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

It is recommended that patients with acute myocardial infarction be able to perform activities of daily living at approximately 3 METs at the time of hospital discharge. Implementation of this recommendation requires that the hemodynamic responses at the 3 METs level be assessed prior to discharge. Symptoms, blood pressures, heart rates, and electrocardiographic responses of 41 AMI patients (eight women and 33 men, mean age, 60 years) during a low-level treadmill test were studied 11 days after acute myocardial infarction. Twenty-nine of 41 patients (71 per cent) completed the test. Fatigue was the most common reason for stopping the test early. Between rest and maximum exercise there were increases of 13 per cent in systolic blood pressure, 25 per cent in heart rate, and 40 per cent in pressure-rate product. The resting systolic blood pressures, heart rates, and pressure-rate products were significantly higher (p less than or equal to 0.05) in the patients who were unable to finish the test. ST-segment elevation or depression larger than or equal to 1 mm. was seen in 14 patients. This low-level treadmill test was safe under well supervised conditions; it provided objective information about the patient's readiness for discharge. This type of information can be used for patient teaching and discharge planning.
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PMID:Low-level treadmill testing of 41 patients with acute myocardial infarction prior to discharge from the hospital. 24 26

In an effort to determine the usefulness of prodromata for predicting a myocardial infarction, a prospective analysis was made of 211 consecutive patients with chest pain who were admitted to the Stanford University Medical Center Coronary Care Unit. In their subsequent course, 91 patients had a myocardial infarction, 102 had a myocardial infarction ruled-out, and 18 had a noncardiac etiology for their chest pain. Prodromal chest pain in the previous six months had occurred in 65% of patients and unstable angina in 61%. Infarction versus noninfarction patient groups could not be identified on the basis of prodromal ill health, chest pain, unstable angina, typical versus atypical nature of the chest pain, or activity at the onset of pain. Complaints of preceding fatigue and increased perceived stress were common in both groups. Activity at the onset of the admission chest pain was strenuous in 15% of the infarction patients and 12% of the noninfarction patients. We conclude that prodromal symptoms are common in both infarction and noninfarction patients. Although chest pain probably remains the single most frequent identifier of a new cardiac event, it is common in noninfarction patients and cannot be used alone to predict infarction or death.
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PMID:Prodromal characteristics as indicators of cardiac events in patients hospitalized for chest pain. 49 4

When exercise testing 159 patients with prior myocardial infarction, we identified 39 who were limited by fatigue. This group was all in sinus rhythm; none were taking drugs likely to impair the chronotropic response of the heart; none experienced chest pain or developed ischemic ECG changes. In 18 of this group, maximal heart rate achieved with exercise was 2SD or more below the age predicted value, and their heart rate response to exercise was reduced compared to that of the other 21 whose maximal exercise heart rates were within 2SD of age predicted values. A subgroup of 8 subjects with reduced exercise heart rates was studied before and after vagal blockade. In the 4 subjects whose infarction was inferior, the reduction in heart rate response was more profound and persisted after vagal blockade, suggesting either reduced pacemaker responsivness, due to ischemia or infarction, or autonomic imbalance as possible mechanisms. All 8 showed alinear increases in ventilation at higher power outputs and mean blood lactate postexercise was 7.5 mM/I without vagal blockade. Our findings suggest that a reduced heart rate response to exercise, already shown to imply added coronary risk, may be subdivided aetiologically and possibly prognostically. The use of a "Target Heart Rate" in such patients offers no safety margin, and maximal exercise capacity will be grossly over-estimated if extrapolated from the submaximal heart rate response. A cardiovascular limitation to exercise may be detected by an alinear increase in ventilation.
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PMID:Reduced heart rate response to exercise in ischemic heart disease: the fallacy of the target heart rate in exercise testing. 52 31

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

In the third week after acute myocardial infarction, mean 18 days, exercise tests have been performed in 209 patients prior to discharge from the Coronary Care Unit. The exercise was done on a bicycle ergometer with electrically controlled braking, starting at the load 300 kpm/min (equal to 50 W), increasing with 300 kpm/min every 6th min, aiming at a maximal symptom-limited performance. ECG, in 3 extremity leads and 3 precordial leads, and heart rate (HR) were continuously recorded, and blood pressure (BP) was measured every minute. The most common cause for discontinuing exercise was fatigue (in 58%). Anginal pain or dyspnoea was the cause in 23.8%. Only in 9.1% was the exercise interrupted by the investigator because of rhythm disturbances or pronounced ST-T changes. Maximal work varied from 1 min exercise at 300 kpm/min to 6 min at 900 kpm/min (150 W); 18% of all patients were able to work for 6 min at 600 kpm/min (100 W). HR increased on an average from 80 beats/min at rest to 129 beats/min at maximal work load. Systolic blood pressure (SBP) increased on an average from 126 to 170 mmHg. The maximal values reached during exercise were HR 170/min, and SBP 270 mmHg. The product HR X SPB increased a little more than two-fold on an average. ST-T changes indicating myocardial ischaemia during exercise were observed in 70%. During exercise ventricular ectopic beats occurred in 42%. All rhythm disturbances provoked by exercise disappeared spontaneously shortly after work. Persistent ECG changes, reinfarction or other serious complications were not observed in connection with the exercise test. It is concluded that an exercise test under controlled circumstances is safe in patients of all ages in the third week after myocardial infarction. It is an objective measure of physical work capacity and described the reaction to physical activity. It gives a basis for advising return to normal life and is of great psychological importance to the patient.
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PMID:Routine exercise ECG three weeks after acute myocardial infarction. 121 Dec 15

