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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty-six patients with coronary artery disease were studied by first-pass radionuclide angiography to assess the effects of myocardial revascularization on exercise-induced myocardial ischemia. The radionuclide studies were performed in the 30 degree right anterior ablique position, at rest and during exercise, 1 to 3 days preoperatively and 10 to 14 days postoperatively. The mean population age was 53 years; the mean number of grafts placed was 4.0 per patient. Fifteen normal male volunteers were tested by rest and exercise radionuclide angiography to serve as normal control subjects. In all exercise radionuclide studies, progressive upright bicycle exercise was performed to symptoms of fatigue, dyspnea, or chest pain. The parameters of ejection fraction (EF), end-diastolic volume (EDV), and regional wall motion (RWM) were determined. Twenty-nine of the 36 patients had postoperative coronary arteriography that was correlated with radionuclide determinations. The results showed that in the normal subjects with maximal exercise the mean EF rose, the mean EDV increased 19%, and there was no exercise-induced regional wall motion dysfunction (ERWMD). In the patients with coronary artery disease prior to operation, the mean EF fell significantly, the mean EDV rose 24%, and 26 of 36 patients had ERWMD. After operation, the mean EF of the group rose, the EDV increased only 15%, and only two of 36 patients continued to show ERWMD. Of the eight patients who demonstrated on abnormal response postoperatively, seven had what was considered to be inadequate revascularization, and in one there was no explanation. The data demonstrate that myocardial revascularization does improve ventricular function by abolishing exercise-induced evidence of ischemia (decreased EF, increased EDV, and ERWMD) as assessed by radionuclide angiography. Failure to abolish the exercise-induced functional instability suggests incomplete revascularization.
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PMID:Improvement in left ventricular function after myocardial revascularization: assessment by first-pass rest and exercise nuclear angiography. 736 32

A cohort of 189 men was followed up for 1 year after performance of coronary angiography and determination of risk factors to ascertain which risk factors or clinical and laboratory findings could aid in predicting the patients who would have a substantial cardiac morbid event. Data on clinical signs and symptoms, psychosocial assessments, angiographic findings and presence of standard risk factors for coronary artery disease were collected in each case. Twenty-five percent of the men experienced a substantial cardiac morbid event (hospitalization, myocardial infarction, resuscitation or death). With or without inclusion of the patients who underwent surgery, discriminant analysis equations were successful in predicting morbidity on the basis of risk factor data. For the whole sample such analysis was significant at p < 0.00005 and accurately predicting the fate of 78 percent of the subjects. With exclusion of the surgically treated patients, the discriminant analysis accurately predicted future morbidity 83 percent of the time (p < 0.0001). The following risk factors for increased morbidity were common to both analyses: severity of angina, history of myocardial infarction, family history of heart disease, fatigue and absence of type A behavior.
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PMID:Predicting cardiac morbidity based on risk factors and coronary angiographic findings. 745 12

