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Maximum exercise testing using treadmill walking and cycle ergometry was compared in 40 male patients who had suffered a myocardial infarction in the preceeding twelve months. Maximum oxygen uptake was on average 17% greater in the treadmill than the cycle test and maximum heart rate was also higher, but the rate pressure product (RPP) was a similar due to a higher blood pressure in the cycle ergometer test. Eleven subjects showe ST-segment depression greater than 1 min and eight subjects showed ST-segment elevation greater than 1 mm. There was a close relationship (r2 = 0.96) between the magnitude of ST-segment changes in the two tests. Four subjects showing ST depression of 1 mm in the treadmill test showed depression during the cycle ergometer test which was less than this conventionally "positive" value. In these subjects RPP was lower during cycling than in treadmill walking. With both tests maximum ST-segment changes were measured immediately on stopping exercise: resolution of ST depression was more rapid than ST elevation. The two exercise testing modes are closely comparable in their ability to reveal changes of myocardial ischemia.
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PMID:Comparison of the electrocardiographic changes induced by maximam exercise testing with treadmill and cycle ergometer. 63 26

Forty consecutive survivors after myocardial infarction (MI) were compared by means of a semistructured interview with a matched sample of 40 controls in respect of various psychosocial factors. The MI group reported a much higher prior occurrence of symptoms of anxiety and depression. The complaints included being tired, irritable, restless, upset and anxious, plus insomnia and anhedonia. Preceding stressful life events were about 2 1/2 times as common with the MI group. However, long-term persanality traits which were not recent additions due to psychiatric change before MI did not strongly discriminate between the two groups, and recognized variables such as cigarette smoking had a lesser association with MI. Similar results were obtained when information about each patient and each control was supplied by a close informant.
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PMID:Psychiatric antecedents of myocardial infarction. 66 88

Static and dynamic work involving the arms and the legs was performed by 40 men seven weeks after myocardial infarction. Leg ergometry produced a significantly higher peak work load, systolic blood pressure (BPs), heart rate (HR), and HR X BPs X 10(-2) product (DP) than did arm ergometry: 842 +/- 178 vs 546 +/- 135 kg-m/min, 176 +/- 24 vs 154 +/- 19 mm Hg and 256 +/- 54 vs 219 +/- 48 (SD). Peak heart rates were 145 and 142. Endpoints were primarily muscular and generalized fatigue and dyspnea. Ischemic abnormalities and ventricular ectopy were more frequent with leg ergometry. Sustained forearm lifting elicited higher HR, PBs and DP responses than sustained handgrip contraction: 95 +/- 16 vs 91 +/- 16 beats/min, 162 +/- 18 vs 152 +/- 17 mm Hg and 154 +/- 33 vs 139 +/- 33 (SD). Ischemic ST segment depression and significant ventricuar arrhythmias were infrequent with static effort. Dynamic leg testing is superior to dynamic or static arm testing in assessing the capacity of patients to perform physical work tasks after myocardial infarction.
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PMID:Cardiovascular responses to dynamic and static effort soon after myocardial infarction. Application to occupational work assessment. 66 87

Comparison of the data of electrocardiographic diagnosis for determining the size of the necrotic and periinfarction zones in records from 35 precordial leads with the results of pathoanatomical study of the size of the focus of affection in 8 dead persons who had suffered from acute myocardial infarction showed the adequacy of the method for assessment of the state of the necrotic and periinfarction zones in patients with acute myocardial infarction by the sum elevation of the ST segment in anterior myocardial infarction and by the area of segment ST depression in inferoposterior myocardial infarction.
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PMID:[Comparison of electrocardiographic (35 leads) and pathologicoanatomic diagnostic data in determining the dimensions of necrotic and peri-infarct zones]. 67 26

In 1,455 subjects (947 men and 508 women) who underwent a bicycle ergometer stress test for evaluation of atypical chest pain, the incidence of coronary events (definite myocardial infarction or sudden death) was assessed by the life table method. The follow-up period ranged from 3 to 7 years (mean 5.2 years). In men with positive exercise test (ischemic ST depression greater than or equal to 1 mm), the 5-year incidence of coronary events was 18.3%, compared with 1.9% in negative responders. In women with positive response, the 5-year incidence of coronary events was 4.6%; in negative responders, it was 0.3%. The poor predictive value of ischemic ST responses to exercise in women is emphasized.
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PMID:Different prognostic value of exercise electrocardiogram in men and women. 67 24

