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Biomedical subjects

G J Balady

Publications and source records attributed to G J Balady.

At least 37 records · Page 2Linked to original sources
PubMed1997

Cardiovascular screening and emergency procedures at health clubs and fitness centers.

A survey of 110 fitness centers in Massachusetts reveals that many do not follow generally accepted guidelines for administering preparticipation cardiovascular screening, obtain physician consent for individuals with known cardiovascular disease, and prepare for emergency situations should they occur. Thus, the promotion of physical activity to the general public now underway in the United States must also coincide with better screening at all fitness centers to maximize the potential for safe exercise participation at fitness centers.

Cardiovascular Diseases↗
PubMed1997

When to start cholesterol-lowering therapy in patients with coronary heart disease. A statement for healthcare professionals from the American Heart Association Task Force on Risk Reduction.

At present a large number of patients with atherosclerotic disease are not receiving aggressive cholesterol-lowering therapy. Consequently they are being deprived of a cost-effective, risk-reducing treatment. Every physician who treats patients with clinical atherosclerotic disease should become fully informed about the results of cholesterol-lowering trials in patients at high risk. All physicians who care for high-risk patients should take responsibility for cholesterol management, including primary care physicians and cardiovascular specialists. Highly effective and generally safe drugs for cholesterol lowering are available. The benefits of therapy for reducing recurrent CHD and prolonging life are considerable. There is no justification for unduly delaying institution of therapy for the majority of patients. The many advantages of nonpharmaceutical therapy call for its use in almost all patients, but drug treatment should not be postponed if the target for LDL cholesterol lowering (< or = 100 mg/dL) is unlikely to be achieved in the near term by a nonpharmaceutical approach alone. The view that patients with CHD or other forms of atherosclerotic disease do not receive substantial clinical benefits from aggressive cholesterol-lowering therapy is no longer warranted. Intensive cholesterol reduction, initiated immediately, has the potential to significantly reduce both morbidity and mortality. Cholesterol-lowering therapy thus should become a routine part of clinical management to reduce risk of future coronary events and to prolong life in patients with CHD or other forms of atherosclerotic disease.

Anticholesteremic Agents↗
PubMed1997

Exercise and its role in the prevention and rehabilitation of cardiovascular disease.

The purpose of this article is to review the beneficial effects of regular exercise in the primary and secondary prevention of coronary artery disease (CAD). Epidemiologic studies indicate that a physically inactive life-style is associated with twice the risk of developing CAD. The magnitude of risk is similar to that of other modifiable risk factors. Meta-analysis of studies of cardiac rehabilitation after myocardial infarction demonstrate that cardiac rehabilitation participants lower their risk of death by 20% to 25% compared to controls. Exercise training results in several beneficial physiological changes including an increase in exercise endurance, higher resting and exercise stroke volumes, lower resting and submaximal exercise heart rates, and increased capillary density and oxidative enzyme capacity in skeletal muscle. In patients with established CAD, exercise training improves symptoms of angina and congestive heart failure and attenuates the severity of exercise-induced ischemia. Regular exercise can favorably modify other risk factors, but the benefits are modest. Reductions in systolic and diastolic blood pressure readings average 6 to 9 mm Hg; decreases in total and low-density lipoprotein (LDL) cholesterol approximate 5 to 10 mg/dL; and increases in high-density lipoprotein (HDL) cholesterol approximate 2 mg/dL. Exercise training as a sole intervention does not appear to enhance smoking cessation. Regular exercise does improve psychosocial well-being. Most studies of physical activity have enrolled predominantly middle-aged men; however, available evidence suggests similar cardiovascular benefits for women, the elderly, and children and youth. Physical activity levels decrease substantially during the school-age-adolescent transition in both males and females. More than half of the adult population is sedentary or inactive. Collectively, accumulated data suggest the need for both individualized/high-risk and population-based approaches to increasing physical activity across the life span.

Adult↗
PubMed1997

Cardiovascular evaluation of the athlete. Issues regarding performance, screening and sudden cardiac death.

