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

Since the realization that hypertension was a risk factor for cardiovascular disease, methods of lowering elevated blood pressure have been developed. The main goal of antihypertensive treatment is to prevent or to arrest cardiovascular damage. Based on the successes and failures encountered for over 30 years or more of therapeutic experience in hypertension, several treatment goals have been established. Previously, it was claimed that the advantages of lowering blood pressure were not dependent on the antihypertensive drug used. Now, this is being questioned. For instance, fatigue is often observed in hypertensive patients treated with drugs that reduce cardiac output and limit peripheral blood flow. Is it therefore more rational to reduce blood pressure by returning increased vascular resistance to normal? Since antihypertensive therapy is life-long, we are becoming increasingly aware of the long-term effects (both beneficial and adverse) of antihypertensive drugs. The metabolic changes caused by current antihypertensive drugs are now being studied in detail. The potassium-depleting action of diuretics is well-known, and the significance of such an effect is being re-examined. The effects of various antihypertensive agents on serum lipids are relatively recent observations, the clinical importance of which is worthy of wider discussion and investigation. The abolition or reduction of all vascular complications of hypertension is the goal for which current antihypertensive treatment has most often failed. Whereas prevention of cerebrovascular accidents, renal failure, and heart failure has indeed been successfully achieved, coronary complications (the most frequent adjunct of hypertension) have been little influenced by antihypertensive therapy. Is this because coronary heart disease may be simply an associated disease, rather than a consequence of hypertension? Or is this because the beneficial action of the most widely used antihypertensive drugs on vascular disease is largely counteracted by unfavorable metabolic effects? These and similar questions have to be debated and resolved before we can define treatment goals more precisely and develop the most appropriate means to achieve them.
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PMID:Treatment goals in hypertension. 670 59

Mitral valve prolapse (MVP) now is a commonly recognized syndrome with an apparent prevalence of approximately 4-6%. It appears to occur more frequently in females and occasionally it is familial. In most instances, the syndrome is idiopathic, although it occurs in association with many other conditions, particularly Marfan's syndrome, rheumatic heart disease, coronary heart disease, congestive cardiomyopathy, ostium secundum atrial septal defect, Ehlers-Danlos syndrome or abnormalities of the thoracic cage. The majority of patients with the syndrome have minimal, if any, symptoms and have a benign course. When symptoms do occur, more frequently they are palpitations, chest pain, dyspnea on exertion or fatigue. Neuropsychiatric symptoms or even transient ischemic episodes may occur rarely. Very rarely, complications such as severe mitral regurgitation, arrhythmias or infective endocarditis may occur. Characteristically, patients have a midsystolic click, occasionally followed by a systolic murmur. The timing of the click and the onset of the murmur usually is variable, depending on the ventricular volume. The electrocardiogram frequently shows ST-T wave changes. The diagnosis usually can be confirmed by echocardiography or left ventricular angiography. Most patients with MVP require no treatment other than reassurance. If a systolic murmur is present, prophylaxis against infective endocarditis during dental work probably is useful. Patients with palpitations or chest pain usually respond well to treatment with propranolol. Patients with progressive severe mitral regurgitation require mitral valve replacement.
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PMID:Mitral valve prolapse. 699 66

The role of pindolol in treating ventricular arrhythmia was studied in 43 patients with this disorder. Of these patients, 23 had coronary heart disease, 5 had valvular disease, and 15 had no demonstrable heart disease. patients underwent acute drug testing with 20 mg pindolol (phase 1) followed by maintenance therapy (phase 2) for 3 days (20 to 80 mg daily). Efficacy during both phases was evaluated by ambulatory monitoring and treadmill exercise testing. During acute drug testing, 50% of te patients responded. A concordant response between acute drug testing and phase 2 monitoring was seen in 81% (p less than 0.005) of patients and between acute drug testing and phase 2 exercise testing in 88% (p less than 0.005). Arrhythmia was suppressed during the phase 2 exercise test in 53% of patients; these included 80% of the patients without heart disease and 50% of those with coronary heart disease (not significant). During phase 2 monitoring, 60% of patients without heart disease responded vs. 25% with coronary heart disease (not significant). Side effects occurred in 12 patients (28%). These included congestive heart failure (3 patients); fatigue, lightheadedness, and insomnia (2 patients each); nausea, tremor, urinary retention, and bronchospasm (1 patient each); and aggravation of arrhythmia (7 patients). It is concluded that although pindolol alone is marginally effective for treating ventricular arrhythmia in patients with coronary heart disease, it appears to be more valuable in those without heart disease, especially when arrhythmia is provided by exercise. Acute drug testing proved highly predictive of the results with maintenance therapy and is a valuable rapid-screening procedure for identifying potential responders to pindolol.
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PMID:Pindolol for ventricular arrhythmia. 710 35

