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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Variations in clinical noninvasive systolic pressure at the point of symptom-limited exercise on a treadmill were examined in six groups of subjects: 5,459 men and 749 women classified into three categories each. Among the men, 2,532 were asymptomatic healthy, 592 were hypertensive and 1,586 had clinical manifestations of coronary heart disease (that is, typical angina pectoris, prior myocardial infarction or sudden cardiac arrest with resuscitation). Among the women, 244, 158 and 347 were in the corresponding clinical categories. None had had cardiac surgery; all had follow-up status ascertained by periodic mail questionnaires. Reported deaths were reviewed and classified by three cardiologists; 140 deaths were attributed to coronary heart disease, 118 of them in the men classified as having coronary heart disease. The majority of maximal systolic blood pressure readings were reported to the nearest centimeter rather than millimeter of pressure. Retesting of 156 persons from 1 to 32 months later showed that pressure values agreed within 10 percent in two thirds, the overall mean difference was only 8.6 mm Hg and the correlation at maximal exercise was superior to that of the resting observations just before exercise. Hypertensive patients had a significantly greater body weight than normotensive persons. Among men, the lowest maximal systolic pressure was observed in the group with coronary heart disease; among women, the lowest mean pressure was found in the healthy group. Patients with coronary heart disease were slightly older, and only the women showed a significant correlation in maximal pressure with age. Only 5 percent of the variation in maximal systolic pressure in the patients with coronary heart disease was due to a shortened duration of exercise. Maximal systolic pressures correlated fairly well (r equals 0.46 to 0.68 for the various groups) with resting systolic pressure, and this relation was independent of the diagnosis of cardiovascular disease in both men and women. Relations between pressure and the number of stenotic coronary arteries and imparied ejection fraction at rest were examined in 22 men without and 182 men with coronary artery disease. Lower maximal systolic pressures were often associated with two or three vessel disease or reduced ejection fraction, or both. The prognostic value of maximal systolic pressure for subsequent death due to coronary heart disease was examined in the men with coronary heart disease. The annual rate of sudden cardiac death decreased from 97.9 per 1,000 men to 25.3 and 6.6 per 1,000 men as the range of maximal systolic pressure increased from less than 140 to 140 to 199 and to 200 mm Hg or more, respectively. Cardiomegaly, Q waves in the resting electrocardiogram and persistent postexertional S-T depression were more common in men with the lowest systolic pressure at maximal exercise.
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PMID:Variations in and significance of systolic pressure during maximal exercise (treadmill) testing. 87 Nov 10

To evaluate whether elevated arterial free fatty acids (FFA) increase myocardial oxygen demand and ischemia, 15 fasting patients with coronary artery disease underwent a standardized atrial pacing test before (PTI) and during (PT2) heparin infusion. The patients were monitored for clinical and electrocardiographic (ECG) manifestations of ischemia. Myocardial extraction of lactate, inorganic phosphate, oxygen and FFA was measured before and during each PT. The control arterial FFA was 0.65 +/- 0.03 micromole/ml and rose to 1.83 +/- 0.16 micromole/ml during heparin influsion. Myocardial oxygen extraction at rest and during PT was not affected by the increase in arterial FFA. Seven patients asymptomatic during PT1 did not develop ischaemic manifestations during PT2. In eight patients with angina during both PTs, increased arterial FFA concentration did not modify the severity of anginal pain, the amount of ST-segment depression and the myocardial balance of lactate or inorganic phosphate. Elevation of arterial FFA by heparin neither increased myocardial oxygen extraction at rest or during pacing nor accentuated ischemic manifestations during PT.
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PMID:Effect of increased free fatty acids on myocardial oxygen extraction and angina threshold during atrial pacing. 87 27

The hemodynamic, coronary sinus blood flow and myocardial metabolic effects of 0.15 mg/kg body weight of intravenously administered propranolol were studied in 19 patients with coronary artery disease and 6 normal patients. Atrial pacing was performed in all patients and produced angina in 15 of the 19 patients with coronary artery disease. In these patients propranolol reduced heart rate from 78 to 69 beats/min, cardiac index from 3.0 to 2.6 liters/min per m2 and left ventricular stroke work index from 47 to 43 g-m/m2; it increased total peripheral resistance from 24 to 28 units and lactate extraction from 16.3 to 22.5%. There was no significant change in mean arterial pressure, left ventricular end-diastolic pressure, coronary sinus blood flow or myocardial oxygen consumption. During a second pacing stress propranolol produced clinical improvement in 9 of the 15 patients who experienced angina initially. The improvement was associated with less severe abnormalities in S-T depression and left ventricular end-diastolic pressure, increased lactate extraction and no significant change in coronary sinus blood flow or myocardial oxygen consumption. Thus, propranolol appears to be capable of modifying the anginal threshold as determined with atrial pacing, and the clinical response appears to be independent of global changes in coronary sinus blood flow and myocardial oxygen consumption.
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PMID:Effects of propranolol on the hemodynamic, coronary sinus blood flow and myocardial metabolic response to atrial pacing. 87 19

