[The effects of bicycle ergometry on the peak flow value of a patient with bronchial asthma].
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Bicycle exercise test, load myocardial 99mTc pyrophosphate (99mTc-PYP) scintigraphy and echocardiography were performed in 42 women with chronic tonsillitis between the ages of 18 and 35 years. Of the 21 patients with chronic decompensated tonsillitis combined with ventricular extrasystole and horizontal ST segment depression during the exercise test 18 exhibited diffuse myocardial 99mTc-PYP uptake. Patients with positive scintigraphic findings had reduced index of left-atrium emptying compared with controls and patients with a negative 99mTc-PYP test finding.
In 75 men with uncomplicated acute myocardial infarction early symptom-limited submaximum bicycle ergometric test was performed 24-48 hours before discharge from hospital. 32 patients (42.7%) showed a positive test (ST-depression greater than 0.1 mV with duration of greater than or equal to 0.08 s and/or angina pectoris). The prognosis assessed by the number of cases with unstable angina pectoris, recurrent myocardial infarction or sudden death in the patients with positive test is significantly worse (p less than 0.0001). The patients with positive early bicycle ergometric test are indicated for direct examination and are potential candidates for aortocoronary bypass or percutaneous transluminal coronary angioplasty. An algorithm for attitude toward patients with uncomplicated acute myocardial infarction is presented.
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Fifty six patients were studied while in the Coronary Care Unit: 17 with unstable angina and 39 with acute myocardial infarction. All patients underwent dobutamine stress testing (doses of 5, 10, 15 and 20 micrograms/kg/min every 5 min) and exercise testing (modified protocol to finish at an energy expenditure of approximately 5 METS): 4-5 days after the last crisis of angina or 6-8 days after the onset of noncomplicated acute myocardial infarction. The heart rate increased from 72 +/- 10 to 104 +/- 12 beat/min with dobutamine (p = 0.00001) and from 84 +/- 11 to 118 +/- 15 beat/min with exercise testing (p = 0.00001). The systolic blood pressure increased from 116 +/- 9 to 138 +/- 11 mmHg with dobutamine (p = 0.00001) and from 117 +/- 8 to 156 +/- 7 mmHg with exercise testing (p = 0.00001). Due to different reasons 33 patients did not finish the exercise protocol, while only 8 patients did not finish the dobutamine testing. The ST segment wast elevated in 22 cases with dobutamine and in 9 cases with exercise, eight of them coinciding in both tests. The ST segment was depressed in 36 cases with dobutamine and in 21 cases with exercise, 20 of them coinciding in both tests. Angina was present in 11 cases with dobutamine and in four exercise, three of them coinciding. If the unfinished tests or those with angina or ST segment depression are considered abnormal, there were 40 abnormal tests with dobutamine and 38 with exercise, 32 of them coinciding.(ABSTRACT TRUNCATED AT 250 WORDS)
With the aid of a Siregnost FD 5, modified with a reference resistance of 2 kPa/l/s, measurements of the oscillatory airway resistance were carried out in 16 healthy subjects and 22 patients with asthma aged between 7 and 22 years, during and after physical exercise. As a consequence of increasing turbulent flow, in the case of the patients with healthy airways, a significant increase in the airway resistance (RmOS) occurred under conditions of physical exercise, which was due to the most part to an increase in the phase angle. Initial measurements with the custo vit suggest that the used reference resistance in the FD 5 is responsible for this. In the case of asthmatic patients, the average increase in RmOS was more marked. However, two groups of patients were differentiable: in the first group, under conditions of exercise, a decrease in the initially slightly elevated airway resistance occurred, while in the other patient group the airway resistance remained unchanged at a high level, even after exercise. In two patients, marked obstruction occurred on conclusion of the exercise examination. In one of the subjects with supposedly healthy airways, a bronchospasm developed during physical exercise and made it necessary to abandon the examination. Thus, there can be no doubt as to the clinical relevance of such measurements during and after physical exercise.
For determination of the endurance limit range, 8 healthy male probands aged between 20 and 26 years loads had carried out for one hour on a bicycle ergometer at an ambient temperature of +20 degrees C, +28 degrees C and +35 degrees C. Staying in an ambient temperature of 35 degrees C leads to a decrease in the physical endurance limit in an order of magnitude of 10 W. At 20 degrees C, in the endurance range the following values result (mean +/- s): load 68+/- 10.3 W, heart rate 113.6 +/- 5.8 beats per min., net heart rate 31.8 +/- 2.4 beats per min., oxygen uptake 1340 +/- 170 ml per min., auditory canal temperature 36.5 +/- 0.24 degrees C, sweat rate 275 +/- 143 g. At 35 degrees C, the endurance limit is attained at the following values: 57 +/- 10.6 W, heart rate 125 +/- 11.8 beats per min., net heart rate 27.4 +/- 3.6 beats per min., oxygen uptake 1210 +/- 130 ml per min., auditory canal temperature 37.2 +/- 0.3 degrees C, sweat rate 577 +/- 96 g.
