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Enalapril is an effective agent in the treatment of mild to severe hypertension. It is equally effective in elderly and young adult patients but appears to be more effective in white than in black hypertensive patients. Following treatment with enalapril, an assessment of maximum exercise performance found a decrease in total peripheral resistance without significant changes in cardiac output, heart rate, or stroke volume compared with pretreatment values. In addition, there have been reports of reversal of left ventricular hypertrophy in enalapril-treated hypertensive patients. Enalapril is also effective and well tolerated in hypertensive patients with renal impairment of varying etiology. The most common adverse experiences reported in controlled clinical trials were headache (5.2%), dizziness (4.3%), and fatigue (3.0%). In high-risk hypertensive patients, no enalapril-treated neutropenia, proteinuria, dysgeusia, or ageusia were reported. It may be concluded that the benefit-to-risk ratio of enalapril is among the best of the antihypertensive therapies currently available.
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PMID:Enalapril: benefit-to-risk ratio in hypertensive patients. 169 15

Controversy exists as to whether plasma volume (PV) expansion has the potential to increase maximal oxygen uptake (VO2max). In the present study, VO2max and exercise time to fatigue were measured in nine untrained men when plasma volume (PV) was normal and then again on the next day following two levels of PV expansion. Resting PV was expanded (via intravenous infusion of a 6% dextran solution) by 282 +/- 16 ml (i.e., PVX-1) and then by 624 +/- 26 ml (i.e., PVX-2). PVX-1 increased stroke volume (CO2 rebreathing) during submaximal exercise by 15% (P less than 0.05) above normal levels. VO2max following PVX-1 was increased 4% (P less than 0.05; 3.78 to 3.92 l/min) despite a 4% reduction in hemoglobin concentration. Exercise time to fatigue was also increased (P less than 0.05). PVX-2 resulted in an 11% (P less than 0.05) reduction in hemoglobin concentration during maximal exercise and a return of VO2max and exercise time to normal levels. In summary, we have observed in untrained men that 200-300 ml of PV expansion increases SV, measured during submaximal exercise, yet causes only a small amount of hemodilution. As a result, VO2max is increased slightly and performance is improved. Further PV expansion to levels 500-600 ml above normal results in an excessive hemodilution and a subsequent decline in VO2max and performance to normal levels. There is an optimal PV for eliciting VO2max in untrained men which appears to be approximately 200-300 ml above their normal levels.
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PMID:Maximal oxygen uptake relative to plasma volume expansion. 169 70

The past literature suggests the hypothesis that depression is associated with decreased physical functional ability in stroke patients. On a medical rehabilitation ward, 21 stroke patients were evaluated for depression by psychiatric interview and self-report, and were also rated on the Barthel's Functional Index (BFI). The hypothesis was supported: Patients scoring 17 or higher on the Beck Depression Inventory (BDI) (N = 7) had lower initial scores on the BFI than patients with lower BDI scores. There was a trend for these seven depressed patients to improve more slowly as ascertained by the BFI. Depression was suggested to lower functional ability by increasing fatigue, hopelessness, and decreasing motivation.
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PMID:Physical consequences of depression in the stroke patient. 173 Apr 3

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

Physical and physiological factors accounting for the variability of performance in 500, 1000, 10,000, and 42,000 m flatwater kayaking were investigated using linear regression. Times achieved for each distance were used as the dependent variable for analysis while the independent variables were the parameters derived from the test battery. The 38 kayakists who participated were categorized as either state team members or nonselected paddlers, based on an objective selection policy. Several of the participant subjects were Australian international representatives. All selected paddlers were grouped together and Student's t-tests performed to determine which variables could distinguish between selected and nonselected paddlers. Simple regression was used to determine the strength of association of each parameter with performance time over each race distance, and multiple regression was used to generate equations for the prediction of performance times. Aerobic power and variables related to the aerobic-anaerobic transition were examined using gas analysis during an incremental workload test on a kayak ergometer. A 1-min all-out test also on a kayak ergometer was used to obtain an indication of anaerobic capacity and power. Muscular strength and fatigue were assessed using a simulated kayak stroke on a Cybex isokinetic dynamometer. Physical characteristics were determined using kinanthropometric tests. Aerobic power, anaerobic power and capacity, muscular strength, resistance to muscular fatigue, and measures of body size were significantly greater in more successful kayakists. All of the parameters measured correlated significantly with performance time over at least one of the four race distances.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Physiological and kinanthropometric attributes of elite flatwater kayakists. 176 47