This study presents the results of maximal treadmill testing and coronary angiography in 31 asymptomatic USAF aircrewmen with acquired left bundle branch block. There were two subgroups: 26 men with normal coronary angiography and five men with significant angiographic coronary angiography and five men with significant angiographic coronary artery disease. The mean amount of maximal ST-segment depression induced by treadmill exercise was --0.5 mv. for both groups and the range in the normal subgroup was --0.3 to --1.0 mv. No significant differences were found between the groups. We concluded that apparently healthy, asymptomatic men with acquired left bundle branch block can have considerable ST-segment depression in response to maximal treadmill testing and that their ST-segment response cannot be used to make diagnostic decisions about them.
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PMID:The electrocardiographic response to maximal treadmill exercise of asymptomatic men with left bundle branch block. 88 64

Thirty-seven subjects (10 asymptomatic and 27 symptomatic) who had undergone maximal treadmill exercise tests and coronary arteriography were selected to determine whether the predictive value of ST-segment depression as a marker of coronary artery disease (CAD) in asymptomatic subjects could be enhanced. All subjects had greater than or equal to 2 mm ST-segment depression during testing. Three of the ten asymptomatic subjects had significant CAD (predictive accuracy 30%) and all had greater than or equal to 2 mm ST depression in the one-minute recovery tracing. ST-segment depression resolved by one minute in all seven subjects without CAD. All 27 symptomatic subjects had CAD (predictive accuracy 100%) and 26 of 27 had greater than or equal to 1 mm (21/24 greater than or equal to 2 mm) ST depression in the one-minute recovery tracing. The age, maximum heart rate and exercise tolerance did not differ significantly between the symptomatic and asymptomatic subjects. Thus the predictive accuracy for CAD in asymptomatic subjects is not enhanced by increasing the degree of ST depression required for a positive exercise test. The predictive value may be enhanced if ST depression persists for greater than or equal to 2 minutes into recovery. These data suggest that by using new criteria accurate identification of asymptomatic patients with CAD by exercise testing may be practical.
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PMID:New criteria to enhance the predictability of coronary artery disease by exercise testing in asymptomatic subjects. 91 41

1. Nine subjects with severe coronary artery disease were studied during graded "sprint" and "steady-state" exercise before and after intravenous administration of the beta-receptor antagonist alprenolol. During "sprint" workload was increased every minute until maximum work capacity (Wmax) was reached. "Steady-state" exercise was performed at work rates of 0.250, 0.50, and 0.75 of each subject's sprint Wmax. Variables measured included ST-segment depression, changes in heart rate, blood pressure, respiratory gas exchange, and arterial blood composition. Cardiac output (indirect Fick) was measured during "steady-state" exercise. 2. Alprenolol did not alter Wmax during "sprint" but reduced the incidence of angina in both types of exercise. After the drug work capacity was limited by symptoms and signs suggestive of mild left ventricular failure. 3. The relationship between workload (normalized in terms of Wmax) and ST-segment depression was curvilinear. Under control conditions a given rate of work during "steady-state" exercise was assocaited with more marked ST-segment depression than during "sprint". Alprenolol displaced the work-ST-depression curve to the right in each type of exercise; now a given rate of work produced similar ST-depressing during "steady-state" and "sprint" exercise. 4. Alprenolol attentuated the exercise tachycardia during both types of exercise. Cardiac output was lower in "steady-state" exercise after the drug than under control conditions. Metabolic effects included significant reduction in body oxygen consumption after alpreprenolol at 0.25 Wmax and diminished arterial lactate at 0.75 Wmax. The beneficial effects of the drug thus appeared to involve not only cardiac but peripheral effects on beta receptors. 5. Before alprenolol cardiac output was relatively fixed at all workloads, but after the drug there was a work-related rise in output in five out of nine subjects. Comparison with data in normal subjects suggested that in anginal subjects cardiac output at low "steady-state" workloads was inappropriately high.
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PMID:Effect of beta-adrenergic blockade with alprenolol on ST-segment depression and circulatory dynamics during exercise in patients with effort angina. 96 82

