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PubMed2000

[Good reasons to propose to the cardiology patient a cardiologic rehabilitation program].

According to the latest data available, in Italy a cardiac rehabilitation program is currently proposed to only 17% of patients after an acute myocardial infarction and to 76% of patients after a coronary artery bypass grafting. One possible explanation for this difference is an underestimation of the rehabilitating techniques and some doubts about its efficacy on the quality of life and on secondary prevention. Regarding secondary prevention, many research results and independent reviews are now available and they give us the opportunity to develop a sufficiently evidence-based analysis of cardiac rehabilitation program results. Great improvements in functional capacity and substantial changes in the way of life seem to have been demonstrated, with good-health oriented behaviors and improvements in the whole risk profile (less cigarette smoking, more sports activities, less stress, improvement in lipid profile). It has been well proven that with comprehensive rehabilitation programs, there is a relevant slow down in atherosclerosis progression. Rehabilitation programs also have favorable effects on the quality of life in patients with cardiac disorders, with fewer symptoms and more psychological and social well being. Three high-quality meta-analyses resulted in a significant reduction in total and cardiovascular mortality, mostly linked to sudden death and fatal reinfarction reduction, equal to the one obtained by currently recommended postinfarct treatments. Certainly, there are still difficulties to overcome before definitive conclusions can be reached, because of differences both in rehabilitation programs in the various studies and because of the results achieved in recent years through changes in the pharmacological approach to secondary prevention. The Global Secondary Prevention Strategies to Limit Event Recurrence After Myocardial Infarction (GOSPEL study) from the Italian Study Group on Cardiac Rehabilitation (GICR) has been designed to answer to some of these questions. One of its goals is to evaluate whether an intensive intervention of cardiac rehabilitation in the postinfarct patients is actually applicable and efficacious.

Heart Diseases↗
PubMed2001

[A new organization model for hemodynamic cardiology diagnosis and intervention cardiology].

In centers without hemodynamic laboratories the quality of medical care may be suboptimal since the unavailability of these technologies may reduce medical experience in the treatment of heart disease, mostly in acute coronary syndromes, and may increase the need for referring some patients to other hospitals. The problem will be of great relevance in the case of expansion of the aggressive approach in the treatment of acute ischemic syndromes such as acute myocardial infarction and unstable angina. The impelling need for small centers of improving medical care may promote the spontaneous and uncontrolled proliferation of hemodynamic laboratories. The high number of hemodynamic laboratories may lead to a low institutional volume and, as a consequence, may negatively influence the outcome of coronary intervention and increase health care costs. The experience of operators and the costs are probably more relevant as regards angioplasty than coronary angiography. Therefore we propose the implementation of departments of interventional hemodynamic laboratories including different hospitals: diagnostic laboratories will be allocated in hospitals with coronary care units, while interventional laboratories will be allocated in referring hospitals.

Coronary Care Units↗
PubMed1987

123-Iodine heptadecanoic acid (HDA) cardiac metabolism of inactive sportsmen with nuclear cardiology, impacted into complex cardiological studies.

In 8 sportsmen and 8 healthy subjects of similar middle age the examination of the myocardial uptake of 123-I HDA and 201-T1 exhibited a correlation of r = 0.88 using our own quantitative circumferential evaluation program. The myocardial kinetics of the 123-I HDA was assessed by different methods: 1. according to Feinendegen et al. (1981), with complementary NaI-123 injection for the extra-myocardial background correction, 2. according to Dudczak (1984), with bi-exponential peeling, similar to the simplified method of the van Eenige group (1984, 1985). The utilisation-elimination kinetics resulted in comparable results with correlation coefficients of r = 0.80 and they were in accordance with the literature data; so this examination can be carried out without surplus NaI-123 injection, as well. The only significant difference was observed in some sportsmen who, after discontinuing the competitions, had a minimal delay of the HDA-kinetics in the septal region, where the echo-CG registered septal hypertrophy, as well. Otherwise the data of the HDA-kinetics, of the 201-T1 uptake and wash-out redistribution were in agreement with the results of the global and regional left ventricular ejection fractions, with the ECG at rest and during ergometric stress with the mechano-CG and with the cardio-volumetry, all exhibiting overlaps in the normal range between the sportsmen and healthy controls.

Adult↗