Persistent overloading causes fatigue followed by exhaustion and then ill-health resulting from homeostasis violation and reduced resistance. A breakdown is inevitable if the struggle continues. This course can be illustrated by a shaped performance-arousal curve. The paradigm clarifies the effects of psychosocial handicaps (low curves), of training (high curves), of arousal reduction (= relaxation), and of arousal rising from normal to destructive levels. The paradigm accommodates catastrophe theory and provides an unambiguous basis for screening and intervention in hypertension and coronary heart disease where there is a self-defeating struggle to close the ever widening gap between the actual performance capability and the intended.
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PMID:The human function curve - a paradigm for our times. 718 56

The present paper reports 2 experiments which investigate Type A and Type B children's efforts to achieve. The Type A behavior pattern is a major risk factor for coronary heart disease in adulthood and is characterized by extremes of achievement-striving, impatience-aggression, and easily aroused hostility. Experiment 1 required fourth graders to perform a series of simple arithmetic problems with or without an explicit time deadline. Results showed that, in general, Type A's solved more problems than did Type B's during the 5 min of the experiment. This effect was mainly due to Type A's outperforming Type B's in the no-deadline condition. Because the results could have been due to A's simply being more competent in solving arithmetic problems than B's, we conducted a second experiment using a task on which A's and B's were equally capable. In experiment 2, sixth-grade boys were asked to hold a weight for a predetermined length of time. The weight varied according to a premeasure of their maximal hand strength. In fact, they were never told to stop. Results revealed that Type A's held the weight 50% longer than Type B's. They also underreported their subjective fatigue relative to the effort they expended. These findings suggest that Type A children, similar to their adult counterparts, make greater efforts to excel than B's on tasks that have ambiguous performance criteria. The results are discussed in terms of the achievement literature, and the implications of underreporting fatigue for coronary risk are outlined.
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PMID:Efforts to excel and the type A behavior pattern in children. 731 23

Research on coronary heart disease (CHD) lacks sensitive outcome measures. Health complaints, although subjective in nature, may provide information on the degree of recovery from CHD. The purpose of Study 1 was to identify common health complaints in a group of 535 men (mean age, 57.5 years) with CHD. In the weeks after a coronary event, they frequently reported somatic (e.g., chest pain, dyspnea, fatigue, sleep problems) and cognitive (e.g., concern about health and functional status) health complaints. Statistical analyses produced the Health Complaints Scale (HCS), which comprises 12 somatic and 12 cognitive complaints. Confirmatory factor analysis provided evidence for the model undergirding the HCS, and the somatic and cognitive scales of the HCS were found to have high internal consistency (alpha > or = .89), adequate test-retest reliability (r > or = .69), and good construct validity. Study 2 provided evidence for the idea that the HCS can be distinguished from standard scales of psychopathology. Statistical analyses in 266 men with CHD indicated that, compared to symptoms of psychopathology, the HCS scales displayed discrete factor loadings as well as higher scores at baseline and a normal clustering of scores. Important to note, HCS scores decreased in 60 subjects participating in cardiac rehabilitation (p < .0001) but not in 60 control subjects. Although research should not disregard psychological biases on symptom reporting, it is argued that health complaints need to be accurately assessed in CHD patients.
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PMID:Health complaints and outcome assessment in coronary heart disease. 780 47

The association of snoring with some cardiovascular risk factors was studied cross-sectionally by a postal survey among 3750 males aged 40-59 years. In univariate analyses, snoring associated statistically significantly (P < 0.01) with hypertension, smoking, obesity, heavy alcohol use, physical inactivity, dyspnoea, hostility and morning tiredness. In a multiple logistic regression model adjusted by age, snoring associated significantly with smoking, obesity, physical inactivity, hostility and morning tiredness. When smoking was excluded from the multivariate model, alcohol use was also associated significantly with snoring. The association of snoring with smoking, and with obesity seemed to be almost independent from other studied correlates of snoring. Our results indicate that in further studies on predictive value of snoring with regard to coronary heart disease and stroke, the associations of snoring with hypertension, smoking, obesity, heavy alcohol use, physical inactivity and hostility have to be considered, as these risk characteristics may cause confounding effects.
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PMID:Snoring and cardiovascular risk factors. 782 98