Recent studies have reported ECG anomalies and a high prevalence of exercise-related arrhythmias among well trained, apparently healthy endurance athletes with superior levels of cardiorespiratory fitness. The occurrence of sudden and premature cardiac deaths in amateur and professional athletes, who appear to embody all of the virtues of health and fitness, ahs raised our consciousness regarding the underlying atherosclerotic or nonatherosclerotic causes, and the need for, and extent of, preparticipation screening in competitive athletes. It appears that strenuous physical activity may trigger acute cardiovascular events in some athletes. Coronary artery disease is the most frequent autopsy finding in those over the age of 35 years who die suddenly. In contrast, structural cardiovascular abnormalities, including hypertrophic cardiomyopathy and malformations of the coronary arteries, are the major cause of sudden death in younger athletes. This article reviews these issues, with specific reference to the assessment of cardiorespiratory fitness, legal and prohibited performance-altering medications, the pathophysiological basis of exertion-related untoward events, the athlete at risk, limitations of conventional screening programmes and contemporary recommendations to identify latent cardiovascular disease in athletic populations.

Anaerobic Threshold↗
PubMed1995

Comparison of outcome of cardiac rehabilitation in black women and white women.

Coronary artery disease is the leading cause of death among black women in the United States. Black women also demonstrate a greater prevalence of coronary risk factors and a higher mortality after myocardial infarction than white women. To evaluate the clinical profile and outcome of black women in an urban-based cardiac rehabilitation program, 35 black women (aged 54 +/- 13 years) and 47 white women (aged 57 +/- 10 years) were prospectively studied. Black women had similar admitting diagnoses as white women, with recent myocardial infarction being the most common (37%). Coronary risk factors were more prevalent in black women than white women in the program: hypertension (71% vs 53%; p = 0.09) diabetes mellitus (46% vs 26%; p = 0.06), obesity (74% vs 49%; p < 0.05). Cholesterol and high-density lipoprotein levels were similarly elevated in black (251 +/- 53 mg/dl) and in white (248 +/- 52 mg/dl) women, whereas 34% of black and 21% of white women were active smokers. There was no significant difference in initial exercise capacity at program entry. Fewer black women (51%) completed the 12-week program than white women (64%), p = NS. Comparison of initial and follow-up exercise tests after 12 weeks of moderate to high-intensity dynamic exercise demonstrated significant and similar improvements in functional capacity in both black (4.2 +/- 1.6 vs 5.6 +/- 1.7 METs; p < 0.001) and white (4.8 +/- 2.2 vs 5.7 +/- 2.2 METs; p < 0.01) women. Among obese patients, only the white women lost weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Black People↗
PubMed1995

Bartonella henselae endocarditis in an immunocompetent adult.

We describe a case of aggressive Bartonella henselae endocarditis in an immunocompetent man who owned a cat. Aortic valve replacement was required, and his infection was diagnosed by histology, serology, and polymerase chain reaction analysis. The manifestations of his disease included mediastinal lymphadenopathy, glomerulonephritis, myocarditis, and a petechial rash; the unusual finding of a positive titer of c-antineutrophil cytoplasmic antibodies was noted. Serological titers were markedly elevated for > 1 year despite clinical improvement.

Adult↗
PubMed1994

Comparison of submaximal exercise responses using the Bruce vs modified Bruce protocols.

The purpose of this study was to determine whether the parameters commonly used to evaluate a training effect can be compared when serial tests are performed using different protocols. Thirty-two patients with stable coronary artery disease performed both the standard and modified Bruce protocols in a random order, 1 h apart. Physiologic variables at matched exercise stage I including heart rate (99 +/- 12 vs 101 +/- 14 bpm), rate-pressure product (15 +/- 3 vs 15 +/- 3 bpm x mmHg x 10(3)), and VO2 (13.5 +/- 2.1 vs 13.0 +/- 3.0 ml.kg-1 x min-1) were not significantly different for exercise tests performed using the standard vs modified Bruce protocols respectively. Similarly, these parameters were also nearly identical at matched exercise stage II. However, peak VO2 was significantly higher using the standard vs modified Bruce protocol, although the difference was small. Therefore, these data indicate that a difference in the heart rate response at matched submaximal workrates on tests using these two protocols before and after a training program is most likely due to a training effect. Conversely, improvements in peak VO2 using the standard vs modified Bruce are at least in part due to inherent differences in responses between these two protocols.

Blood Pressure↗
PubMed1993

The benefits and risks of exercise training: the exercise prescription.

