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Query: UMLS:C0015672 (fatigue)
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To evaluate the relationship of functional results after aortocoronary saphenous bypass surgery, 66 patients of age 33--65 yr (mean 52) underwent a standarized bicycle exercise test before and an average of 14 mth after operation. Capacity of exercise was correlated with symptomatic response and graft patency. Group exercise tolerance was significantly improved after operation, and was about 60% of that of a population-based series of 52-yr-old men [6]. After operation 74% of the patients could exercise to fatigue without apparent limiting cardiac symptoms, while 26% still were incapacitated because of angina. Improvement in tolerance for exercise correlated with symptomatic improvement as well as patency of the grafts; patients with no grafts remaining patent showed no improvement in exercise performance.
Eur J Cardiol 1979 Mar
PMID:Exercise ECG in evaluation of aortocoronary bypass surgery; report on 66 patients. 31 Dec 89

The efficacy of oral isosorbide dinitrate was evaluated in nine hospitalized patients with chronic angina pectoris and positive maximal bicycle exercise tests. Patients were randomized double-blind to receive either 20 mg of isosorbide dinitrate or placebo on successive days after a control maximal upright bicycle exercise test. On each day hourly exercise tests were performed for 4 hours after drug administration to an end point of fatigue or angina pectoris. Mean systolic blood pressure 4 hours after the administration of isosorbide dinitrate was 25 mm Hg less than the control value (P less than 0.001). The values for resting heart rate and exercise-attained heart rate-blood pressure product were not significantly different from the values after placebo. The duration of exercise was prolonged (P less than 0.025) for at least 3 hours, and less ST depression (P less than 0.01) was observed up to 3 hours after the administration of isosorbide dinitrate compared with control values. The demonstration of sustained imporved exercise performance and previously described hemodynamic effects with the use of higher doses suggests that adequate blood levels of isosorbide dinitrate or mononitrate metabolites may be important for the efficacy of oral organic nitrates.
Am J Cardiol 1979 Feb
PMID:Sustained effect of orally administered isosorbide dinitrate on exercise performance of patients with angina pectoris. 36 36

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.
G Ital Cardiol 1979
PMID:[Early exercise testing after myocardial infarction (author's transl)]. 39 15

Nitroglycerin reduces elevated left ventricular filling and pulmonary arterial pressures in resting patients with rheumatic valve disease and reduces symptoms when given over long periods to patients with primary myocardial disease. To determine whether nitroglycerin may prove effective therapeutically in ambulatory patients with heart valve disease, its effects on hemodynamics and exercise capacity were studied in 11 severely symptomatic adults who were already receiving optimal treatment with digitalis and diuretic agents. Seven had predominant mitral valve disease, one had predominant aortic insufficiency and three had equally severe mitral and aortic valve disease. Maximal exercise capacity was assessed with graded treadmill exercise after placebo and after nitroglycerin (0.5 mg sublingually) administered in random sequence to each patient. Exercise capacity (exercise time to limiting fatigue or dyspnea) increased from a mean of 8.3 minutes after placebo to 9.8 minutes after nitroglycerin (P less than 0.005). Eight patients were studied hemodynamically during further intense treadmill exercise. Pulmonary arterial pressure was significantly lower (P less than 0.05) after nitroglycerin than after placebo (mean 44 versus 56 mm Hg), but cardiac output was greater after nitroglycerin (5.0 versus 4.6 liters/min, P less than 0.005). Thus, nitroglycerin appears to increase exericse tolerance and improve the hemodynamic response to exercise in patients with heart valve disease and may be valuable in the long-term pharmacologic therapy of such patients.
Am J Cardiol 1978 Feb
PMID:Nitroglycerin-induced improvement in exercise tolerance and hemodynamics in patients with chronic rheumatic heart valve disease. 41 13

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.
Clin Cardiol 1979 Feb
PMID:Prodromal characteristics as indicators of cardiac events in patients hospitalized for chest pain. 49 4

45 patients with an age of 3--15.5 yr are reported. Only 9 of them showed symptoms (palpitations, dyspnea, fatigue). The murmur was often uncharacteristic, only 42% had a click. ECG changes could be found in 60%. The associated cardiac lesions and the angiographic findings are represented. Correlating to an angiocardiographically LVOTO we found in 13 patients (28.9%) the echocardiographic signs of an ASH with a septum/LV posterior wall quotient of 1.45 +/- 0.15. We conclude, that myocardial disease is one pathogenetic factor in the MVPS.
Eur J Cardiol 1978 Mar
PMID:Clinical and angio- and echocardiographic findings in 45 children with mitral valve prolapse syndrome. 64 79