To check up the value of atrial pacing (AP) in estimating the degree of healing in myocardial necrosis, an ECG study was carried out in 20 dogs with experimental myocardial infarction induced by ligation of the left descending coronary artery. The main ECG changes recorded after ligation i.e., Q waves in 14 animals (73%), S-T segment elevation in 14 (74%) and decrease of QRS voltage in 12 (63%), disappeared within a 7-day interval. Anesthesia with Nembutal 56--57 days after ligation and before AP application induced the occurrence of Q waves in 6 animals, S-T segment depression in 18 and T wave inversion in 12. AP during 20 minutes, at a heart rate of 200 beats/min, produced the appearance or the increase of S-T segment depression in 14 animals and T wave inversion in 12. These findings support the assumption that the AP stress test can be used for the evaluation of the necrosis degree in the healing stages of experimental myocardial infarction, but a correct interpretation of the ECG changes induced by AP should also take into account the previous abnormalities due to anesthesia.
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PMID:Value of the electrocardiographic stress test by atrial pacing in the healing stages of experimental myocardial infarction. 69 92

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.
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PMID:[Clinical efficacy of perhexiline maleate in stable angina pectoris (author's transl)]. 69 49

Ventricular performance was evaluated sequentially in 31 patients with uncomplicated acute transmural myocardial infarction (13 anterior and 18 inferior). Left ventricular ejection fraction, ejection rate, regional wall motion, and right ventricular ejection fraction were ascertained using first-pass radionuclide angiocardiography on four occasions during hospitalization. Inferior infarction resulted in a greater reduction in right ventricular ejection fraction than anterior infarction (mean +/- SEM; 48 +/- 2 versus 56 +/- 2%, P less than 0.01). In contrast, in anterior infarction there was greater depression of left ventricular ejection fraction than in inferior infarction (34 +/- 3 versus 50 +/- 3%, P less than 0.01). From initial to discharge studies, there was no significant change in global performance or regional wall motion in either group. These data show that the location of transmural infarction has a profound effect upon the magnitude of right and left ventricular dysfunction. In addition, ventricular systolic performance remains relatively stable during the hospital phase of uncomplicated transmural myocardial infarction.
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PMID:Sequential radionuclide assessment of left and right ventricular performance after acute transmural myocardial infarction. 69 21

To ascertain whether exercise testing might predict multivessel coronary disease and left ventricular aneurysm after a myocardial infarction, 154 patients with a single documented myocardial infarction who had both exercise testing and coronary angiography were grouped according to whether they had greater than or equal to 1 mm ST depression, greater than or equal to 1 mm ST elevation, or neither during exercise testing: 83 patients developed ST depression alone (group 1); 22 patients had ST elevation with concomitant ST depression in other leads (group 2); 19 patients had ST elevation alone (group 3); and 30 patients had no ST changes (group 4). Multivessel disease, defined as greater than or equal to 70% luminal narrowing in two or more coronary vessels, was present in 76% (63 of 83) of group 1, 91% (20 of 22) of group 2, 21% (four of 19) of group 3, and 13% (four of 30) of group 4. A left ventricular aneurysm was present in 31% (26 of 83) of group 1, 68% (15 of 22) of group 2, 79% (15 of 19) of group 3, and 40% (12 to 30) of group 1. We conclude that ST changes during exercise testing in patients after a myocardial infarction can reliably predict the extent of coronary disease and the presence of a left ventricular aneurysm; ST depression with or without ST elevation predicts multivessel disease; ST elevation alone or a negative exercise test suggests single vessel involvement; and ST elevation with or without ST depression predicts left ventricular aneurysm.
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PMID:ST segment changes post-infarction: predictive value for multivessel coronary disease and left ventricular aneurysm. 69 55

Depression, anxiety and fear of recurrence following myocardial infarction often lead to disability in excess of actual cardiac impairment in a large number of patients. The high social, economic and emotional cost of psychogenic cardiac invalidism has stimulated the development of cardiovascular rehabilitation programs throughout the country. The liaison psychiatrist can play a critical role in the rehabilitation effort. This paper describes the psychological impact of the rehabilitation process in combating psychogenic cardiac disability. The conflicts of the post-infarction patient and their management by the rehabilitation team are presented from the perspective of the team psychiatrist. Cardiovascular rehabilitation as described is a productive area for psychiatric liaison, through individual consultation, group therapy sessions and team meetings which address the psychosocial issues of convalescence.
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PMID:The liaison psychiatrist in cardiovascular rehabilitation: an overview. 70 Sep 30


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