Application of Inspiratory Muscle Training to Improve Physical Tolerance in Older Patients with Ischemic Heart Failure.

Regardless of the management regime for heart failure (HF), there is strong evidence supporting the early implementation of exercise-based cardiac rehabilitation (CR). Respiratory therapy is considered to be an integral part of such secondary prevention protocols. The aim of the study was to evaluate the effect of inspiratory muscle training (IMT) on exercise tolerance and the functional parameters of the respiratory system in patients with heart failure involved in cardiac rehabilitation. The study included 90 patients with HF who took part in the second-stage 8-week cycle of cardiac rehabilitation (CR). They were randomly divided into three groups: Group I underwent CR and IMT; Group II only CR; and patients in Group III underwent only the IMT. Before and after the 8-week cycle, participants were assessed for exercise tolerance and the functional parameters of respiratory muscle strength. Significant statistical improvement concerned the majority of the hemodynamic parameters, lung function parameters, and respiratory muscle strength in the first group. Moreover, the enhancement in the exercise tolerance in the CR + IMT group was accompanied by a negligible change in the HRpeak. The results confirm that the addition of IMT to the standard rehabilitation process of patients with heart failure can increase the therapeutic effect while influencing some of the parameters measured by exercise electrocardiography and respiratory function.

Influence of Inspiratory Muscle Training of Various Intensities on the Physical Performance of Long-Distance Runners.

The aim of this study was to assess the efficacy of inspiratory muscle training (IMT) at different intensities on the pulmonary function and physiological adaptations of long-distance runners undergoing sports training. This study involved 25 long-distance runners. The subjects were randomly divided into three groups depending on the type of IMT applied: POWERbreathe device (group 1), Threshold IMT device (group 2), and a control group. The following lung variables were evaluated: vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF). Respiratory muscle strength was assessed by maximum inspiratory pressure (PImax) and maximum expiratory pressure (PEmax). Spiroergometric measures included: heart rate (HR), oxygen uptake (VO2max), carbon dioxide production (VCO2max), maximum ventilation (VE) and respiratory exchange rate (RER), which were measured breath by breath using a gas analyser (VYNTUS CPX). Group 1, which used the POWERbreathe device, showed significant increases in all assessed physiological and physical performance variables. In group 2, which used the Threshold device, only VO2max, VE and tRER ventilation were significantly increased to a similar level as that observed in group 1. In the control group, we only observed a significant reduction in saturation. The use of IMT with a higher intensity resulted in significant improvements in all tested variables of lung ventilation and respiratory muscle strength. Also, after training, lactate accumulation was significantly decreased. Physiological characteristics (VO2max/kg) and muscle respiratory strength variables were significantly improved in the group that used the POWERbreathe device after 8 weeks of training.

Pheochromocytoma of the adrenal gland selectively secreting dopamine -- a case report.

Pheochromocytoma of the adrenal gland secreting catecholamines is a relatively rare endocrinological cause of secondary arterial hypertension, usually developing in people aged between 40 and 50, more often in women than in men. Each accidentally diagnosed lesion in adrenal glands is an incidentalom0a. Incidentalomas are most commonly benign tumours: adenomas, adipomas and angiomas; less often they are of a malignant or metastatic character. Establishing the character of the lesion and its hormonal activity is of crucial diagnostic significance. Diagnostics of pheochromocytoma covers marking the urine output of catecholamines and their metabolites, as well as marking serum amine concentration. Possible treatment of hormonally active lesions includes their surgical removal. This thesis presents the case of a young female suffering from arterial hypertension for several years, including organ complications, who was diagnosed with pheochromocytoma selectively secreting dopamine.

Comparison of left ventricular function by tissue Doppler imaging in patients with diabetes mellitus without systemic hypertension versus diabetes mellitus with systemic hypertension.

Because diabetes mellitus substantially increases the risk of development of heart failure, we sought to establish early alterations in left ventricular systolic and diastolic function in patients with diabetes mellitus with and without coexisting systemic hypertension. We studied 134 subjects using echocardiography comprising standard 2-dimensional and conventional Doppler as well as tissue Doppler imaging. Our study demonstrated the early appearance of both left ventricular systolic and diastolic dysfunction in diabetic patients at rest and the contributory effects of diabetes to myocardial impairment produced by hypertension, as well as the high usefulness of tissue Doppler imaging in detection and quantitation of myocardial dysfunction in diabetics. This method was superior to other echocardiographic techniques and plasma brain natriuretic peptide evaluation.

Relation between heavy metals and left ventricular diastolic function in patients with coronary artery disease.

One of the earliest detectable abnormalities in patients with coronary artery disease is left ventricular diastolic dysfunction. Its main cause is myocardial ischaemia, but still many of other mechanisms are possible. The aim of this study was to investigate the relation of cadmium, lead, copper, zinc, and selenium with left ventricular diastolic function indices in patients with coronary artery disease. The study included 33 patients (14 with single-vessel disease and 19 with multivessel disease on angiography) who were not exposed occupationally to heavy metals. Control group consisted of 18 patients with normal coronary arteries. The blood cadmium and lead concentrations and serum zinc, selenium and copper concentrations were determined using atomic absorption spectrophotometry. Left ventricular diastolic function parameters were estimated by echo-Doppler and colour M-mode. All heavy metal concentrations were within the standard ranges in all studied groups. Patients with single-vessel disease, multivessel disease and control group did not differ in concentrations of studied metals. On univariate and multivariate analysis only cadmium significantly correlated with echocardiographic parameters of left ventricular diastolic function: peak early to peak late mitral inflow velocity ratio (r = -0.36, p < 0.05) and deceleration time of early mitral inflow (r = 0.43, p < 0.01) in patients with CAD. No significant correlations between concentrations of heavy metals and indices of left ventricular diastolic function were found in control group. The present data suggest that cadmium in concentrations even below the threshold limit value for unexposed population may contribute to development of left ventricular diastolic dysfunction in patients with CAD, potentializing the effect of myocardial ischaemia.

[Thrombocytopenia and disseminated intravascular coagulation in a patient with left atrial myxoma--a case report]. / Maloplytkowosc i zespól wykrzepiania sródnaczyniowego u chorego ze sluzakiem lewego przedsionka.

A case of a 47-year-old man, a Jehovah's Witness, with left atrial myxoma is presented. Clinical presentation included several months of thrombocytopenia and disseminated intravascular coagulation. Deterioration of heart failure was complicated by pneumonia and worsening of disseminated intravascular coagulation. Therapeutic challenges related to patient's religious beliefs are discussed.

[Renal artery aneurysm as a cause of resistant hypertension in a young female--case report]. / Tetniak tetnicy nerkowej przyczyna opornego na farmakoterapie nadcisnienia tetniczego wystepujacego w mlodym wieku.

A case of a 19-year-old woman suffering for 5 years from pharmacologically resistant hypertension, is presented. During invasive diagnostic procedures left renal artery aneurysm was found. Surgical resection with vessel prosthesis implantation was successfully performed. Examination carried-out 6 months later revealed good response to pharmacological treatment with normal levels of blood pressure.