The configuration, time of onset, and duration of depressed ST segments during and after treadmill exercise testing were evaluated in 269 patients with angiographically proven coronary artery disease and 141 normal subjects. The test specificity was 93% and sensitivity 64%, the latter being influenced by the type of ST response; false-positive responses were rare with depressed, downsloping STs (1 of 123, 1%), occurred more frequently with horizontal ST depression (9 of 60, 15%), and occurred commonly with slowly upsloping STs (15 of 47, 32%). Depressed downsloping STs, ischemic changes appearing in the first 3 minutes of exercise, and those persisting past 8 minutes in recovery were associated with 91%, 86%, and 90% prevalences of two- to three-vessel or main left coronary disease, respectively. It is concluded that attention to configuration, time of onset, and duration of ischemic ST depression aids both in assessing the validity of exercise responses in diagnosing coronary artery disease and in delineating patients with advanced coronary obstruction.
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PMID:Treadmill stress tests as indicators of presence and severity of coronary artery disease. 96 19

The following prospective study was undertaken to observe the clinical course, early prognosis and coronary anatomy of patients with subendocardial infarction. Subendocardial infarction was defined as typical chest apin (greater than 15 minutes), serum enzyme elevation and persistent (greater than 48 hours) new T wave inversion and/or S-T segment depression in the absence of new pathologic Q waves. Fifty consecutive patients were defined, followed in a prospective manner and subjected to early coronary arteriography. A prior history of unstable angina was found in 33 patients (66 per cent); 22 patients (44 per cent) had significant dysrhythmias during the acute hospital phase, and seven patients (14 per cent) had evidence of mild left ventricular failure. Coronary arteriography demonstrated significant lesions (greater than 75 per cent narrowing in at least one vessel) in all 50 patients, with 30 patients (60 per cent) having either double- or triple-vessel disease. Follow-up (mean 10.6 months) revealed that 15 patients (30 per cent) had stable angina, 23 patients (46 per cent) unstable angina and only 12 patients (24 per cent) remained free of angina. Of 28 patients in a medically treated group, acute transmural infarctions developed in six (21 per cent) and one died (3 per cent). We conclude that subendocardial infarction is symptomatically an unstable entity, is associated with severe coronary artery disease and, in a medically treated group, is followed by a significant incidence of early transmural myocardial infarction (21 per cent). Therefore, these patients require in-hospital monitoring, careful follow-up and consideration for early coronary arteriography.
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PMID:The clinical course, early prognosis and coronary anatomy of subendocardial infarction. 102 Jul 51

This study has assessed whether chest pain occurring during or after a step test could improve the accuracy of exercise testing in the diagnosis of coronary artery disease (CAD). One hundred and fifty-three consecutive men underwent the double Master two-step test prior to diagnostic coronary arteriography. On hundred and twenty-five had CAD, 28 insignificant disease (NCA). The post-exercise ECG showed at least 0-5 mm of ischaemic ST depression in 71 (57%) of the men with CAD and in five (18%) with NCA. Ischaemic ST depression of at least 2-0 mm occurred in 24 men, all of whom had CAD. Chest pain occurred during or after the test in 78 (62%) men with CAD and in nine (33%) with NCA. The accuracy of diagnosis of CAD could be improved by combining the occurrence of chest pain in the test with a positive post-exercise ECG. Either a 2 mm positive post-exercise ECG with or without test angina or 0-5 mm to 1-9 mm positive post-exercise ECG with test angina was found in 56 (45%) of men with CAD and one (4%) with NCA. Thus the concurrence of chest pain during or after a double Master two-step test, together with ischaemic ST segment depression after the test, strongly suggests the presence of CAD.
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PMID:The significance of chest pain occurring with the Master two step test. 106 95

Serious obstructive coronary artery disease was found in all patients who developed hypotension accompanying the onset of angina during multistage exercise testing. Seventeen exercising patients demonstrated a fall in systolic pressure to below resting levels as chest pain and ST-segment depression appeared. Two patients died suddenly six weeks after treadmill testing and prior to arteriography. The remaining fifteen were studied with coronary arteriography and all except one exhibited greater than or equal to 90% stenosis of the left anterior descending artery (LAD). The remaining patient demonstrated two 75% LAD stenoses in series. Five exhibited significant (greater than or equal 75%) narrowing of the main left coronary artery (MLCA) and thirteen of fifteen had significant stenosis of proximal LAD and circumflex arteries. The two patients without significant circumflex disease exhibited greater than or equal to 90% stenosis of the dominant right coronaryartery (RCA) circulation. Six of six patients had restoration of a normal blood pressure response following coronary bypass surgery, which also relieved angina and reversed ST-segment depression. Conditions essential for proper interpretation of this sign are discussed. If these conditions are met, then a fall in systolic pressure during treadmill-induced angina pectoris is a reliable sign of severe compromise of left ventricular blood supply.
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PMID:Hypotension accompanying the onset of exertional angina. A sign of severe compromise of left ventricular blood supply. 107 84


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