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

Digitalis and diuretics constitute conventional therapy of congestive heart failure, but systemic vasodilators offer an innovative approach in acute and chronic heart failure of decreasing increased left ventricular systolic wall tension (ventricular afterload) by reducing aortic impedance and/or by reducing cardiac venous return. Thus, vasodilators increase cardiac output (CO) by diminishing peripheral vascular resistance (PVR) and/or decrease increased left ventricular end-diastolic pressure (LVEDP) (ventricular preload) by diminishing venous tone. Concomitantly, there is reduction of myocardial oxygen demand, thereby reliably reducing angina pectoris in coronary disease, and potentially limiting infarct size and ischemia provided systemic arterial pressure remains normal. The vasodilators produce disparate modifications of cardiac function depending upon their differing alterations of preload versus impedance: nitrates principally cause venodilation (decrease LVEDP); nitroprusside, phentolamine and prazosin produce balanced arterial and venous dilation (decrease LVEDP and increase CO) provided left ventricular filling pressure is maintained at the upper limit of normal; whereas hydralazine predominantly effects arteriolar dilation (increases CO). With depressed CO plus highly increased LVEDP and increased PVR, nitrates also induce some increase of CO by reducing PVR. Combined nitroprusside and dopamine synergistically enhance CO and decrease LVEDP. Mechanical counterpulsation aids nitroprusside in acute myocardial infarction. The 30-minute venodilator action of sublingual nitroglycerin is extended for 4 to 6 hours by cutaneous nitroglycerin ointment, by sublingual and oral isosorbide dintrate, and by oral pentaerythritol tetranitrate and sustained-release nitroglycerin capsules. Ambulatory oral vasodilator therapy is provided by long-acting nitrates (relieve pulmonary congestion); hydralazine (improves fatigue); prazosin alone, combined nitrate-hydralazine combined prazosin-hydralazine (improve both dyspnea and fatigue).
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PMID:Afterload reduction and cardiac performance. Physiologic basis of systemic vasodilators as a new approach in treatment of congestive heart failure. 9 30

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

203 patients suffering from acute myocardial infarction performed a cycloergometric submaximal exercise test before leaving hospital. The causes for stopping the test were fatigue or submaximal heart rate (24,1%), angina (14,2%), ischaemic S-T changes (28,08%), arrhythmias (4,9%) and changes of blood pressure (17,2%). No important complications were observed. The test proved useful for the definition of more objective criteria in order to prescribe an individualized rehabilitation programme. Above all it was possible to prescribe treatment which would not have otherwise been prescribed at the time of discharge. The short term prognostic value is not, however quite clear as yet.
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PMID:[Early exercise testing after myocardial infarction (author's transl)]. 39 15

Veloergometry was practised in 35 patients with acute myocardial infarction at the time of their activiation (mainly on the 45-50th day of the disease or 7-8 days after they have been put on the feet). The investigation was aimed at detecting some signs of coronary insufficiency and cardiac incompetence, as well as of the limit of physical activity of such patients at the time of stimulated physical performance. The patients under examination demonstrated a significantly reduced amount of the work performed, which averaged 327 kgm. Among the patients complaints that led to discontinuance of the exercises were general fatigue and that of the feet in particular, dyspnoea and sensation of air deficiency, anginal attacks and deranged cardiac rhythm. In 28 cases changes in the terminal part of the ventricular ECG complex were recorded. The T-V1 greater than T-V6 syndrome was also analyzed before and after veloergometry. Of interest are the ECG changes in 2 groups of the patients, viz. the 1st without any ECG indications of transmural infarction and the 2nd one presenting such signs. Changes in the terminal part of the ventricular complex recorded in patients of the 2nd group, combined with dyspnoea, asphyxia and marked tachycardia during veloergometry suggest the presence in them not only of the coronary, but also of the left ventricular insufficiency.
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PMID:[Veloergometric indicators in patients with acute myocardial infarct during the period of their activation]. 112 83

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

The influence of clinical doses of drugs that affect beta-adrenoceptors has been examined on heart rate, blood pressure, duration of exercise, and on electrolyte concentrations (Na, K, Ca and Mg) during recovery from exercise in healthy volunteers. The drugs used were a beta 1-adrenoceptor antagonist atenolol, a nonselective beta-adrenoceptor antagonist propranolol, and a cardioselective, partial beta 1-adrenoceptor agonist with 43% ISA activity, xamoterol. The duration of exercise was smaller on propranolol. Maximum exercise heart rate and blood pressure were reduced significantly by propranolol and atenolol. Xamoterol reduced maximum exercise heart rate and had no effect on blood pressure. The degree of breathlessness and fatigue revealed no differences between treatments. Recent evidence has suggested an association between hyperkalaemia and hypomagnesaemia with an increase in the occurrence of arrythmias following acute myocardial infarction. Exercise-induced hyperkalaemia has been suggested as a factor in sudden death. The results confirmed a rise in serum potassium during exercise and attenuation of the fall during recovery under beta-adrenoceptor blockade. Xamoterol was no different from placebo in these respects. Exercise also produced a rise in magnesium levels and during recovery the level fell below baseline. Both these effects were attenuated by propranolol. Calcium levels were not affected by any of the treatments.
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PMID:Comparison of the effects of xamoterol, atenolol and propranolol on breathlessness, fatigue and plasma electrolytes during exercise in healthy volunteers. 168 93