Evidence indicates that emotional distress has a long-term impact on morbidity and mortality in patients with coronary heart disease (CHD), and that symptoms of depression, fatigue, and reduced energy may identify high-risk patients. This study was designed to: (1) devise a sound and practical measure of emotional distress in CHD patients; (2) examine the relationship between emotional distress and fatigue following CHD; and (3) examine changes in emotional distress as a function of cardiac rehabilitation. A sample of 478 men with CHD (mean age = 57.8 +/- 8.7 y) filled out questionnaires 3-6 weeks following a myocardial infarction (N = 110), bypass surgery (N = 302), or coronary angioplasty (N = 66). Statistical analyses of 56 Dutch mood terms were used to produce the 20-item Global Mood Scale (GMS) which measures negative affect (characterized by fatigue and malaise), as well as positive affect (characterized by energy and sociability), in patients with CHD. The GMS was found to be a reliable scale (alpha > 0.90; r > 0.55 over a 3-month period), and correlations with existing measures of emotional functioning and self-deception indicated its convergent and discriminant validity. Most importantly, fatigue was not related to cardiorespiratory fitness in a subset of 140 patients, but clearly was associated with negative affect. Consistent with the self-efficacy model, scores on the GMS mood scales improved significantly as a function of rehabilitation (P < 0.0001). Although symptoms of emotional distress are easily explained away by situational factors, previous research suggests that failure to recognize the clinical significance of these symptoms in CHD patients may result in the delay of much needed intervention. The current findings suggest that the GMS is a theoretically and psychometrically sound measure of emotional distress in CHD patients, and that this scale is sufficiently sensitive to assess change.
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PMID:Emotional distress and fatigue in coronary heart disease: the Global Mood Scale (GMS). 847 98

To evaluate the effect of cardiac rehabilitation and exercise training on depression after major cardiac events, we studied 338 consecutive patients in whom a major cardiac event had occurred 4 to 6 weeks previously and who were participating in phase II cardiac rehabilitation consisting of 36 sessions over a 3-month period. Depressive symptoms and other behavioral characteristics and quality-of-life parameters were analyzed by validated questionnaire. Depression was prevalent in patients with coronary heart disease, occurring in 20% of the patients evaluated. At baseline, depressed patients had lower exercise capacity, reduced high-density lipoprotein cholesterol level, and higher triglyceride levels; had lower scores for mental health, energy or fatigue, general health, pain, overall function, well-being, and total quality of life; and had greater scores for somatization, anxiety, and hostility than those of nondepressed patients. After cardiac rehabilitation, depressed patients had marked improvements in depression scores and other behavioral parameters (anxiety, somatization, and hostility) and quality of life. Depressed patients also showed improved exercise capacity, percentage of body fat, and levels of triglycerides and high-density lipoprotein cholesterol. Depressed patients exhibited statistically greater improvements in certain behavioral and quality-of-life parameters than did nondepressed patients. Two thirds of the patients who were initially depressed resolved their symptoms by study completion. In conclusion, depression is reduced in patients with symptomatic coronary heart disease patients enrolled in cardiac rehabilitation. Greater emphasis is needed to ensure that depressed patients are referred to and attend formal cardiac rehabilitation programs after major cardiac events.
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PMID:Effects of cardiac rehabilitation and exercise training programs on depression in patients after major coronary events. 883 59

Prospective studies have reported a positive association of excess fatigue and hopelessness with coronary heart disease mortality; a relation to atherosclerosis has not been investigated. We examined the cross-sectional association of the Maastricht excess fatigue questionnaire with carotid intimal-medial wall thickness among 12,448 coronary heart disease-free individuals age 47-68 years. In age-, race-, and field center-adjusted analyses, we found a strong, positive association between excess fatigue and carotid intimal-medial wall thickness in both sexes. Adjustment for other coronary heart disease risk factors substantially attenuated the relation. Pack-years of smoking was the strongest confounder. Furthermore, there was little association among never-smokers. It appears that the association of excess fatigue with atherosclerotic disease is largely accounted for by established risk factors.
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PMID:No relation between excess fatigue and asymptomatic carotid atherosclerosis. 889 92


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