The purpose of the study was to assess the relationship between left and right ventricular function measured at rest and maximal exercise capacity in patients with recent acute myocardial infarction (AMI). Forty-three male patients (Killip Class I, n = 36; Killip Class II, n = 7) with a wide range of left ventricular (LV) function and size underwent graded bicycle exercise testing less than 4 weeks after AMI (mean 21 days, 17-27). None of the patients had exercise limiting factors other than dyspnoea and fatigue. Left and right ventricular ejection fractions were determined by a radionuclide ventriculographic method which also allowed determination of absolute LV volumes and actual LV peak filling rate. LV ejection fraction had a weak association to estimated maximal oxygen uptake (VO2 max) (r = 0.37). No association was found between LV size, LV stroke volume, or LV peak filling rate and estimated VO2 max. Similarly, right ventricular ejection fraction showed no correlation to estimated VO2 max. Patients with well preserved LV function had a higher exercise induced increase in systolic blood pressure than patients with reduced LV function, but the increase in systolic blood pressure could not be used to estimate LV function with any reasonable accuracy. We conclude that the maximal exercise capacity of patients with recent AMI is virtually independent of their left and right ventricular function determined at rest, and that exercise testing and radionuclide ventriculography should be regarded as complementary procedures in the evaluation of patients with AMI.
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PMID:Cardiac function and maximal exercise capacity early after acute myocardial infarction. 178 47

Eighteen female and 22 male college swimmers completed a paced 182.9 m swim before and after a 72 h period of increased training. Training volume was increased from 6,800 to 11,200 m.d-1 for the females and from 8,800 to 12,950 m.d-1 for the males. Salivary cortisol, heart rate, stroke mechanics, as well as overall and local ratings of perceived exertion (RPE) were measured in conjunction with the two swim tests. Mood states, as measured by the Profile of Mood States, and ratings of perceived muscle soreness were assessed daily. Significant (P less than 0.005) elevations in stroke frequency, overall and local RPE, fatigue, overall mood, and muscle soreness levels occurred in association with the increased training. Significant (P less than 0.005) reductions in vigor and stroke length were also observed as a consequence of the greater training load. The main effects for gender and the gender by trial interactions were not significant for each variable tested. It was concluded that: 1) affective, biomechanical, and perceptual variables are sensitive to a 3 d increase in the volume of swim training, 2) heart rate and cortisol levels are not influenced by the type of increased training employed in this study, and 3) female and male college swimmers do not differ in their psychological or physiological responses to a rapid increase in training volume.
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PMID:Psychobiologic effects of 3 d of increased training in female and male swimmers. 194 26

Impaired diastolic function of the hypertrophied and stiffened left ventricle is a characteristic feature of hypertrophic cardiomyopathy (Figure 1). Altered left ventricular filling dynamics and reduced left ventricular distensibility or increased left ventricular diastolic chamber stiffness are associated with reduced left ventricular stroke volume, increased left ventricular filling pressures and compressive effects on the coronary microcirculation. These factors contribute importantly to the clinical presentation of many patients, including symptoms of fatigue, dyspnea and angina pectoris. Reduced distensibility results both from factors determining the passive elastic properties of the ventricular chamber (including severity of hypertrophy, fibrosis and cellular disarray) and from factors influencing the rate and extent of active left ventricular relaxation (Figure 2). The factors contributing to impaired relaxation in hypertrophic cardiomyopathy are mediated via either inactivation dependent or load-dependent mechanisms. In laboratory animals, compromise of myocardial inactivation results in a persistent increase in intracellular calcium concentration and in prolonged interaction of the contractile proteins. Additionally, there is evidence for an increased number of active receptors for calcium antagonists and, lastly, for myocardial ischemia (Figure 3). Load-dependent mechanisms include diminished wall tension at the opening of the mitral valve, changes in afterload, contractility and coronary flow. Other factors are nonuniform and asynchronous regional ventricular function due to differing increases in thickness of the ventricular walls and ischemia (Figure 4). Calcium channel blockers exert a favorable influence on left ventricular relaxation and filling (Figure 5); verapamil and diltiazem are preferable to nifedipine. Verapamil increases left ventricular stroke volume without an increase in the end-diastolic pressure (Figure 6), reduces regional asynchrony if present, and leads to a more homogeneous regional diastolic filling (Figure 4).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Left ventricular diastolic function in hypertrophic cardiomyopathy. 202 81