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

This study describes the outcome in terms of health-related quality of life (QL) five years after onset of symptoms in 397 patients with an initial suspicion of acute myocardial infarction (MI) but in whom the diagnosis was not confirmed. The patients were approached by means of a postal inquiry that comprised two questionnaires. The most pronounced impairment in health-related QL was expressed as decreased energy, whereas social life was the least affected area. The overall QL was very similar to that in patients who had a confirmed MI. Subsets of patients with impaired QL were those given the diagnosis of angina pectoris or possible infarction.
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PMID:Long-term follow-up of health-related quality of life in patients with suspected acute myocardial infarction when the diagnosis was not confirmed. 204 29

Eleven cases with 13, incidentally found coronary-pulmonary fistulous communications were discovered out of about 11,000 diagnostic coronary angiograms performed in different patients, over the period 1968 to 1989. These patients were followed-up for an average period of 4.4 years (range 2-11 years). The majority had a fistulous malformation originating from the proximal part of the left anterior descending artery and terminating in the pulmonary trunk. In three subjects, the right coronary artery participated in formation of the shunt. The fistulas consisted either of a convoluted mass of serpentive vessels, sometimes with aneurysmal formation, or of a solitary single vessel. Angina pectoris, atypical chest pain and fatigue were the most common symptoms. All patients were treated conservatively except one, who underwent ligation of the fistula and coronary arterial bypass grafting. Two subjects are still free of symptoms. No death occurred. None of the patients developed subacute bacterial endocarditis, acute myocardial infarction or left ventricular failure during the period of follow-up of more than four years. Three individuals, prior to the follow-up period, had suffered myocardial infarction contralateral to the shunt. They had no recurrence.
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PMID:Coronary-pulmonary fistula: long-term follow-up in operated and non-operated patients. 236 8

The Cardiac Arrhythmia Pilot Study tested the feasibility of performing a large-scale study to evaluate the effect of therapy of ventricular arrhythmias after acute myocardial infarction (AMI). Ten clinical sites identified patients with greater than or equal to 10 ventricular premature complexes (VPCs)/hour, recorded 6 to 60 days after AMI in patients with an ejection fraction greater than 0.20. Patients were randomized to receive 1 of 5 agents: encainide, flecainide, imipramine, moricizine or placebo. Successful therapy was defined as greater than or equal to 70% suppression of VPCs and greater than 90% suppression of runs of ventricular tachycardia. Randomization to a second agent occurred if a patient did not achieve adequate suppression with the initial agent. Patients initially randomized to placebo continued to receive placebo. Patients were evaluated at 3-month intervals for the next year. Of 30,763 patients screened, 10,734 (35%) were younger than 70 years old and had a qualifying AMI. A Holter recording was obtained in 3,957 patients, of whom 871 (22%) had qualifying arrhythmias and 687 were eligible. Of the 687 eligible patients, 502 (73%) were randomized. Mean age of enrolled patients was 59 years. One-half of patients were randomized within 1 month after AMI. Mean ejection fraction was 0.45, with 175 (35%) patients having an ejection fraction less than 0.40. On baseline drug-free recording, 173 (35%) patients had less than 30 VPCs/hour; 149 (30%) between 30 and 100/hour and 180 (36%) greater than or equal to 100/hour. At least 1 run of ventricular tachycardia was seen in 172 (34%) patients. Drugs taken at baseline were similar in all groups with 116 (23%) patients taking digitalis, 161 (32%) taking diuretics, 203 (41%) taking beta blockers and 200 (40%) taking calcium antagonists. Slightly more patients, 53 (51%), randomized to flecainide were taking calcium antagonists. No significant relation was noted between baseline VPC frequency and ejection fraction, but baseline VPC frequency was correlated with heart rate, arrhythmia noted before AMI and right bundle branch block. As expected, a high ejection fraction correlated with lower peak creatine kinase values, an inferior location of the infarct and fewer signs of congestive heart failure. At baseline, at least 1 adverse symptom was volunteered by 192 (39%) patients. The most common symptoms were unusual tiredness or fatigue, heart beating fast or skipping beats or headache. In this study, over 20 age- and AMI-eligible patients were identified to obtain each randomized patient. The randomization process successfully distributed baseline variables across drug groups.
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PMID:Recruitment and baseline description of patients in the Cardiac Arrhythmia Pilot Study. The Cardiac Arrhythmia Pilot Study (CAPS) investigators. 245 14


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