My answer to the question is: Yes, the influences of social classes are inevitable [1]. The following results will support this hypothesis. It is difficult to compare the influence of social classes on rehabilitation of cardiac patients in completely different societies. But it seems possible, although difficult, to compare the influence of social classes on cardiac rehabilitation between different western countries. The medical system in Germany is different from that of the United States and other western countries. Approximately 90% of the German population are insured by government policy. The medical insurance system is subdivided into blue-collar workers and white-collar workers. Ten percent of the population are insured privately, mainly professionals like laywers, architects, docters, teachers. Thus German society is clearly subdivided into blue-collar workers, white-collar workers and privately insured. This allows us to study the influence of social classes on rehabilitation after myocardial infarction. Therefore I will present predominantly German data.

In 33 patients (30 male, 3 female, mean age 48 years) 99mTc-Trend Scintigraphy (Schad) was compared with left ventricular angiography. 25 patients suffered of a chronic myocardial infarction. In 26 patients complete or partial agreement between the two methods was seen. The scintigraphy showed false negative results in the apical region and false positive results in the basal segments. The comparison of both methods shows that 99mTc-Trend Scintigraphy can be used to evaluate non-invasively the function of the left ventricle.

Left ventricular function was examined in a control group of 8 healthy men (average age 26 +/- 6.2 years) and was compared to 40 post-MI patients (average age 50 +/- 8.2 years, 39 men, one woman). It was measured using the floating-catheter technique under isometric exercise (50% of maximal voluntary contraction using both hands) and also under dynamic exercise (progressive supine bicycle-ergometry). In the control group, there was a significant increase in heart rate, arterial blood-pressure and the average PCP from rest to isometric exercises. PCP was noted to stay within its normal range (less than 20 mm Hg) under both modes of exercise. There was no significant difference comparing the effects of dynamic and isometric exercise (isometric: PCP 13.3 +/- 3.3 mm Hg; dynamic: PCP 11.8 +/- 3.6 mm Hg). In Group I (20 post-MI-patients showing ischemia during exercise-ECG) PCP stayed normal under isometric exercise (PCP 18.8 +/- 10.2 mm Hg). Under dynamic exercise, their PCP increased up to a pathological level (PCP 24.9 +/- 10.1 mm Hg, p less than 0.01). In Group II (20 post-MI-patients with lacking proof of ischemia during exercise-ECG) there was no significant difference between the increase in PCP under isometric vs dynamic exercise (isometric: PCP 18.7 +/- 13.4 mm Hg; dynamic: PCP 18.5 +/- 10.0 mm Hg).The results lead to the conclusion that isometric exercise alone (50% of maximal voluntary contraction using both hands, handgrip) can replace dynamic exercise in the diagnosis of LV malfunction in post-MI patients who do not show ischemia during exercise-ECG.

Die hier berichteten Untersuchungsergebnisse wurden aus einem umfangreichen Untersuchungsprogramm entnommen, das sich mit der Frage der Einwirkung von korperlichem Training auf Herzinfarktpatienten befast. Es wurden 99 Patienten mit Hilfe der Radionuklidventrikulographie (RNVA) (Borer et al. 1979, 1980) in Ruhe und unter symptomlimitierender submaximaler Belastung untersucht (Grodzinski et al., 1982). Das Herzvolumen wurde nach der Methode von Musshoff et al. bestimmt. In dieser Arbeit wird uber das Verhalten der RNVA bei normal grosen ( 14 ml/kg) berichtet.

Exercise hypertension, defined as a blood pressure response to a dynamic exercise stressor which is considered excessive to what is normally observed in a healthy population, is currently the subject of much discussion. This interest appears to be related to the recent concerns that are being expressed in the utilization of hypertensive drugs with respect to their long-term benefits and risks. I would seem that the proper selection of patients for drug therapy will become as important as the treatment itself, not only for clinical purposes but to insure the quality of life of a patient in the pursuit of his/her daily activities. Also, a number of retrospective studies have shown that an exaggerated blood pressure response to exercise in resting normotensive persons could be a useful indicator to assist in detecting those persons who may be on the way to developing sustained hypertension. The literature suggests that this is a tenable hypothesis but one that will require testing by prospective research. In this respect, it has been suggested that if the blood pressure response to a dynamic exercise in borderline or labile hypertensives is normal, it is possible to dismiss the diagnosis of hypertension, at least temporarily. However, if the blood pressure response is exaggerated, then the diagnosis of hypertension should be considered. In Canada, the Canadian Aerobic Fitness Test (CAFT) has been utilized to assist in detecting exercise hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Data from 7013 patients with suspected ischemic heart disease has been analyzed in an attempt to determine the incidence of myocardial infarction (MI) without demonstrable narrowing in the coronary arteries, and to determine whether there were clinical or other features that helped to clarify the etiology.

To determine the prognostic and clinical significance of exercise-induced hypertension (ExHPT) in heart infarction (HI) patients, blood pressure (BP) and course of disease in 83 HI patients with ExHPT were compared with those in a control (CT) group of 54 HI patients without ExHPT. After 7–8 years, 60 patients from the ExHPT-group and 30 patients from the CT group were reevaluated.