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Biomedical subjects

G F Fletcher

Publications and source records attributed to G F Fletcher.

At least 55 records · Page 3Linked to original sources
PubMed1986

Rehabilitation after coronary angioplasty--is it effective?

To determine the effects of cardiac rehabilitation following coronary angioplasty, 30 patients were evaluated by telephone questionnaire following discharge from a cardiac rehabilitation program. Angioplasty educational booklets and fat-controlled dietary instruction were provided for all 30 patients; however, the diet was actually implemented by only 11. Activities of daily living and home physical exercise guidelines were provided for 24 of the 30 subjects. Outpatient follow-up questionnaire within six months after discharge revealed 14 of 30 working full-time, 18 of 30 on fat-controlled diet, 16 of 30 regularly exercising, and 18 of 30 not smoking. Anginal chest discomfort warranting physician evaluation had developed in 11 of the 30. We identified the following problems in our cardiac rehabilitation program for angioplasty patients: no advance starting notice to rehabilitation team, short hospitalization (mean 4.9 days), little family unit instruction, and physicians ordering a regular diet when a special one was indicated. We conclude that our program of inpatient cardiac rehabilitation following angioplasty is not effective in altering patient behavior with regard to fat-controlled diet, exercise habits, and smoking habits, and that symptoms of angina pectoris requiring physician evaluation are common in these patients.

Adult↗
PubMed1985

Exercise training during chronic beta blockade in cardiovascular disease.

To determine whether cardioselective and nonselective beta-blocking agents impair exercise training effects in patients with cardiovascular disease, 50 subjects were evaluated. All were in a 3-times-weekly medically supervised outpatient exercise program for 3 months or longer. Treadmill exercise tests were done initially and at 3-month intervals. Eight patients were receiving atenolol, 23 propranolol, 3 timolol, 6 metoprolol, and 8 nadolol and 1 patient receiving timolol changed to atenolol and 1 receiving nadolol changed to propranolol. Treadmill test duration increased significantly (p less than 0.05), from 7.5 +/- 2.5 to 9.9 +/- 2.3 minutes, with exercise training. In 35 of the 50 subjects heart rate at rest decreased significantly (p less than 0.05) from 67.5 +/- 11.7 to 60.4 +/- 10.5 beats/min. The other 15 subjects were excluded from heart rate analysis because beta blockade was begun 1 to 2 weeks after the initial exercise test. It is concluded that exercise training effects (increase in exercise test duration and decrease in resting heart rate) can be achieved in patients with cardiovascular disease in the presence of both cardioselective and nonselective beta-blocking agents.

Adrenergic beta-Antagonists↗
PubMed1984

Telephonically-monitored home exercise early after coronary artery bypass surgery.

To evaluate the usefulness of telephonically-monitored home exercise in patients within two weeks postcoronary bypass surgery, we randomly enrolled 46 male patients in a 12-week home program of either short walks or bicycle ergometry. Home exercise was done five times weekly and monitored both before and immediately after three times weekly. New arrhythmias or conduction disturbances were detected in 18 of 23 (78 percent) of the bicycle group and in 20 of 23 (87 percent) of the short walk patients. New symptoms developed in three patients, two from the short walk group and one from the bicycle group. Two bikers and one walker developed elevated blood pressure; all were referred to physicians and were successfully managed. Electrocardiographic abnormalities led directly to diagnostic and therapeutic intervention in nine of the 46 patients-four bikers and five walkers. There were no complications such as ventricular tachycardia or ventricular fibrillation. Technically clear telephone rhythm strips were obtained from patients calling both locally and long distance.

Arrhythmias, Cardiac↗
PubMed1983

Twenty-four-hour continuous electrocardiography during exercise and free activity in 80 apparently healthy runners.

To determine the incidence of arrhythmias and conduction disturbances in trained athletes and the level of physical training at which they occur, 24-hour ambulatory electrocardiographic recordings were obtained in 80 healthy runners during both exercise and free activity. Subjects were grouped according to the number of miles per week (mpw) they had regularly run during the previous 3 months: Group I--0 to less than or equal to 5 mpw (less than or equal to 8 km); Group II--greater than 5 to less than or equal to 15 mpw (greater than 8 to less than or equal to 24 km); Group III--greater than 15 to less than or equal to 30 mpw (greater than 24 to less than or equal to 48 km); and Group IV--greater than 30 mpw (greater than 48 km). Ectopic ventricular complexes occurred in 41 of 80 subjects (50%) and ectopic supraventricular complexes occurred in 33 (41%). There were 2 episodes of paired ventricular ectopic activity and a 5-beat run of ventricular tachycardia with exercise. The study revealed no significant differences in the occurrence of arrhythmias or conduction disturbances in the different groups, although the 2 episodes of paired ventricular ectopic activity and 5-beat run of ventricular tachycardia are of concern.