Although essential hypertension is usually defined as a hemodynamic disorder, it is expressed differently among individuals and varies during progression of the disease state. Therefore, various types of treatment can be envisioned. The use of selective I1-imidazoline-receptor agonists to modulate I1-imidazoline receptors involved in the central regulation of blood pressure has led to the introduction of a novel class of centrally acting antihypertensive drugs. Moxonidine, a representative molecule of this class, dissociates between a 10% alpha 2-adrenoceptor-agonist action linked with side effects such as fatigue or dry mouth, and a 90% specific antihypertensive action resulting from its selective agonistic action at I1-imidazoline receptors. Clinical experience is based on more than 2,000 patients and volunteers, and long-term efficacy has been demonstrated in about 500 patients who received a daily dose of moxonidine 0.2-0.4 mg. Moxonidine produces a pronounced reduction in peripheral vascular resistance without reflex tachycardia, accompanied by reduced plasma norepinephrine concentration and plasma-renin activity. Cardiovascular responses to exercise and standing remain nearly normal, and serious or life-threatening side effects, particularly the sympathetic overactivity that can occur on sudden withdrawal of other centrally acting agents, are never observed. In addition, moxonidine behaves neutrally with respect to plasma levels of cholesterol, potassium and glucose, glucose and lipid metabolism, and renal function, and can be administered without complication to patients with asthma or certain other diseases. Studies with magnetic resonance imaging have shown that moxonidine significantly reduces left ventricular mass, an indicator of left ventricular hypertrophy (LVH), within a 6-month treatment period, an effect that coincided with decreased plasma concentrations of catecholamines and renin. Comparisons between moxonidine and other well-established antihypertensive drugs such as nifedipine, atenolol, or angiotensin-converting enzyme inhibitors showed equal effectiveness in lowering blood pressure, whereas the adverse events profile always favored moxonidine. Considering its efficacy, safety, and specific effects (e.g., its ability to reduce LVH), moxonidine meets the criteria satisfied by other currently prescribed antihypertensive drugs. Because of its especially favorable benefit-to-risk ratio, moxonidine should be recommended as first-line treatment of hypertension and may also be useful in treating related problems such as LVH, coronary artery disease, and ventricular premature beats.
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PMID:I1-imidazoline-receptor agonists in the treatment of hypertension: an appraisal of clinical experience. 753 26

The primary trigger mechanisms leading to coronary artery disease are largely unknown; however, consensus has been reached that unstable angina pectoris is always associated with acute pathological and anatomical changes in a plaque, most commonly in the form of a plaque fissure or rupture involving the fibrous luminal cap with thrombosis, hemorrhage and dissection. Rupture almost always occurs at the weakest part of the fibrous cap and leads to exposition of extracellular lipids and matrix, necrotic tissue and lipid-laden foam cells. The exact mechanisms of plaque rupture are not entirely known; it is possible, however, that they do represent fatigue breaks in the tissue. The clinical consequences of these events are unstable angina pectoris and myocardial infarction.
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PMID:[Pathological-anatomic basis of unstable angina pectoris]. 787 Dec 99

Excessive tiredness is one of the most prevalent premonitory symptoms of myocardial infarction and sudden cardiac death. This state is labelled as vital exhaustion and consists of three components: fatigue, increased irritability, and demoralization. Vital exhaustion has been found to be an independent risk-indicator of myocardial infarction in one prospective study and several case-control studies. It is as yet unclear whether the association between vital exhaustion and future myocardial infarction can be explained by confounding of (subclinical) coronary artery disease. Therefore, the present study investigates the predictive value of vital exhaustion for the occurrence of new cardiac events after percutaneous transluminal coronary angioplasty (PTCA), while explicitly controlling for the severity of coronary artery disease. Patients with a successful PTCA were followed during 1.5 years. A new cardiac event was defined as present if one of the following end points occurred: cardiac death, myocardial infarction, coronary bypass surgery, repeat-PTCA, increase of coronary atherosclerosis, or new anginal complaints with documented ischemia. Vital exhaustion was assessed using the Maastricht Questionnaire two weeks after hospital discharge. Participants of the present study were 127 patients (mean age 55.6 +/- 9.1; 105 men, 22 women). Fifteen (35%) of the 43 exhausted patients experienced a new cardiac event, whereas 14 (17%) of the 84 not exhausted patients had a new cardiac event (OR = 2.7; CI = 1.1-6.3; p = .02). Multiple logistic regression analysis revealed that vital exhaustion continued to be of predictive value when other significant risk factors for new cardiac events were controlled for (i.e., severity of coronary artery disease and hypercholesterolemia).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Vital exhaustion predicts new cardiac events after successful coronary angioplasty. 797 9