Many studies on cardiac assist devices using skeletal muscle ventricle (SMV) require preconditioning for 6-9 weeks as a countermeasure to prevent skeletal muscle fatigue. Therefore this method does not seem to be indicated in cases of acute heart failure. However we performed experiments to develop Alternate-Drive Twin SMVs as a cardiac assist device without preconditioning. Adult mongrel dogs were used. In order to obtain adequate alternating SMV during pattern, fundamental experiments were performed. The function of SMVs prepared by rolled pedunculated sartial muscle was studied hydrodynamically in three groups; continuous driving for one hour in group a (n = 3): intermittent driving for 3 hours in group b (n = 15): intermittent driving for 12 hours in group c (n = 3). Group b was divided into three subgroups with interval for 10 minutes in subgroup I (n = 5), for 20 minutes in subgroup II (n = 5), for 30 minutes in subgroup III (n = 5). In group b and c, the recess interval between driving was set the same as the driving interval in each subgroup. All SMVs were stimulated by electrical bursts. In every experiment pump pressure, pump max dp/dt and pump stroke work index/10 kg body weight were measured for 3 hours. In subgroups I and II, pump function decreased gradually, however, the parameters did not show any change for up to 3 hours in subgroup III. We defined the reduction ratio as the difference of parameters before and after driving divided by the value at the start of driving.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Cardiac assist device with skeletal muscle ventricle--alternate-drive twin pump system as a countermeasure to prevent skeletal muscle fatigue]. 202 16

The response of patients with chronic severe heart failure to extended infusions (greater than or equal to 48 hours) of milrinone was evaluated in a multicenter, baseline-controlled, phase III efficacy and safety trial in 189 patients in the United States. Milrinone was given as loading and maintenance infusions according to one of four dose regimens. An effective response was defined as greater than or equal to 20% increases in cardiac index or decreases in pulmonary wedge pressure. All loading doses (range, 37.5 to 75 micrograms/kg/10 min) were effective short term, and maximum response occurred at 15 minutes. For the three effective regimens, cardiac index increased initially (at 15 minutes) by 24% to 42%, and pulmonary wedge pressure decreased by 24% to 33%. Systemic vascular resistance was reduced by 15% to 31%. The maximal acute response was effective in 99% of individual patients. During maintenance therapy, effective responses were seen at infusion doses of 0.375, 0.50, and 0.75 micrograms/kg/min, whereas an infusion of 0.25 micrograms/kg/min was ineffective. During 2 days of maintenance therapy, cardiac index remained augmented by 34% to 39% for the low and intermediate doses and by 44% to 73% for the high-dose infusion regimen. Pulmonary wedge pressure decreased an average of 18% on day 1 and 30% on day 2. Systemic vascular resistance was reduced by 20% to 25%, and stroke work index was augmented by 21% to 58%. Symptomatic improvement was common during intravenous milrinone therapy for symptoms of dyspnea (61% response), orthopnea (63%), edema (62%), and fatigue (40%). Improvement occurred more frequently in those with worse baseline functional indexes and in those with greater hemodynamic responses to therapy. Safety and tolerance were exceptionally good for these patients with advanced heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hemodynamic and clinical benefits with intravenous milrinone in severe chronic heart failure: results of a multicenter study in the United States. 203 27


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