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One hundred forty-five male welders from a West Coast shipyard were studied cross-sectionally and across a Monday work shift by pulmonary function tests and a questionnaire. Ten years of welding was associated with chronic bronchitis in 23.3% of nonsmokers compared to 3.3% in male controls, shortness of breath in 31.5% of nonsmokers compared to 1.5% in controls, and chest pain or heaviness in 38.4% compared to 4.4% in controls. Men who welded aluminum but had never smoked had more frequent wheezing, chest tightness, phlegm, feverishness and fatigue than those welding mild (black) or stainless steel. There were no significant cross-shift effects from welding exposure on measurements of pulmonary function. Although baseline expiratory flows were reduced slightly when compared to Caucasian-predicted values, ethnic specific comparisons for the largest subgroup showed only that FEF25-75 was reduced to 92.9 percentage of predicted values. Diffusing capacities for carbon monoxide were significantly reduced as compared to referents. The pulmonary function values of 25 current smokers were indistinguishable from the 41 who had never smoked, which probably reflects their low consumption of cigarettes.
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PMID:Respiratory symptoms and functional impairment from acute (cross-shift) exposure to welding gases and fumes. 281 87

Based on analysis of 399 symptomatic patients with mitral valve prolapse (MVP) and the reported experience of others, we developed a clinical classification in order to improve nosology, provide better identification and promote insight into the mechanism of symptoms in patients with MVP. The heading of anatomic MVP designates those in whom symptoms or complications were primarily or directly related to valvular dysfunction and the heading of MVP syndrome designates those patients in whom symptoms cannot be explained on the basis of valvular dysfunction alone. Patients with MVP syndrome present with a symptom complex which results from various forms of neuroendocrine or autonomic dysfunction; the most common symptoms include chest pain, palpitations, cardiac arrhythmias, orthostatic phenomena, syncope, presyncope, fatigue, exercise intolerance, dyspnea and neuropsychiatric symptoms (Table 1). Mechanisms underlying the condition have been shown to include increased adrenergic activity, disturbances of catecholamine regulation, hyperresponsiveness to adrenergic stimulation, anomalous beta-adrenergic receptors, dysfunction of the parasympathetic portion of the autonomic nervous system, disturbances in renin-aldosterone regulation, decreased intravascular volume, diminished left ventricular diastolic volume in the upright position as well as abnormal secretion of atrial natriuretic factor (Table 2). In MVP syndrome, alterations of the heart, kidney, the adrenals and the autonomic nervous system coexist and interact, creating a complex "neuro-endocrine cardiovascular process" which may account for many of the symptoms otherwise unexplained on the basis of the valvular abnormality alone.
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PMID:Mitral valve prolapse syndrome: neuro-endocrinological aspects. 284 39

Training bradycardia during autonomic blockade has been studied in rats and humans. The heart rate after autonomic blockade (intrinsic heart rate) is also lowered as a part of the adaptation to training. However, this nonautonomic component of the cardiac adaptation requires a long duration of intense endurance training to appear. This is in contrast to the autonomic component of the training bradycardia. From animal studies we have concluded that even if the training bradycardia is due to an adaptation within the heart itself, the adrenergic nerves are important for the development of a slow intrinsic heart rate. Neither the beta-receptor stimulation nor the degree of the heart rate increase during exercise is the main stimulus for the development of a training-induced bradycardia. Well-trained bicyclists had an intrinsic heart rate 20 beats lower than untrained normal control subjects. The heart rate at rest and the maximal heart rate were also on an average 20 beats lower for the bicyclists. There was no significant difference between propranolol and the beta 1 selective metoprolol in this study regarding their effects on heart rate and on deterioration of the maximal oxygen consumption after blockade. This deterioration was more marked in the well-trained than in the sedentary group. Based upon studies both in normal subjects and patients a careful rating of symptoms including physical exertion, fatigue or pain in the legs, dyspnea and chest pain using a Borg scale is recommended during exercise testing with beta blockade.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effects and adverse effects of autonomic blockade in physical exercise. 285 91