Aim of this study was to analyze the cardiovascular response to graded physical exercise in patients who have undergone cardiac transplantation and to assess the ability of exercise stress testing in early detection of coronary artery disease. We studied 114 transplanted subjects (100 men and 14 women, mean age 46.6 +/- 11.3 years), who performed exercise stress testing 6 months after bypass and then every 6 (+/- 1) months during a 5-year follow-up. Variations of hearth rate (HR), systolic blood pressure (SBP), heart rate-pressure product (RPP) values and exercise stress tolerance were studied both in basal and maximum workload conditions. Mean HR values at basal conditions (103.9 +/- 11.3 b/min at 6 months and 89 +/- 12.7 b/min at 60 months, p < 0.05) and maximum workload tolerance (67.7 +/- 20.4 W at 6 months and 100 +/- 17 W at 60 months, p < 0.05) were significantly different at the beginning and at the end of follow-up. SBP values both at basal conditions and at peak exercise had always been constant. Exercise was stopped for leg muscle fatigue in 92% and dyspnea in 7% of the subjects; isolated T-wave and ST segment changes were found in 29.8% and in 10.5% of the patients respectively, whereas 11.4% exhibited both ST-T variations. Angiographic examination (performed in 80/114 patients) showed significant coronary disease (stenosis > 50%) in 8, coronary atherosclerosis (CAD) of minor degree in 4 and provoked spasm in 2 subjects. In this subgroup exercise stress testing induced ischemic ECG changes (ST segment depression > or = 1 mm) without angina in 1 patient, ST-T segment variations only in 5 and no electrocardiographic alterations (negative tests) in 2 patients. Four subjects with CAD and 1 with coronary spasm induced by angiography showed isolated ST segment and T-wave changes. Our work demonstrated that exercise stress testing plays a relevant role in the study of the denervated heart response to dynamic exercise. The rise in workload tolerated, observed in our population, seems to be related to time elapsed from surgery, improvement in clinical conditions, psychological stability and patient's confidence in his own abilities. The tolerance to exercise 6 months after graft seems to predict the quality of performance in the following tests. Our angiographic results reveal a low sensitivity of the exercise stress test in detecting CAD in this population according to traditional electrocardiographic criteria for myocardial ischemia.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[The ergometric test after a heart transplant: its usefulness and limits]. 808 12

Excess fatigue and exhaustion are among the most prevalent premonitory complaints of myocardial infarction and sudden cardiac death. These feelings may reflect subclinical heart disease, prolonged psychological tension, or both. The present study investigates to what extent coronary artery disease explains exhaustion. For this purpose, the relationship between the severity of coronary artery disease and exhaustion, and the relief of exhaustion after successful percutaneous transluminal coronary angioplasty (PTCA) is investigated. Patients who had a successful elective PTCA (N = 120) were evaluated on feelings of exhaustion on admission, 2 weeks after discharge and 6 months after discharge, making use of the Maastricht Questionnaire. Multiple regression analyses were used to investigate to what degree exhaustion on admission and after PTCA was determined by the extent of coronary artery disease and other patient characteristics. Severity of coronary artery disease before PTCA was positively associated with exhaustion and successful PTCA resulted in a significant decrease of exhaustion scores (P < 0.001). However, less than 5% of the variance of the exhaustion scores before PTCA could be explained by severity of coronary artery disease (R2 = 0.04, F = 5.1, P = 0.03). The majority of patients who were exhausted before PTCA remained exhausted after PTCA. Exhaustion was present in 75% of the patients before PTCA and in 65% 2 weeks after PTCA, which indicates that restoration of coronary perfusion by successful PTCA does not substantially reduce the number of exhausted patients. At 6 months, exhaustion was present in 60% of the patients, and there was no difference between patients with and without typical anginal complaints at that time.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The effect of successful coronary angioplasty on feelings of exhaustion. 813 36

