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Query: UMLS:C0392674 (exhaustion)
 13,658 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patients with chest pain and normal epicardial coronary arteries are characterized by an impairment of myocardial perfusion reserve. Functional and morphological abnormalities of the intramyocardial arterioles are suggested to be responsible for this, possibly as a consequence of hypertension and/or left ventricular hypertrophy. In an attempt to isolate predisposing factors of microvascular angina we investigated 34 patients (15 f, 19 m) with a mean age of 53 +/- 7 years. They were diagnosed as microvascular angina without hypertension or left ventricular hypertrophy. Parameters such as plasma insulin, glucose, cholesterol, LDL-cholesterol, triglycerides, (VLDL-cholesterol) and fibrinogen were determined for a metabolic profile. Furthermore, insulin and glucose were measured after an oral glucose load of 100 g glucose (OGTT) over 3 h. All parameters were compared to a control group of 15 healthy people matched for age and body mass index. In the study population systolic blood pressure was within normal limits at 137 +/- 17 mm Hg and thus higher than control at 124 +/- 11 mm Hg (p < 0.02). Furthermore, diastolic blood pressure was 85 +/- 7 mm Hg compared to 78 +/- 9 mm Hg in controls (p < 0.02). Insulin was significantly elevated in patients with microvascular angina 90 min (median: 101 vs 54 microU/ml; p < 0.01) and 120 min (median: 88 vs 51 microU/ml; p < 0.05) after ingestion of 100 g glucose. The fasting glucose was elevated at 98 +/- 12 compared to 87 +/- 7 mg/dl in controls (p < 0.01). Glucose concentration was also elevated after 30 min at 176 +/- 28 compared to 148 +/- 32 mg/dl (p < 0.02), after 45 minutes (198 +/- 35 compared to 152 +/- 53 mg/dl) (p < 0.01) and 60 minutes (193 +/- 44 compared to 145 +/- 54 mg/dl) (p < 0.01). In microvascular angina parameters such as total cholesterol: (244 +/- 46 vs 199 +/- 29 mg/dl (p < 0.01)), LDL-cholesterol (157 +/- 41 vs 122 +/- 18 mg/dl (p < 0.01)) and fibrinogen: (377 +/- 150 vs to 285 +/- 69 mg/dl (p < 0.03)) were elevated. These findings suggest a pathogenetic role of insulin resistance, hyperlipoproteinemia and elevated levels of fibrinogen for impaired myocardial coronary reserve. This metabolic constellation as well as exhaustion of coronary reserve is often found in hypertensive patients and may identify microvascular angina as an early stage of hypertensive heart disease before manifest hypertension has developed.
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PMID:[The significance of insulin resistance and hyperlipidemia in microvascular angina (syndrome X)]. 773 10

Resting cardiac function is a poor indicator of functional cardiac reserve that is invoked during exercise. The objective of this study was to investigate the relationship between functional cardiac reserve and systemic vascular resistance (SVR) using an ambulatory radionuclide monitoring system (the Vest system) in patients with heart disease. The study population consisted of 29 patients (all male [mean +/- SD age, 63 +/- 10 years]), 23 with coronary artery disease, 3 with dilated cardiomyopathy, and 3 with hypertensive heart disease. All patients underwent cardiopulmonary stress testing using a ramped treadmill protocol and the Vest system. The anaerobic threshold (AT) was autodetermined using the V-slope method. Systemic vascular resistance was calculated using the mean blood pressure and cardiac output as determined using the Vest system parameters. All patients exercised beyond the AT until exhaustion. Resting left ventricular ejection fraction, peak ejection ratio, and peak filling ratio increased with the AT (P < .01 for all). Resting SVR decreased with the AT (P < .01). The percentage changes from rest to the AT in SVR correlated with those from rest to the AT in ejection fraction, peak ejection ratio, and peak filling ratio (r = -0.735, r = -0.510, and r = -0.697, respectively; P < .01). These findings indicate that SVR as recorded using the Vest system is a good determinant of functional cardiac reserve in patients with heart disease. Therefore, cardiopulmonary function testing combined with the Vest system is a good modality for the evaluation of functional cardiac reserve.
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PMID:Systemic peripheral vascular resistance as a determinant of functional cardiac reserve in response to exercise in patients with heart disease. 1787 59