A 27 year old woman was hospitalized for progressive dyspnea, fatigue and retrosternal chest pain. She had progressive cardiac enlargement with clinical and laboratory confirmation of a dilated cardiomyopathy. Transvenous percutaneous right ventricular endomyocardial biopsy yielded a specimen showing a noncaseating granuloma. The patient's dyspnea responded dramatically to steroid therapy with corresponding improvement in radiographic and echographic measures of ventricular performance. This case illustrates the problem of diagnosing cardiac sarcoidosis when there is no apparent evidence of other organ involvement.
Am J Cardiol 1978 Jul
PMID:Cardiac sarcoidosis. Diagnosis with endomyocardial biopsy and treatment with corticosteroids. 67 30

The response to electrocardiographically monitored submaximal exercise stress testing has been studied in 44 patients with mitral leaflet prolapse (MLP). With exercise, ventricular premature contractions occurred in 7, ventricular tachycardia in 1, and atrial fibrillation in 1. Exercise was terminated short of target heart rate in 18 patients, because of chest pain (5), fatigue (7), ventricular arrhythmia (4), dizziness (1) or ST segment depression (1). 23 patients developed postexercise ST segment abnormalities, of whom 5 had 'ischemic' patterns and arteriographically proven coronary artery disease (CAD); among the 18 others, the ST segments were depressed and minimally downsloping in 2, slowly ascending from depressed J point in 3, horizontal for greater than or equal to 80 msec with J depression of less than 1 mm in 12, and cupped in 1. The incidence of arrhythmias provoked by submaximal exercise stress testing in patients with MLP was lower than suggested in previous reports. In all 5 cases where MLP and CAD coexisted, the classical 'ischemic' electrocardiographic response to exercise was not obscured. Even in the absence of CAD, postexercise ST segment abnormalities were common with MLP (18/39 = 46%) and differed from the progressively resolving ST segment deviation characteristic of CAD with angina. Exercise testing can safely be recommended, subject to standard contraindications, in patients with MLP and yields useful information.
Eur J Cardiol 1978 Oct
PMID:The electrocardiographic response to exercise in 44 patients with leaflet prolapse. 71 Apr 93

The midsystolic click-late systolic murmur syndrome is a complex entity with variable manifestations that involves a primary process causing myxomatous degeneration of the mitral valve leaflet(s) and subsequent systolic mitral valve leaflet prolapse. Other cardiac diseases may cause mitral valve prolapse and regurgitation associated with a midsystolic click that mimics this primary syndrome. The prolapsing mitral valve leaflet(s) syndrome occasionally may be familial. Most patients are asymptomatic but some complain of chest pain, palpitation, dyspnea or fatigue. Prolapsing mitral valve leaflet(s) can be distinguished from other causes of systolic clicks and mitral regurgitation murmurs by the characteristic movement of the clikmurmur complex in systole with various hemodynamic interventions. The clinical diagnosis usually can be confirmed by echocardiography, which demonstrates the abnormally prolapsdrome usually is minimal but can be progressive and lead to the need for prosthetic valve replacement. Most symptomatic patients can be managed medically but some require cardiac catheterization to evaluate the possibility of coexistent coronary artery disease, to assess the degree of mitral regurgitation and to evaluate other associated cardiac lesions. All patients with this syndrome should receive antibiotic prophylaxis prior to any surgical or dental procedures. Those patients suspected of having arrhythmias should be evaluated by continuous ambulatory ECG monitoring and dangerous arrhythmias probably should be treated. The prognosis usually is excellent, but sudden death and rapidly progressive mitral regurgitation due to ruptured chordae tendineae have been reported. Although more than a decade has elapsed since the midsystolic click-late systolic murmur syndrome was first recognized, much remains to be learned about this common but complex clinical entity.
Curr Probl Cardiol
PMID:The systolic click-murmur syndrome: clinical recognition and management. 101 8

Two cases of aortic pseudocoarctation were presented, the first one associated to rheumatic heart disease and the other one with an added obstruction of the left subclavian artery due to an angulation. The alterations of the subclavian arteries due to obstruction have been described very few occasions because they are usually asymptomatic. In our case there was only tiredness of the affected limb. The association of pseudocoarctation with rheumatic heart disease has been never reported, but we consider it to be just a mere coincidence. After reviewing what has been reported, we conclude that since the aortic pseudocoarctation is a benign sickness, the only thing to be done is to check these patients periodically.
Arch Inst Cardiol Mex
PMID:[Pseudocoarctation of the aorta. Association with cardiopathy or vasculopathy]. 115 2


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