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The chronological relationship between the S2 of the phonocardiogram and the T wave of the ECG, and the behaviour of the QT and QTc intervals, have been investigated in two cases of idiopathic long QT syndrome (LQTS) at rest and during effort. At rest and during effort with heart rates (HR) under 120/min, the S2 is always abnormal before the end of the T wave where the QTc interval is generally prolonged, but is sometimes within normal range (less than or equal to 440 msec). In cases where the QTc interval falls within normal range, the use of Bazett's formula to calculate the QTc interval may mislead and cause the existence of LQTS to be overlooked. Study of the chronological relationship (timing) between S2 and T wave is a reliable method of detecting LQTS even with a normal QTc interval. During ergometer exercise, if we observe (as in our two cases) not only a normal acceleration of the HR but a shortening and even a normalization of the QTc interval, therapeutic abstention (betablockers) may be recommended in asymptomatic LQTS. It is concluded that (1) in LQTS at rest and with HR under 120/min, S2 is always abnormal before the end of the T wave, (2) study of the timing S2/T wave is a reliable method of detecting the existence of LQTS even with a normal QTc interval, (3) in asymptomatic LQTS where the QTc interval shortens or falls within normal range during effort with S2 appearing at the end of the T wave, as reported in our first case, therapeutic abstention (betablockers) may be recommended.
Fourteen patients with chronic aortic regurgitation (AR) underwent radionuclide angiography at rest and during supine exercise with ergometric controls. Ten subjects without evidence of heart disease were taken as controls. The behavior of heart rate, ST segment and R wave amplitude were analyzed at peak exercise in relationship with ejection fraction (EF) changes. Abnormal EF, (defined by an increase less than 10%, no change or decrease respect EF control), was present in 9 of 14 patients. Five of 14 patients had normal EF response to exercise defined by an increase of 10% or more than control value. Sensitivity and specificity of heart rate changes at exercise (abnormal: less than 10 beats to MET) to identify abnormal EF were 10% and 100%, respectively. The analysis of ST segment alterations at peak exercise (abnormal more than 2 mm ST depression) to the same objective showed 33% of sensitivity and 80% of specificity. Changes in R wave amplitude (abnormal: increase, no change or decrease less than 22% R wave amplitude at control) at peak exercise had 100% sensitivity and 80% of specificity to identify abnormal EF. Our results suggest that exercise test could be useful to analyze the response to left ventricular function during stress in patients with AR. Changes in R. wave amplitude at peak exercise appeared the best parameter.
Tidal volume, respiratory frequency, ventilatory equivalent, mean inspiratory flow Vt/Ti, and respiratory timing Ti/Ttot were measured at each level of an incremental exercise in a group of 8 untrained boys. Breathing pattern of the child is characterized by a fast frequency and a small tidal volume. Ventilation at maximal exercise reaches 50% of adults mean value. For the same ventilation, Vt/Ti (when expressed in ml X mn-1 X kg-1) is higher in the child. That suggests a higher central inspiratory activity.
The present study was undertaken to define the response of plasma beta-endorphin immunoreactivity (ir-BE) to exercise of increasing intensity. Nineteen healthy males performed continuous exercise for 32 min on a cycle ergometer, comprised of 8-min bouts at %VO2max approximating 25, 50, and 75% of maximal exercise. Venous blood samples were collected before exercise (T = -20 and 0 min), during exercise (T = 8, 16, 24, and 32 min), and in recovery (T = +15, +30 min). Ir-BE in plasma was measured by radioimmunoassay using Immuno Nuclear assay kits. Plasma ir-BE level (pg X ml-1) was not altered from pre-exercise (18.3 +/- 1.3) after 8 min of exercise at 25 and 50% VO2max intensity; however, ir-BE rose significantly after 8 min of 75% VO2max work intensity (27.1 +/- 2.4) and was further elevated at maximal exercise (74.1 +/- 8.6). Ir-BE level remained elevated 15 min (60.9 +/- 8.1) and 30 min (35.2 +/- 5.2) post-exercise. The response pattern was further characterized by a significant (P less than 0.05) inter-individual variation, both at rest and during exercise; also, regression analysis indicated the ir-Be levels attained at maximal exercise were inversely related to the relative VO2max (ml X kg-1 X min-1) of the subject (predicted ir-BE = 248.2 - 3.39 VO2max; r = -0.397, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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In order to evaluate isopropylarterenol infusion (ISO) as a diagnostic procedure in ischemic heart disease, we performed a clinical study in 54 patients controlled with exercise stress test (ERGO) and validated by coronary arteriography. Eighteen patients had normal coronary arteriographic findings and 36 had coronary artery disease. In both groups the hemodynamic response was similar in either test used (ERGO or ISO), when similar heart rates were reached. The sensitivity of ERGO was 80.55% and 86.11% for ISO and specificity of 77.72% and 72.26% respectively in the diagnosis of coronary artery disease. When both tests are associated their sensitivity is 83.30% and their specificity is 75.0% (Table V). The ISO test was not accompanied with adverse effects and could be considered as a useful method in the diagnosis of coronary heart disease, similar to ERGO. Additionally ISO could be applied to understand some physiopathological mechanisms of ischemic heart disease.
The paper is concerned with the objectivization of qualitative assessment of a response to exercise testing during rehabilitation of patients after aortic valve replacement. The authors propose methods for a study of hemodynamic provision of submaximum and threshold exercises confirming significantly a higher myocardial reserve in patients after submaximum exercises. Hemodynamic characterization of different types of threshold reactions has shown that a common feature in the majority of patients is a decrease in cardiac ejection during exercise testing, mainly as a result of ino- or chronotropic depletion. A significant increase in the number of submaximum bicycle ergometric exercises is an important criterion of the efficacy of a rehabilitation program.