Hormonal supply during physical exercise in elderly patients with ischemic heart disease

30 males, suffering from ischemic heart disease (IHD), and stable exertional angina pectoris, whose age ranged from 60 to 74 years and also 15 apparently healthy volunteers of the same age participated in the study. The IHD patients' blood displayed increased basal levels of adrenocorticotropic hormone (ACTH), cortisol, and met-enkephalins. During graded physical exercise two types of hormonal system response were established: in the first group of patients the plasma ACTH and cortisol levels were seen to rise at maximal threshold load, while in the second group the content of the above hormones declined. The first group of patients showed a less economical hemodynamic response to standard loading in comparison to the second group. A relation was found between changes in hemodynamic system and function of pituitary-adrenal system in elderly IHD patients during physical exercise. Inadequate ACTH and cortisol increase in the course of effects of stress contributed to IHD aggravation in old age, along with reduced tolerance to physical exercise. beta-Adrenoblocker, propranolol, influenced both types of hormonal response, thereby diminishing their shifts in physical stress.     

Dynamic observations of tolerance to physical exercise in patients with ischemic heart disease during drug therapy]

Proceeding from a dynamic observation of the tolerance of physical exercises in the process of drug therapy of 90 patients with ischaemic heart disease the author concludes that a certain dissociation exists between the subjective effect of the antianginal drugs and the results of bicycle tests in the evaluation of the efficacy of the treatment. While a subjective improvement was declared in 2/3 of the patients, the exercise test indices improved only in 1/3. The bicylce test before and after the therapeutic course seems to facilitate a more precise evaluation of the efficacy of the antianginal drugs.     

Hemodynamic support of physical loads in patients with ischemic heart disease and a permanent artificial pacemaker

A study, using noninvasive monitoring during bicycle ergometry, was carried out to assess hemodynamic support of physical stress in coronary patients with implanted pacemaker (IPM). Heart contractility of IPM-carrying coronary patients was reduced, with capacity for compensation diminished even at rest, while exercise contributed to further deterioration of those. Adequate hemodynamic support of stress was only observed in patients belonging to the second functional class.     

Hemodynamic effects of sildenafil in patients with stable ischemic heart disease

Background: Recently the new specific phosphodiesterase-5 inhibitor sildenafil was introduced into therapy for erectile dysfunction. The hemodynamic effects of sildenafil may be potentially hazardous for patients with cardiac disease. Sildenafil has been reported to augment the hypotensive effects of nitrates. There is sparse information regarding the systemic and pulmonary hemodynamic effects of a single oral dose of sildenafil in patients with stable angina. Methods: Male patients referred for coronary angiography with diagnosis of chronic stable angina were enrolled in this study to assess the acute hemodynamic effects of sildenafil. Patients receiving long-acting or sublingual nitrates for the last 6 h before the study were excluded. Hemodynamic measurement were taken during right and left heart catheterization in the basal state and 60 min after 50 mg of oral sildenafil. Results: Twelve patients (age 53±7 years) were studied. All had stable angina CCS class II or III. Four had previous myocardial infarction. By coronary angiography, seven patients had at least one coronary artery with >70% stenosis, four had at least one with 50–70% stenosis, and one had only intimal irregularities. There were no significant effects of sildenafil on systemic or pulmonary arterial pressure, left ventricle endiastolic pressure, cardiac output, and systemic or pulmonary vascular resistance (P>0.05 for all). No adverse events were observed. Conclusion: A single oral dose of sildenafil had no significant hemodynamic effect in supine patients with stable angina. Isolated administration of sildenafil does not appear to be associated to adverse cardiovascular effects.     

Trimetazidine improves exercise tolerance in patients with ischemic heart disease

Aim

This study aimed to evaluate the effect of trimetazidine (TMZ) in addition to standard treatment on exercise tolerance in patients with ischemic heart disease (IHD).

Methods

Studies were identified via a systematic search of PubMed, Embase, Cochrane Library, and the Chinese CNKI databases from January 1978 to January 2015. Data extraction, synthesis, and statistical analysis were performed by standard meta-analysis methods. Random or fixed effects models were used to estimate pooled mean differences in total exercise duration (TED), peak oxygen uptake (pVO₂), metabolic equivalent system (METS), and 6-minute walking test (6-MWT).

Results

In all, 16 randomized controlled trials (RCTs) consisting of 2,004 participants were included. Pooled results showed that TMZ treatment significantly improved TED (WMD: 37.35, 95?% CI: 25.58–49.13, p?<?0.00001), pVO₂ (WMD: 2.41, 95?% CI: 1.76–3.06, p?<?0.00001), METS (WMD: 1.33, 95?% CI: 0.38–2.28, p?=?0.006), and 6-WMT (WMD: 62.46, 95?% CI: 35.86–89.05, p?<?0.001) in all patients with IHD. Subgroup analysis showed that TMZ significantly increased TED in nondiabetic participants (WMD 34.77, 95?% CI: 22.28–47.25, p?<?0.001), but not in diabetic participants (WMD: 40.36, 95?% CI: ??18.76–99.48, p?=?0.18). And, subgroup analysis of TED by intervention duration suggested that there is no statistically difference between the 3-month and 6-month periods (WMD: 35.47, 95?%CI: 18.35–52.60, p?<?0.0001 and WMD: 49.94, 95?%CI: 44.69–55.19, p?<?0.00001). In addition, TMZ improved TED (WMD: 50.01, 95?% CI: 44.77–55.25 and WMD: 24.20, 95?% CI: 12.72–35.68) in IHD patients with or without heart failure (HF), respectively.

