Rehabilitation modalities as a function of the severity of heart insufficiency

After a review of the different central and peripherical factors limiting exercise capacity in chronic heart failure, the authors report the mechanisms of these increment with exercise training. The different indications for clinical training techniques of segmental training on a specific bench are discussed; but it appears that both aerobic and repetitive weight programs seem to have short term favorable and complementary effects.     

心脏病康复治疗

<正>世界卫生组织将心脏病的康复治疗定义为:运用各种方式,确保心脏病患者处于最佳的身体、精神及社会状态;使他们靠一己之力,可以重新获得正常的社会地位,并过着有活力的生活。因此,心脏病康复治疗的目标即让患者恢复最佳的身体、精神及职业状态,且有效降低心脏病的发病率及死亡率。直至20世纪70年代以前,医学界都还认为急性心肌梗死后卧床并减少活动量是标准治疗的一部分。但50至60年代逐渐有研究发现,缺乏活动的心肌梗     

���IJ���������

随着人们生活水平的提高和体力活动的减少,冠心病的发病率逐渐增加。而人们对冠心病的认识已经不仅仅满足于治疗,而是需要全面提高健康水平和生存质量,因此,以运动为核心的冠心病康复逐渐成为理想的治疗手段。     

Assessment of right heart function in the athlete's heart

 It is known that the heart of an athlete has been physiologically adapted by prolonged training. There are a large number of echocardiographic studies which have focused on left ventricular wall thickness and dilatation, but there are few studies concerning right heart function in the athlete's heart. The aim of this study was to assess right heart function in elite athletes by conventional and new echocardiographic methods. The study population consisted of 36 elite highly-trained male athletes and 16 age-matched healthy sedentary controls. Right atrial, right ventricular, and inferior vena cava dimensions, and pulsed Doppler measurements of tricuspid inflow and right ventricular outflow were obtained, and systolic (preejection period, ejection time, preejection time/ejection time, QV peak, isovolumic contraction time) and diastolic (E peak, A peak, E/A ratio, decelaration time, isovolumic relexation time) function parameters were measured. The myocardial performance index was calculated as (isovolumetric contraction time + isovolumetric relaxation time)/ejection time. In addition, right ventricular systolic and diastolic functions were determined by Pulsed wave tissue Doppler imaging (S, E, and A velocities) at the lateral corners of the tricuspid annulus. The left ventricular mass index (P < 0.005), and right atrial (P < 0.001), right ventricular (P < 0.001), and inferior vena cava dimensions (P < 0.001) were significantly greater in athletes than in controls. Tricuspid E peak, A peak, E/A ratio, deceleration time, isovolumic relaxation time, preejection period, right ventricular ejection time, preejection time/ejection time, isovolumic contraction time, QV peak, and myocardial performance index were found to be similar in athletes and in controls (P > 0.05). Systolic, early diastolic, and late diastolic tissue Doppler imaging velocities were not significantly different in athletes and controls (P > 0.05). Left ventricular hypertrophy (LV mass index >134 g/m²) was found in 15 of the athletes. Right atrial dimension was greater in the athletes with left ventricular hypertrophy than in those without hypertrophy (P < 0.05). All right ventricular systolic and diastolic echocardiographic parameters were similar in athletes with and without left ventricular hypertrophy (P > 0.05). The results of this study indicate that right ventricular systolic and diastolic functions do not deteriorate in the athlete's heart despite significant chamber dilatation. They suggest that these changes are a normal physiologic adaptation to prolonged training. Received: November 28, 2001 / Accepted: March 8, 2002     

老年人的康复治疗与功能维持

老年病的康复过程包括康复评定和康复治疗.康复评定应涵盖病损、活动受限和参与障碍三个层面.老年病康复的最重要目标是提高老年患者的日常生活活动能力.康复治疗对老年病患者改善功能障碍,提高生活独立性,改善生活质量具有重要作用.     

老年心脏病的康复

中国是世界上人口最多的国家,也是老龄人口绝对数量最多的国家,其老龄化速度居世界之首。老年期的心脏病常随着年龄的增加和生活方式的改变,疾病谱发生变化,其中最明显的是冠心病发病率的增加,资料表明,当前中国冠心病发病率以每年3％的速度上升,其中绝大多数为老年和老年前期患者,因此在不久的将来,中国将有近半数老人患有心脏病,其中主要是冠心病。     

冠心病患者的康复

此文主要内容系作者为陈在嘉,高润霖主编的<冠心病>(2002年出版)的"第五十一章心脏康复",卓大宏主编的<中国康复医学>(第二版)的"第七十八章冠心病患者康复"撰写的内容.     

