[Changes in left ventricular function with effort in the coronary patient. l]. / L'altération de la fonction ventriculaire gauche à l'effort chez le coronarien.

The altered haemodynamics of the coronary patient have been investigated in 30 patients both at rest and under conditions of maximal effort as carried out on the bicycle ergometer under the usual conditions for an exercise electrocardiogram. Patients with angina of effort but no previous infarction have normal left ventricular function at rest; under the ischaemia induced by exercise there is acute dysfunction of the left ventricle as witnessed by a reduction in maximal cardiac output, a raised end-diastolic pressure, and changes in compliance which are more marked than those in contractility. Patients with a healed infarct but without sequelae have a rigid left ventricle, but it is not failing; they show normal changes in dP/dt max and in the indices of left ventricular work, but a pathological form of negative peak of dP/dt, of end-diastolic pressure, and of deltaP/deltaV (which reflects myocardial compliance). Patients who have had an infarction with sequelae such as angina or attacks of left ventricular failure have filling pressures which are already elevated at rest, and cardiac failure, which becomes evident on exercise.

[Value of readaptation after myocardial infarction. Apropos of 100 cases]. / Intérêt de la réadaptation après infarctus du myocarde. A propos de 100 cas

The short-term and mid-term readaptation of 10000 patients has been studied by means of 400 follow-up exercise tests and a very detailed questionnaire. The effects of physical training are at their maximum at between 9 and 12 months, with an increase in exercise capacity of 26% occuring between one and a half and nine months post-infarction. This improvement in capacity for work seems to be due exclusively to a peripheral mechanism originating from an economy in the work of the heart. Although it does not totally relieve them of their anxiety, a training programme gives the patients an attitude of mind which helps them to regain their socioprofessional position. 82% of the trainees who still had a professional position were able to restart work within an average period of 5 months. Since we have not been able to make up an adequate control group, we have not been able to assess the effect of training on the natural history of coronary artery disease.