Conclusion

Addition of TMZ to standard treatment significantly improved exercise tolerance in patients with IHD, and IHD patients with HF may experience even more benefits. However, there is insufficient evidence to show that TMZ has beneficial effects in participants with diabetes.

     

Hemodynamic time course of acute and chronic isosorbide dinitrate treatment at rest and during exercise in patients with stable ischemic heart disease

Hypothesis: The study was undertaken to establish differences between venous and arterial isosorbide dinitrate (ISDN) effects during acute and chronic treatment, hemodynamics at rest, and during supine exercise. Methods: These effects were assessed invasively in 16 patients with stable ischemic heart disease before and at hourly intervals for 4 h after administration of peroral 30 mg ISDN. Eight patients were previously untreated (acute group), and eight were treated with 30 mg ISDN asymmetrically b.i.d. for two weeks (chronic group). Results: Prior to ISDN administration, right atrial, mean pulmonary artery, pulmonary artery wedge, and mean arterial pressure (RAP, MPAP, PAWP, and MAP) rose from normal resting to pathologic values during exercise. One h after ISDN administration, all exercise pressures were normalized (p<0.001). During the following 3 h, exercise RAP rose similarly in both groups (p<0.01), while MPAP rose particularly in the chronic group (p<0.001). Exercise PAWP and MAP, however, remained low in the acute group, but increased markedly in the chronic group (p<0.01), particularly from the third to the fourth hour after ISDN. Conclusion: The daily, asymmetric administration of 30 mg ISDN b.i.d. maintained beneficial, anti-ischemic effects for 2 to 3 h after a morning dose of the drug, but thereafter attenuation of the effects occurred in the arteries but not in the veins.     

Changes in the hormonal profile in patients with ischemic heart disease during physical training

Changes in blood insulin, thyroxine, triiodothyronine, thyrotropin, somatotropin, corticotropin, cortisol, and aldosterone were defined in 46 male patients with coronary heart disease during daily graded exercises performed on a bicycle ergometer for 30 days. The exercises led to improvement of health in 44 patients. There was a significant reduction in baseline insulin and aldosterone levels and a tendency to lower corticotropin and triiodothyronine concentrations. The amounts of somatotropin, thyrotropin, thyroxine, and cortisol failed to greatly change during the exercise.     

Physiologic aspects of exercise in elderly patients with ischemic heart disease

Starting from the physiological involution processes and the pathophysiological disorders of the cardiological functions, performance-limiting factors have been worked out. Any physical conditioning taking the mentioned limiting factors into account may have a function-improving and performance-improving effect (extension of the performance amplitude, economization of master in loads, psychic stabilization, reduction of risk factors, etc.). In the planning and organization of physical conditioning specific methodical aspects for training have to be taken into account, for example, preferred endurance exercises (running, walking, swimming, etc.), physiological design of the training hours, individual level of intensity, and an indication-related planning of the extent of training. Furthermore, also contra-indication have to be observed which may restrict exercise tolerance (stage of performance, regulation of blood pressure, dysrhythmia, etc.).     

Hemodynamic effects of intravenously administered magnesium on patients with ischemic heart disease

Central hemodynamic parameters were registered by right-side heart catheterization before and after intravenous administration of 12 mmol magnesium chloride (MgCl) in 15 patients with chronic ischemic heart disease and heart failure, New York Heart Association classes II and III. Serum magnesium concentrations increased from 0.76 +/- 0.03 (mean +/- SD) to 1.54 +/- 0.05 mmol/l, which resulted in a reduction in mean arterial as well as pulmonary artery pressure by 10% (p less than 0.0001) and 7% (p less than 0.05), respectively. This reduction was caused by a marked decrease in systemic as well as pulmonary vascular resistance (from 1323 +/- 205 to 1132 +/- 158 dyn.s/cm5, p less than 0.001 and from 156 +/- 73 to 133 +/- 72 dyn.s/cm5 (p less than 0.05). Heart rate, cardiac index, stroke volume index, and stroke work index increased slightly, although these differences did not reach statistical significance. Right and left ventricular filling pressures were not influenced, which indicates that the dilatory effect of magnesium, at the dosages used in the present study, is pronounced only at the arterial side of the vascular bed. The observed hemodynamic effects of the magnesium infusions may be beneficial in the setting of an acute myocardial infarction by reducing left ventricular afterload, which, together with the antiarrhythmic effect of magnesium may contribute to the positive effect of magnesium infusions on mortality in patients with acute myocardial infarction.