The physiologic responses to exercise are mediated by a complex interaction of central, peripheral, and neurohumoral stimuli designed to increase cardiopulmonary function. With repetitive exercise, significant cardiovascular and muscular adaptations occur that facilitate and enhance the response to exercise. Exercise is beneficial not only to younger healthy individuals, but to patients with many chronic medical conditions and to elderly individuals as well. Physical activity has a role in the reduction of major cardiac risk factors and in both the primary and secondary prevention of cardiac events. With proper evaluation and counseling, exercise can be performed safely, even among patients with cardiovascular and other chronic diseases. Given the high percentage of the U.S. population whose sedentary lifestyle predisposes them to the development of cardiovascular disease and the numerous beneficial effects of exercise, it is prudent to prescribe exercise as a means of improving individual and general public health.

Exercise↗
PubMed1993

Types of exercise. Arm-leg and static-dynamic.

Exercise training for patients with heart disease is no longer limited to a monotonous single-activity routine. Training regimens can and should employ a wide variety of activities that involve the arms and legs and both dynamic and static effort (Table 3). Because the physiologic and, hence, ischemic responses to each type of exercise are different, the unique properties of the varying forms of exercise must be well understood. Significant cardiovascular benefit can be derived from a training program that employs a diversity of activities in a safe and effective manner. Improvements in muscular endurance and strength, with reductions in ischemia, can translate to a more satisfying and productive life for the patient with heart disease.

Coronary Disease↗
PubMed1992

Safety and clinical use of exercise testing one to three days after percutaneous transluminal coronary angioplasty.

To evaluate both the safety and clinical use of predischarge symptom-limited exercise testing after successful uncomplicated percutaneous transluminal coronary angioplasty (PTCA), 100 patients were randomized to undergo exercise testing (n = 50) or no exercise testing (n = 50). There were no differences in clinical or angiographic characteristics between the groups. Exercise testing was performed 38 +/- 14 hours after PTCA. Patients who exercised achieved 71 +/- 12% of predicted maximal heart rate, with 38% reaching greater than or equal to stage III of the Bruce protocol. No patient in either group developed cardiac complications during 48-hour follow-up. Of the 11 patients with a positive test result, 92% had angiographically incomplete revascularization. Attending physicians (n = 16) were questioned both before and after exercise testing about when, after discharge, they would allow their patient to perform each of 11 specific activities of daily living. Questionnaires were administered to physicians at similar time frames for patients in the no-exercise group. Comparison of the responses between initial and repeat questionnaires showed that patients in the exercise group (with a test result negative for ischemia) were allowed to perform 7 of 11 activities, including return to work, earlier (p less than 0.05) than the no-exercise patients. These data indicate that in this well-defined group of patients, symptom-limited exercise testing early after PTCA appears to be safe, and alters physician management in allowing patients with a negative test result to return to various activities at an earlier date. Such testing may be useful in counseling patients after PTCA.

Activities of Daily Living↗
PubMed1992

Comparison of the clinical profile and outcome of women and men in cardiac rehabilitation.

Few data are available regarding the outcome of women in cardiac rehabilitation. To determine whether women differ from men in clinical profile and outcome, 225 consecutive patients were prospectively evaluated in an urban, multidisciplinary, exercise-based cardiac rehabilitation program. Among the 51 women (age 56 +/- 10) and 174 men (age 54 +/- 10), most were: white (84%), married (64%), employed (63%), had had myocardial infarction or revascularization, or both (66%), and traveled less than 10 miles to the program (92%). Risk profiles revealed obesity in 48% (mean Metropolitan Relative Weight = 124 +/- 22%), hypertension in 47%, smoking in 23%, diabetes in 16%, and mean cholesterol of 236 +/- 45 mg/dl. Compared with men, more women were nonwhite, unemployed, unmarried, hypertensive or diabetic (p less than 0.0001) and had higher cholesterol (p less than 0.01). Compliance rates were similar for women (51%) and men (63%) (p = not significant). Univariate predictors of program noncompliance differed between women and men. Initial exercise capacity was less for women than for men, but both groups achieved a similar training effect. Women increased their exercise time by 31% and peak METs by 30%, whereas men showed a 21% increase in exercise time and 16% increase in peak METs achieved (p less than 0.001). Thus, in this cardiac rehabilitation program, women have a less favorable risk factor profile and differ from men with regard to baseline demographics and predictors of program completion. Women, however, have similar rates of compliance and achieve the same improvement in functional capacity with training.

Adult↗