[Kidney function tests in heart disease of pregnancy. III. Maximum tubal excretory capacity for para-aminohippuric acid (Tm PAH)].
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Twenty normal subjects and 25 patients with coronary artery disease underwent systolic time interval analysis before and after rapidly smoking two cigarettes. A slight increase in heart rate and arterial pressure was seen in both groups. In patients with coronary artery disease, preejection period/left ventricular ejection time ratio increased; in normal subjects it decreased. Left ventricular performance is diminished after cigarette smoking among subjects who have preexisting significant coronary artery disease.
A wide variety of specialized laboratory tests have been used to characterize prognosis and functional capacity soon after a patient has an acute myocardial infarction. Few attempts have been made to integrate the available data on these tests into clinically relevant guidelines for the clinician. This review evaluates the use of these tests, alone and in combination, throughout the course of recovery from acute myocardial infarction. The primary objective of these tests is to quantify myocardial ischemia and left ventricular dysfunction, the pathophysiologic basis of prognosis and functional capacity. The selection of one test over another depends on whether either test provides information on myocardial ischemia and left ventricular dysfunction not available through the standard clinical evaluation, and the risk, quality, and cost associated with each test. The stepwise application of specialized testing after acute myocardial infarction enables the identification of three groups of patients: approximately 20% at very high risk, due primarily to irreversible left ventricular dysfunction; approximately 30% at moderately high risk, due primarily to myocardial ischemia; and approximately 50% at low risk who are free of significant left ventricular dysfunction or myocardial ischemia. Accurate discrimination among these three groups enables the application of aggressive medical and surgical therapy to patients at moderate to high risk and accelerated recovery for patients at low risk. Specialized testing also helps to guide subsequent management after thrombolysis and revascularization procedures.
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1. An exercise test has been developed which is suitable for elderly or frail subjects. It is based on free walking at three different speeds on a level indoor course of 256m. The subject sets his own pace in accord with simple instructions. 2. Twenty-four elderly men and ten young men took part in the study. 3. The time and number of paces taken to cover two sections of 100m within the course were used to establish that the subjects walked steadily. Walking speed, pace frequency and stride length were then calculated. 4. Heart rate was obtained with body-borne tape recorders and related to the walking speed. The heart rate at a standard walking speed could then be obtained by interpolation. This is an assessment of the cardiovascular response to exercise (physical condition). The variation on repeating the test was +/-5 per cent and there was no significant difference between the two age groups. 5. The assessment was found to correlate moderately well with a conventional assessment of physical condition based on oxygen uptake from tests on a bicycle ergometer. 6. The test could also be used as a performance index since walking speed was characteristic for the subject. The younger group walked significantly faster than the older group. As a performance index the test is therefor sensitive to age differences.
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We carried out a three-dimensional (3-D) vector measurement of exercise-induced magnetocardiograms (MCGs) for normal subjects with a wooden and brass-based bicycle ergometer. MCGs were measured by a 3-D second-order gradiometer connected to 39-channel SQUIDs, which can detect magnetic field components perpendicular to the chest wall (Bz) and tangential to the chest wall (Bx, By) simultaneously. Time-frequency analysis was applied to rest times and exercise-induced MCG data. It was shown that the power spectrum of the ST segment was different between the rest times and exercise-induced MCG. Principal component analysis (PCA) was also applied to the result of time-frequency analysis and the time course of frequency for the ST segment was evaluated quantitatively. It found that dominant frequency of the ST segment in the rest time was ranged 5.5 to 6.5 Hz in all components. And it was clearly shown that the peak frequency of the exercise-induced MCG was shifted to 10.5 Hz compared to that of rest MCG.
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Thirty males with coronary heart disease were examined using bicycle ergometry and a combined statico-dynamic test. It was established that the latter was accompanied by a more rapid (as compared with bicycle ergometry) increase of the heart rate, the systolic arterial pressure, the value of "double multiplication" and, in contrast to dynamic exercise, by an elevation of the diastolic arterial pressure. During a combined test an anginal attack and displacement of the ST segment occurred earlier as against bicycle ergometry. The above characteristics of the hemodynamics during the statico-dynamic exercise justify the use of this test for studying the relationship of the coronary blood flow and myocardial contraction.