摘要:

During the 1980s, cardiac transplantation has become the accepted form of treatment for selected patients with end-stage heart disease. Although 5-year survival is currently 85 percent, patients have complicated courses after surgery with an ever present risk of infection and graft rejection. Immunosuppressant drugs enable the recipient to tolerate the donor heart but have a constellation of side effects. The emotional reaction to the transplant process is complex and intense. A majority of patients display minor psychological problems after transplantation and may benefit from counseling. However, patients generally report a favorable quality of life after transplantation although most patients have below normal aerobic exercise capacities. Because of physical inactivity and severe limitation of cardiac output with resultant deconditioning preoperatively, and the need for psychosocial support postoperatively, these patients are excellent candidates for comprehensive cardiac rehabilitation services. As a result of denervation, the transplanted heart does not have autonomic nervous system modulation of cardiac output and instead relies on circulating catecholamines for augmentation of heart rate during physical activity. Exercise training results in improvement in maximal oxygen uptake and physical work capacity. There are no data to suggest that cardiac rehabilitation practices improve longevity or return to pre-illness lifestyle.

ISSN:0883-9212    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The purpose of the present study was to determine if there is a significant correlation between the ratio of physiological deadspace to tidal volume (VD/VT) and the severity of pulmonary hypertension at rest or during maximal exercise in patients with chronic airflow obstruction (CAO). Twenty-five patients with moderate CAO were studied at rest and during incremental exercise testing. The resting pulmonary artery pressure (PAP) was not significantly correlated with resting VD/VT(r = −0.17), the VD/VTat maximum exercise(r = −0.16), or the change in VD/VTfrom rest to exercise (r = −0.04). With multiple stepwise regression the resting PAP was found to depend both upon the change in SaO2from rest to exercise and the workload (multiple r = 0.55), but there was no significant reduction in the variance when the VD/VTat rest or maximum exercise was added. Similarly, the PAP at maximal exercise was not correlated with the resting, exercise, or change in VD/VT. Although the VD/VTdid not correlate with the PAP, the change in the VD/VTwas significantly correlated with the change in tidal volume (r = −0.61). From this study we conclude that there is no significant relationship between the resting, maximal exercise, or change in VD/VTand the resting or maximal exercise PAP in patients with CAO. Furthermore, even with multiple regression analysis, the PAP cannot be predicted non-invasively with various measures of resting or exercise pulmonary function.

ISSN:0883-9212    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Among 125 patients with a positive Bruce protocol treadmill examination 108 had pain during the test, while 118 had no pain (“silents”). All patients had a second treadmill test about 1 year later (mean interval between the two tests 11.8 ± 7.9 months). Among the patients with pain, the second test was also painful in 59 % and became silent in 41 %. Among the patients with a silent first test, 81 % remained silent during the second test as well and 19 % experienced pain. There was no significant difference in age, sex, previous myocardial infarction, the time interval between the two tests, and a change or lack of change in drug therapy between the patients whose test remained silent or remained painful or those who turned from painful to silent or vice versa. In the patients who had a painful first but a silent second test, the exercise duration and the time to 1 mm ST depression became longer in the second test. In the patients who had a silent first test and turned into painful, there was no change between the parameters of the two tests. In the patients who changed their symptomatology, alteration in drug therapy seemed not to be responsible for the change. Thus, it seems that a silent treadmill test is a good predictor for a silent second test about 1 year later, but a painful treadmill test is somewhat less predictive for a second painful test as this may turn into a silent one in about 40% of patients.

ISSN:0883-9212    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Coronary artery bypass grafting (CABG) is a well-established and common surgical procedure for the treatment of coronary artery disease (CAD). Although CABG is associated with increased survival, especially in patients with left main or 3-vessel disease, the effects of CABG on measures of cognitive performance are less well known. This review examines the incidence and severity of cognitive impairment after CABG and suggests that future research will need to consider issues of cognitive functions, as well as morbidity and mortality, in evaluating the efficacy of treatments for CAD.

ISSN:0883-9212    

出版商:OVID    

年代:1990

数据来源: OVID

ISSN:0883-9212    

出版商:OVID    

年代:1990

数据来源: OVID