The value of beta blockade after myocardial infarction is extremely well documented. Close to 50 randomized trials have been performed, involving about 40,000 patients with short- or long-term follow-up. Over 20,000 patients have been included in more than 20 placebo-controlled trials with a follow-up period of 3 months or more. In long-term follow-up studies, about 1 to 2 weeks to 1 year after myocardial infarction, mortality was reduced by 21% and reinfarction by 24% (about 20,000 patients in 24 trials). The trial medication was withdrawn in about 20% in both placebo and beta-blocker groups in the major trials. In addition to reduction of mortality and reinfarction rate, benefits have clearly been demonstrated on severity of chest pain, arrhythmias, and other thromboatherosclerotic complications, as well as on readmissions. Significantly more patients experienced congestive heart failure, hypotension, bradycardia, and cold hands with beta-blocker treatment, whereas no clear-cut difference was found for atrioventricular block, bronchial constriction, and intermittent claudication. Some studies have reported more tiredness, depression, and gastrointestinal disturbances. In the Stockholm metoprolol trial, analyses on quality of life have been performed. In this trial, 3 years of metoprolol treatment after myocardial infarction resulted in a prolongation of both survival and time spent completely asymptomatic, as well as in an optimal functional state. Furthermore, less time was spent disabled after serious atherosclerotic complications. Long-term beta blockade after myocardial infarction reduces mortality and morbidity but causes adverse reactions in some patients. With proper selection of patients and type and dosage of beta blocker, survival without atherosclerotic complications and side effects can be prolonged.
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PMID:Use of beta blockers in postinfarct prophylaxis: aspects on quality of life. 288 38

A multiple crossover research study was used to evaluate the effect of dialyzer re-use on fever, blood leaks, serum urea and creatinine values and symptoms. Each of 6 crossover periods consisted of 4 weeks on either single-use or re-use, 1 week washout, 4 weeks on the alternative treatment and 1 week washout. The re-use consisted of 6 uses of each dialyzer and the washout weeks consisted of 3 single-use sessions. Analysis of paired observations within rather than between patients showed no effects of time (i.e. among crossover periods 1 through 6) or number of re-uses (i.e. among uses 1 through 6). There was no significant difference for temperature change during dialysis, blood leak rate, or the serum urea and creatinine values before the first dialysis of each washout period. There were no differences for symptoms of pruritus, cramps, nausea, headache, chest pain, backache or fatigue. There were no clinical advantages or disadvantages associated with dialyzer re-use.
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PMID:Dialyzer re-use--a multiple crossover study with random allocation to order of treatment. 307 Apr 14

We investigated exercise capabilities of the elderly patients with significant coronary artery lesions and angina pectoris. The heart rate increased according to workload, but there were few cases in which maximal heart rate was obtained. There was a marked increase in VO2 at endpoint before sufficient work load was achieved. It suggested an increase in O2 demand of the myocardium and entire body. Left ventricular dysfunction from skeletal muscle fatigue and work load-induced myocardial anoxia were also suggested. The conditions of coronary arteries of aged patients and the method of treatment were studied on the basis of coronary angioplastic findings and exercise tolerance. We reviewed percutaneous transluminal coronary angioplasty (PTCA) performed in 49 aged patients (older than 70 years) with angina and investigated long-term results. In this group including 18 patients (43%) with multivessel disease, there was a high success rate (90%), and significant improvements in workload responses were achieved in early stages after PTCA. The rate of recurrence was higher in this group than non aged patients, however, angioplasty was repeated successfully in all of the patients. Dilated sites were recognized as patent in a majority of patients. Late cardiac events occurring six months after PTCA were acute myocardial infarction in only one case (2.2%) and unstable angina in three cases (6.8%). There was no cardiac death. The five-year cumulative survival rate was high (97%). During a follow-up interval of averaged 32 months, chest pain disappeared in 70% of patients and 48% enjoyed daily life without restriction. Since the quality of life appears to be improved and long term results are sufficiently acceptable, we concluded that PTCA is highly recommended for the elderly patients.
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PMID:[Clinical characteristics of ischemic heart disease in the aged: significance of coronary revascularization and role of PTCA]. 327 11

Mitral valve prolapse (MVP) is due to a heterogeneous group of conditions that may affect the mitral valve or the mitral valve apparatus. Although MVP may progress later in life to frank mitral insufficiency requiring mitral valve repair or may predispose to bacterial endocarditis, in most cases it is a benign, idiopathic condition without serious consequences. However, many investigators have documented that MVP is often associated with a constellation of signs and symptoms, which appear to constitute a distinct syndrome. These associated findings include autonomic dysfunction, frequent complaints of chest pain, palpitations, orthostasis, fatigue, dyspnea on exertion and anxiety. Although the risk of significant myocardial dysfunction or bacterial endocarditis appears to be related to patient sex, age and the severity of valvular prolapse and insufficiency, there appears to be little or no relations between the extent of prolapse and the degree of autonomic dysfunction or the severity of symptoms of chest pain, palpitations, dyspnea on exertion and anxiety. The development of uniform diagnostic standards for mental disorders has helped to make it possible to identify several related entities, including generalized anxiety disorder, panic disorder and agoraphobia; patients with these disorders frequently somatize their anxiety and complain of many symptoms which may be seen in patients with MVP. Although several studies have reported an increased frequency of MVP in patients with anxiety disorders, recent studies suggest that the conditions are not linked. Iatrogenic cardiac neurosis is common in both groups of patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Mitral valve prolapse: from syndrome to disease. 332 70

