Cardiovascular reactions to physiological stimuli in the elderly and the relationship with the autonomic nervous system.

In order to evaluate age-related differences in autonomic nervous system control of the cardiovascular system, we studied two groups of healthy subjects of different ages by means of an autonomic function test, the posture test, applied before and after meals. Our results suggest that the reactions of the cardiovascular system to physiological stimuli such as meals or standing up, differ in elderly compared with young people, partly because age modifies the balance between the parasympathetic and the orthosympathetic nervous systems. In the elderly there is a progressive decline in parasympathetic function, which controls the initial heart rate response to standing up. Splanchnic blood pooling and possible hormonal secretions after meals may produce a drop in blood pressure due to cardiovascular modifications in the elderly. Other factors contributing to the different patterns found in the elderly may be reduced compliance of the vascular tree, a decreased baroreceptor response and decreased sympathetic activity.

[The correlation between left ventricular segmental kinesis and a Selvester QRS analysis in stabilized myocardial infarct]. / Correlazione tra alterazioni della cinesi segmentale ventricolare sinistra e analisi del QRS secondo Selvester nell'infarto miocardico stabilizzato.

We have studied the relationship between left ventricular segmental wall motion evaluated by means of biplane left ventricular cineangiography and the myocardial infarct size estimated using Selvester's scoring system based on the QRS of the electrocardiogram. Seventy consecutive patients with old myocardial infarction were recruited. All patients underwent diagnostic retrograde left heart catheterization including left ventriculography and selective coronary arteriography. Nineteen patients were excluded from the study due to intraventricular conduction disturbances and left ventricular hypertrophy. Of the remaining 51 patients, aged 33-76 years (mean 56 years), 31 had inferior or postero-inferior myocardial infarction (Group 1); 7 patients had combined anterior and inferior myocardial infarction (Group 2); 13 patients had anterior or antero-septal myocardial infarction (Group 3). The analysis of left ventricular segmental wall motion was performed according to the Collaborative Studies in Coronary Artery Surgery assigning at hypokinesia, akinesia and dyskinesia 1, 2 and 3 points, respectively. The values of statistical correlations between QRS scoring system and ventricular scoring were: r = 0.85 (Group 1); r = 0.78 (Group 2); r = 0.70 (Group 3). Our data indicate that Selvester's scoring system may provide useful information on functional status and on the extent of left ventricular wall motion abnormalities in patients with previous myocardial infarction.

[Influence of chronically-administered enalapril on isotonic and isometric exercise in patients with moderate grade hypertension]. / Influenza dell'enalapril in somministrazione cronica sul lavoro isotonico ed isometrico in pazienti ipertesi di grado lieve-moderato.

We studied 11 patients affected by mild essential hypertension during chronic therapy with enalapril (E). After a pharmacological wash-out the patients were treated with E once a day (10-20 mg) for 4 weeks. Before and after the treatment period the patients were studied by means of the isotonic exercise stress test on the cycloergometer with increments of 25 W every 2 min and by means of the Sustained Handgrip test (SHG) at 70% of maximal capacity for 1 min. During the study period E reduced the blood pressure at rest in all patients without untoward effects. During the isotonic test and particularly during SHG, E reduced systolic and diastolic blood pressure (BP) and the product systolic BP x heart rate. The treatment did not influence the time length of the isotonic exercise stress test. Our results suggest that E does not increase the MVO2 at rest and during different types of exercise: this can be very important because many patients affected by hypertension suffer from ischemic heart disease. E is utilized also in patients with heart failure, some of whom have an hypertensive or ischemic cardiomyopathy.

[Wall elasticity of the ascending aorta in ischemic heart disease]. / Elasticità parietale dell'aorta ascendente nella cardiopatia ischemica.

M-mode echocardiography was used to examine in male subjects the physical properties of the ascending aorta, 3 cm above the valvular plane. Subjects were divided into three groups based on age, lifestyle and presence or absence of vascular disease: Group A (10 recruited military young men, age 20.87 +/- 0.834 years) in good health; Group B (14 senior competitive athletes, age 49.92 +/- 8.17 years); Group C (10 patients with effort-angina, age 53.1 +/- 11.18 years). We observed that: the inner diastolic diameter of the ascending aorta was different between Group A and B (p < 0.001) and between Group A and C (p < 0.001), and it increased with aging (r = 0.7) whereas no relationship to body surface was seen (r = 0.3); the elasticity-stiffness parameters (aortic wall distensibility, aortic wall stress, wall stiffness index, wall elasticity index and modulus) of major vessels in senior athletes (Group B), were not different (p > 0.05) from military young men (Group A), although they were significantly lower (p < 0.001) in Group C patients; wall elasticity was lower in Group C patients (versus both Group A and B). Altered compliance might be the consequence of vessel structural changes and may contribute to reduce blood flow to the coronary arteries. Our data suggest that sports activity has beneficial effects; physical characteristics of great vessels do not show age-related changes.