Excess fatigue is the most prevalent precursor of sudden cardiac death. This state may reflect prolonged tension or heart disease. In order to test the first explanation a prospective study was done among 3365 males, aged 45-59 years. This cohort was followed during an average period of 9.5 years. Exhaustion was assessed by the statement: 'At the end of the day I am completely exhausted mentally and physically'. Among those free of coronary heart disease at the beginning, 69 subjects died because of myocardial infarction. Data were analysed using Cox's regression analysis. The results showed a highly significant interaction between duration of follow-up and exhaustion upon the risk of cardiac death. The hazard ratios for exhaustion were 8.96, 6.33, 4.47 and 3.16 for the first 10, 20, 30 and 40 months of follow-up respectively. Thereafter the association between exhaustion and cardiac death is no more significant. It is argued that exhaustion before cardiac death does not reflect manifest heart disease but that an interaction between prolonged tension and subclinical levels of ischaemia may increase the risk of cardiac death.
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PMID:Exhaustion as precursor of cardiac death. 139 66

Sleep complaints and unusual sleep durations have been found to increase the risk for coronary heart disease. One explanation states that insomnia and excess fatigue on final waking are predictive for myocardial infarction because they are part of a state of 'vital exhaustion'. Sleep complaints and sleep durations, however, are usually assessed with retrospective self-report procedures. Such procedures must be interpreted with reserve because in insomniacs, a consistent disparity in the perception of habitual and current sleep has been observed. This caused us to question whether this phenomenon is present in exhausted males also. Two approaches were used. The first one consisted of a retrospective assessment of subjective sleep characteristics, the second one of self-monitoring these sleep characteristics during 21 days. In the second week, subjects slept in a laboratory. No disparity was found in how exhausted males perceive their habitual and current sleep. It appeared that sleep quality is worse and sleep duration is shorter in exhausted males. They also feel more sleepy and take longer naps during the day, indicating that their daytime functioning is impaired. Sleeping in a laboratory reduced time asleep and midsleep wake. Sleep quality, however, was essentially the same as at home. These findings made us conclude that it is not the intrusion of nocturnal wake times per se but more likely the impaired daytime functioning which is the reason for exhausted males to complain about their sleep.
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PMID:Vital exhaustion and perception of sleep. 161 84

Postoperative complications such as myocardial infarction, pulmonary infection, thromboembolism and fatigue are probably related to increased demands, hypermetabolism, catabolism and other physiologic changes included in the global "surgical stress response." Strategies have been developed to suppress the detrimental components of the stress response so as to improve postoperative outcome. Of the various techniques to reduce the surgical stress response, afferent neural blockade with regional anesthesia to relieve pain is the most effective, although not optimal. Data from numerous controlled clinical trials have demonstrated a reduction in various aspects of postoperative morbidity by such a nociceptive blockade. Although a causal relationship has still to be demonstrated, these findings strongly argue the concept of "stress-free anesthesia and surgery" as an important instrument in improving surgical outcome.
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PMID:The surgical stress response: should it be prevented? 174 33

Excess fatigue is a common symptom of many chronic cardiovascular disorders with low cardiac output. Impairment of skeletal muscle function due to metabolic alterations seems to play a major role. In heart failure fatigue is a predominant symptom. It may be an early symptom on diseases with slow but progressive inhibition of blood flow, i.e. in constrictive pericarditis, pulmonary hypertension or mitral valve stenosis. Excess fatigue as a precursor of myocardial infarction is being discussed. Finally fatigue may be a limiting side effect of diuretic and beta-blocking agents.
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PMID:[Cardiovascular causes of abnormal fatigability]. 175 69

In a retrospective study of 632 patients with pituitary disease we diagnosed pituitary insufficiency without hypersecretion of any pituitary hormone in 122 patients. Patients were substituted with sex hormones (76%), hydrocortisone (74%) and/or L-thyroxine (77%). 76% had additional growth hormone deficiency, as shown by an increase of growth hormone of less than 5 ng/ml after i.v. administration of L-arginine. In 17% of all patients the diagnosis of osteoporosis was proven or suspected radiologically. 57% had low bone mass of lumbar spine (dualphotonabsorptiometry) and 73% had low bone mass of the proximal forearm (singlephotonabsorptiometry). BMD values of pituitary insufficient patients were in the same range as those of patients with established osteoporosis. More than half of all patients (53%) complained of tiredness, exhaustion and muscle weakness. 40% suffered from adipositas. 77% had hyperlipidemia (68% hypertriglyceridemia and 42% hypercholesterinemia), 18% had hypertension. 14% of the patients had arteriosclerotic events in their history (myocardial infarction or stroke). These figures are higher than incidences shown in the German PROCAM-study. These data show an increased prevalence of osteoporosis and vascular diseases. This is in contrast to the general opinion, that patients with pituitary insufficiency are adequately treated by substitution with adrenal, thyroid and sex hormones. Whether other factors such as the additional growth hormone deficiency are responsible for these diseases has to be examined in prospective studies.
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PMID:[Increased prevalence of osteoporosis and arteriosclerosis in conventionally substituted anterior pituitary insufficiency: need for additional growth hormone substitution?]. 176 81


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