This study assessed behavioral activity, dietary and emotional variables among patient cohorts with angina pectoris, atypical chest pain, and no chest pain in whom coronary disease is suspected. Questionnaire responses of 3,899 employed male patients at the time of coronary arteriography were analyzed. Patients with angina pectoris had high levels of coronary-prone and neurotic attitudes, and fatigue variables including feeling unrested on awakening, easy fatiguability, reducing activity at work and arriving home tired. Atypical chest pain patients showed coronary-prone and neurotic attitudes similar to the angina pectoris group but had less coronary occlusion and lower levels of fatigue variables. Compared to the other groups, atypical chest pain patients were more likely to skip breakfast and showed a trend to eat fast. These findings suggest that including assessment of activity levels, fatiguability, eating behavior, neurotic traits and coronary-prone attitudes at time of coronary arteriography can have some limited value for patients with chest pain who may seek cardiac treatment but could benefit from alternative approaches.
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PMID:Chest pain and behavior in suspected coronary artery disease. 334 20

Sixty-five patients with ST elevation were retrospectively studied in order to evaluate the clinical significance and underlying mechanisms of ST-segment elevation during exercise. Of these, 50 patients had previous myocardial infarction (Group I) and 15 patients did not (Group II). Exercise thallium-201 imaging was performed on 30 patients, resting gated blood pool imaging was performed on 33 patients, and 23 underwent cardiac catheterization for clinical indications. When the two groups were compared, patients in Group I had more frequent multivessel disease (9/13 vs. 3/10, p less than 0.05), anterior infarctions (33/50 vs. 4/10, p less than 0.02), while Group II patients had more frequent single-vessel disease (7/10 vs. 4/13, p less than 0.05). For Group I patients, the most common reason for termination of exercise was fatigue and/or dyspnea (35/50 vs. 0/15, p less than 0.05), with an irreversible defect noted in both stress and delayed views on thallium imaging (20/24 vs. 1/6, p less than 0.05). In Group II, the most common reason for termination was angina (15/15 vs. 2/50, p less than 0.001), with reversible thallium defects noted more frequently (4/6 vs. 3/24, p less than 0.01). Thus, we conclude that in patients with Q waves, left ventricular dysfunction rather than ischemia is the mechanism for ST elevation. In these patients angina is rare, but fatigue, dyspnea, multivessel disease, and fixed thallium defects are common. In patients with non-Q-wave exertional ST elevation, ischemia is the rule, manifested by frequent chest pain and reversible thallium defects.
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PMID:The role of ischemia and ventricular asynergy in the genesis of exercise-induced ST elevation. 335 73

Ruptured sinus Valsalva aneurysm was repaired in 13 patients (mean age c. 33 years). Dyspnea, chest pain, fatigue and palpitation were the most common symptoms and systodiastolic murmur, cardiomegaly and pulmonary congestion the most pertinent clinical findings. The pulmonary-to-systemic flow ratio averaged c. 2.5. Associated cardiac anomalies were ventricular septal defect, aortic or mitral regurgitation, aortic coarctation or subvalvular stenosis, tetralogy of Fallot (altogether 8 cases). The origin of the fistula was the noncoronary, right coronary or left coronary sinus (5, 4 and 3 cases) or was not identifiable (1 case). Rupture occurred into the right atrium (6 cases), right ventricle (6) or pulmonary artery (1 case). Repair was undertaken through aortotomy (6 cases), right ventriculotomy (2) or right atriotomy (1) or through aortotomy + right ventriculotomy or atriotomy (4). In one case aortic valve replacement was performed. All survived the operation. Follow-up averaged 9.6 years. Recurrent fistulation, though with small shunt, was found in two cases. Combined two-dimensional and Doppler echocardiography revealed minor cardiac abnormalities in most patients, particularly aortic regurgitation. All the patients were in NYHA function class I or II.
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PMID:Ruptured aneurysm of sinus of Valsalva. Long-term postoperative follow-up. 343 19


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