This study surveys the occurrence of repetitively negative to flat T waves, alternating with normal upright T waves in 24-h electrocardiographic recordings from a subspecialty infectious diseases outpatient practice during the years 1982 to 1990. Patients with normal resting electrocardiogram in the assayed leads, but with repetitively inverted to isoelectric abnormal T waves at Holter monitors, were considered to have abnormal readings. A total of 300 patients had undergone a 24-h Holter monitor. This group included 24 individuals with chronic fatigue syndrome (CFS). This population was restricted to individuals 50 years old or younger, and the patients with CFS are compared with the patients without CFS. One of the more striking differences between the two groups was the difference in abnormal Holter readings. The patients with CFS all had abnormal Holter readings, while 22.4 percent patients without CFS had abnormal readings (p < 0.01). We further report the occurrence of mild left ventricular dysfunction in 8 of 60 patients in continuing studies of this population with CFS, younger than 50 years old, and with no risk factors for coronary artery disease. All 60 patients with CFS showed repetitively flat to inverted T waves alternating with normal T waves. Stress multiple gated acquisitions (MUGAs) (labeled erythrocytes with stannous pyrophosphate) were abnormal in eight patients with CFS. Although resting ejection fractions (EFs) were normal (mean, 60 percent), with increasing work loads (Kilopon meters [Kpms]), gross left ventricular dysfunction occurred. The fatigue of patients with CFS may be related to subtle cardiac dysfunction occurring at work loads common to ordinary living.
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PMID:Repetitively negative changing T waves at 24-h electrocardiographic monitors in patients with the chronic fatigue syndrome. Left ventricular dysfunction in a cohort. 822 98

Symptoms tend to develop late in the course of both chronic mitral and chronic aortic regurgitation, and when the regurgitation is stable patients may enjoy many years of full activity free from disability. In the absence of complicating atrial fibrillation or coronary artery disease the onset of dyspnoe and fatigue usually indicate myocardial failure and possibly a lost opportunity for a low risk operation and long term benefit. Valve replacement for aortic regurgitation is a good operation which reduces left ventricular work. However, mitral valve replacement is unphysiologic and not surprisingly, the operative mortality and long term results are worse with an excess of deaths caused by left ventricular failure. While the need for operation is obvious when patients already have symptoms or when valvar regurgitation is increasing, timing is far more difficult for patients with severe, chronic, stable regurgitation who still enjoy a high quality of life. It is even more difficult in mitral regurgitation because the stakes are higher with a higher operative risk, but suitability for mitral valve reconstruction justifies earlier operation and therefore makes it mandatory for cardiologists to identify such patients.
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PMID:Optimal timing of surgery for chronic mitral or aortic regurgitation. 826 Nov 61

This study assesses the safety of and physiologic responses to maximal repetition, dynamic, resistive weight lifting at 40, 60, 80 and 100% of maximal voluntary contraction compared with aerobic exercise using a maximal treadmill exercise test. Twelve men with coronary artery disease exercised to fatigue at 4 stations (overhead press, biceps curl, quadriceps extension and supine press). The electrocardiogram was monitored continuously. Heart rate and systolic and diastolic blood pressures (by sphygmomanometer) were measured at rest and during peak exercise. No symptoms or electrocardiographic evidence of ischemia occurred with weight lifting, whereas 5 of 12 patients had ischemic ST-segment depression (> or = 1 mm) with the treadmill. No significant ectopy occurred with either activity. Mean peak heart rates with all lifts were less (range 74 to 92 beats . min-1; p < or = 0.05) than with the treadmill (157 beats . min-1). Peak systolic blood pressures were similar, whereas peak diastolic blood pressures were greater with all lifts (range 93 to 117 mm Hg; p < or = 0.05), except 100% maximal contraction biceps curl and quadriceps extension, than with the treadmill (79 mm Hg). Peak rate pressure product was greater with the treadmill than with all lifts (p < or = 0.05). Diastolic time interval from the electrocardiograph was shorter with the treadmill (0.154 second) than with all lifts (range 0.323 to 0.448 second; p < or = 0.05). Diastolic pressure-time index was greater with all lifts than with the treadmill (p < or = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Physiologic responses to weight lifting in coronary artery disease. 842 69


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