Activities of Daily Living↗
PubMed1983

Comparative functional and physiologic status of active and dropout coronary bypass patients of a rehabilitation program.

To assess the benefits of regular participation in a medically supervised cardiac rehabilitation program, 22 patients who had undergone coronary artery bypass (2 groups of 11 each) were studied retrospectively. Group I (mean age 53 years) was currently enrolled in the rehabilitation program. Group II (mean age 56 years) had begun but had discontinued the program. The stated reasons for discontinuation were not medical. There was no difference in entry exercise tests, and presurgical catheterization data in both groups were comparable. Mean peak oxygen consumption (VO2) by modified Douglas bag technique, heart rate X systolic blood pressure product, and treadmill duration time were recorded in a single testing period. Results revealed that Group I had higher peak VO2 (30 ml/kg/min) than Group II (24) (p less than 0.005) and greater treadmill time (11 minutes) than Group II (8) (p less than 0.01). Nine of 11 subjects in Group I were fully employed, versus 4 of 11 in Group II (p less than 0.01). One of 11 subjects in Group I had been rehospitalized versus 5 in Group II. None in Group I but 4 of 11 subjects in Group II smoked. Thus, based on the sampling and methodology of this study, it is concluded that coronary artery bypass patients in rehabilitation programs have greater peak VO2 and treadmill test time, smoke less, are less often rehospitalized, and are more often fully employed than those who are not in such programs.

Adult↗
PubMed1981

Cardiac arrhythmias in patients with acute cerebrovascular accidents.

To assess the incidence and severity of cardiac arrhythmias in the acute period following a cerebrovascular accident (CVA), 30 patients with a CVA in a stroke intensive care unit had 24 hours of dynamic ECG recordings. Twenty consecutive patients electively admitted for cataract surgery served as a control group and also had recordings. Fifteen (50%) of 30 CVA patients had serious ventricular ectopy, compared with only three (15%) of the 20 control subjects. Among the patients with CVA, two had ventricular tachycardia, two had complete atrioventricular block, and two had asystole, all occurring in CVAs involving the anterior circulation. None of the control subjects experienced these arrhythmias. Cardiac arrhythmias are common in patients with acute CVAs, especially those involving the anterior circulation. Dynamic ECG recordings may detect such arrhythmias and provide data for therapeutic consideration.

Acute Disease↗
PubMed1980

Dose response of squamous cell carcinomas of the upper respiratory and digestive tracts.

Dose-response curves have been computed for 5 tumour sites of the head and neck region, using 2 regression models. In agreement with clinical observation, a significant increase has been found from moderate to high control rates with modest dose increases for exophytic tumours (T1 + T2 retromolar trigone-anterior faucial pillar and T2 + T3 supraglottic larynx). Further significant increases in local control after modest dose increases are not obtained when the control rate is already high and the slope of the dose-response curve consequently diminished. Despite unsatisfactory (50%) control rates for large heterogeneous tumours (T3 + T4 pharyngeal walls), further increases cannot be obtained without excessive doses because the curve flattens at the 50% control rate level.

Carcinoma, Squamous Cell↗
PubMed1979

Dynamic electrocardiographic recording during sexual activity in recent post-myocardial infarction and revascularization patients.

Twenty-four post-cardiac patients had 24 hour DER at a mean time of 30.1 days post-MI and 31.5 days post-MR. All patients experienced sexual activity at least once during the 24 hours. Heart rate ranged from a mean of 74.0 to 107.8 BPM in the MI group and from 90.2 to 117.8 in the MR group. Twelve of the 24 patients recorded cardiac electrical abnormalities during sexual activity and five of these 12 had abnormalities associated only with or more frequently with sexual activity. It is concluded that sexual activity may provoke cardiac electrical events not elicited by other stimuli and this may warrant consideration for patient counseling and/or specific therapy.

Adult↗