冠心病患者的康复(2006年版)

此文系作者为陈在嘉,高润霖主编的《冠心病》(2002年出版)的"第五十一章心脏康复",卓大宏主编的《中国康复医学》(第二版)的"第七十八章冠心病患者康复"的2006年修改稿.     

心力衰竭患者的运动康复

心力衰竭是多种心血管疾病终末期的共同转归,临床症状重,死亡率较高,给个人及社会造成重大负担.心脏康复可提供综合性干预治疗,其中运动锻炼部分日益受到重视.本文重点介绍运动锻炼产生效应的可能机制,并对其实施和评估作一综述.     

The endocrine function of the heart

Atrial cardiocytes in the heart of mammals produce in a regulated manner the polypeptide hormones atrial natriuretic factor (ANF, ANP) and brain natriuretic peptide (BNP). The biological actions of ANF and BNP are similar; they include the modulation of systems that tend to increase extracellular fluid volume and blood pressure, such as the renin-angiotensin system and the sympathetic nervous system. Additionally, both hormones have potent growth-regulating properties. ANF and BNP signal by activating membrane-bound guanylyl cyclase receptors, leading to an increase in intracellular cGMP and thus affecting the activity of cGMP-regulated enzymes and ion channels. Under chronic hemodynamic overload, cardiac ANF and BNP synthesis and secretion are increased. This increase is viewed as a cardioprotective mechanism, given the beneficial effects of ANF and BNP on cardiac preload, afterload and cardiovascular growth. As discussed in this review, some basic facts regarding the synthesis and secretion of ANF and BNP and their peripheral effects remain to be clarified. Nevertheless, at the clinical level, the elevation of circulating ANF and BNP in heart failure or following acute coronary syndromes has been shown to have diagnostic and prognostic implications. Moreover, these peptides themselves hold promise as therapeutic agents in the treatment of heart failure. Additional pharmaceutical applications might be gleaned from current preclinical and clinical studies showing beneficial effects of ANF or BNP in the treatment of hypertension, bronchospasm and in tissue remodeling following acute myocardial infarction.     

Diastolic function of the heart in clinical cardiology

During the last six years, there has been increased interest in the detection of abnormalities of left ventricular diastolic function in patients with heart disease. Before 1981, most studies on diastolic function were performed in the catheter laboratory using invasive techniques and complex methods. Recently, radionuclide angiograms and Doppler echocardiography have been employed to measure the dynamics of filling in normal individuals and in patients with heart disease. These methods are noninvasive, easy to perform, accurate, and reproducible. It is now clear that diastolic function may be altered globally and regionally, at rest and perhaps during exercise, in many patients with ischemic heart disease, hypertension, and hypertrophic cardiomyopathy. Interestingly, these diastolic abnormalities may even appear before systolic abnormalities are identified in these patients. Thus, diastolic abnormalities may permit assessment of presence of disease early in its evolution. Whether detection and quantitation of diastolic abnormalities will permit grading of disease severity or evaluation of therapeutic efficacy remains an important research question. At the present time, it appears that the decision to employ either radionuclide angiography or Doppler echocardiography for the assessment of diastolic abnormalities will depend on the local expertise to carry out the investigation. Both diagnostic modalities require standardization of accuracy and reproducibility with proper selection of control values from the appropriate populations of normal individuals. It is also important to remember that left ventricular diastolic abnormalities have to be identified after the elimination of the confounding influence of variables such as ejection fraction, heart rate, age, and preload (end-diastolic volume). Automation of the derivation of indexes of diastolic filling should provide an objective assessment of the dynamics of left ventricular filling. Although the value of measurement of diastolic filling in the individual patient remains controversial, we believe that the practice of cardiology is incomplete without consideration of the second half of cardiac function.     

Endocrine function of the heart in cardiac disease

An impressive amount of research has been produced in the last 8 years on the possible role of ANF in cardiovascular disease. This is a brief and non-inclusive review of this work. In particular, the potential significance of ANF in hypertension and congestive heart failure is discussed.