Effects of nifedipine on ventilation/perfusion matching in primary pulmonary hypertension.

The effects of nifedipine on hemodynamics and pulmonary gas exchange were investigated in two patients with primary pulmonary hypertension. After 20 mg of the drug taken sublingually, pulmonary and systemic vascular resistances decreased, cardiac output increased, and blood oxygenation was improved. As assessed by the multiple inert gas elimination technique, nifedipine induced a deterioration in ventilation/perfusion (VA/Q) relationships consisting in an increased perfusion of units with low VA/Q. In spite of this negative effect on gas exchange, arterial PO2 increased as a consequence of increased mixed venous PO2 in relation to an augmented cardiac output, and in one patient there was a decrease in the secondary atrial shunt. Both patients were clinically improved by the nifedipine as a long-term treatment.

Physical fitness does not reflect physical activity patterns in middle-aged workers.

Questionnaires and a sub-maximal exercise test were used to assess occupational and leisure time physical activity as well as physical fitness in a standardized prospective study in 2,565 Belgian and Slovakian middle-aged healthy workers. Less than 5% of the subjects engaged in strenuous work requiring an energy expenditure above 31.5 kJ.min-1. One-third of the Belgians and 50% of the Slovakians reported no heavy leisure time activity during the preceding 12 months. Physical fitness, defined as the workload at heart rate 150 beats.min-1 (standardized for body weight), was significantly higher in Slovakians as compared to Belgians (1.52 +/- 0.28 W.kg-1 and 1.48 +/- 0.28 W.kg-1; P less than 0.001). Occupational physical activity in Belgians and heavy leisure time activity in Slovakians were independently related to fitness levels. However, each activity score explained less than 1% of the variance of physical fitness. We conclude that in these mainly sedentary, middle-aged subjects, fitness levels are independent from the usual physical activity patterns.

Effects of molsidomine on exercise tolerance in patients with coronary heart disease.

We performed a double-blind crossover study with molsidomine in 10 patients with coronary heart disease. A single dose of molsidomine and placebo were given sublingually 1 hour before an exercise tolerance test. Molsidomine significantly reduced systolic blood pressure at rest and at all work-loads. There was also a significant reduction in electrocardiographic ST-segment depression at submaximal exercise. At maximal exercise the drug significantly increased symptom-limited oxygen consumption and total mechanical work. Molsidomine could prove useful in the treatment of angina pectoris. It has no adverse effects on pulmonary function.

[Experimental models for the pharmacologic study of anti-arrhythmia drugs]. / Modèles expérimentaux pour l'étude pharmacologique des anti-arythmiques.

In order to assess the value and therapeutic safety of an antiarrhythmic drug, it must be submitted to multiple tests, which reproduce as faithfully as possible the conditions observed in human pathology. The main experimental approaches are presented here: screening and control tests. For each test, the authors emphasize the various experimental factors limiting their interpretation and allowing the extrapolation to men.

From physical capacity to fitness to work in coronary patients.

The authors studied the energetic expenditures of 15 coronary patients during work. The subjects with reduced physical capacity tolerated a high fraction of their VO2 SL during their work with activity peaks close to their maximal capacity.

Intermittent claudication--epidemiology and natural history.

Epidemiological information on the prevalence, incidence and natural history of intermittent claudication and peripheral vascular disease is limited, partially by the limitation of techniques of their study. The available data from the literature are review and supplemented by results from an on-going survey the ankle blood pressure measurement with Doppler ultrasound.

[Appearance on effort of an image of a sub-epicardial lesion in the absence of signs of myocardial necrosis. Clinical, electrocardiographic and coronographic studies of 10 cases]. / L'apparition à l'effort de l'image de lésion sous-épicardique en l'absence de signes de nécrose myocardique. Etude clinique, électrocardiographique et coronographique de 10 cas.

A clinical, electrocardiographic and coronarographic study of ten cases shows that surelevation of ST-segment during exercise (without any signs of infarction) correspond to very different clinical situations of anatomical state of coronary vessels, occurrence of coronary spasm and evolution of the ischemic disease. "Inversed coronary Insufficiency" is proposed to design this syndrome. Practical recommandations are formulated.

[Physical activity, physical fitness and coronary disease]. / Activité physique, aptitude physique et affections coronariennes.

The relationship between physical activity on and off the job, physical fitness and coronary artery disease was investigated in a prospective study involving 2 363 men, 40 to 55 years old. Sudden death and myocardial infarction occurred in 31 subjects during a 5-year follow-up. Preliminary data are reported. There was no significant correlation between quartiles of physical activity on and off the job and incidence of coronary events. Physical fitness was significantly inversely correlated with incidence of coronary events (p less than 0.05) and was significantly lower in the 31 new cases (p less than 0.03). Multivariate analysis showed that HDL-cholesterol, smoking and physical fitness significantly and independently discriminate between coronary prone patients and healthy subjects. We conclude that physical fitness is an independent, inverse risk indicator of new coronary events.

[Rehabilitation of the coronary patient. Current concepts]. / La réadaptation du coronarien. Conceptions actuelles.

The principles of rehabilitation--or rather the long-term treatment--of the patient following myocardial infarction or coronary artery surgery have been defined for some time: a number of measures aimed at ensuring an optimal physical, social and psychological condition for the patient. However, the modalities of application of these principles have changed over the years, with earlier and earlier mobilisation, a briefer hospital stay, progressive physical training, early evaluation of the residual disease, a systematic psychological approach, secondary prevention and, finally, a more frequent return to work. Although the short-term results of these new approaches appear to be excellent, the long-term results are less encouraging. New research may modify our present therapeutic approaches, which are often purely empirical.

[Adaptation of the normal and ischemic heart to muscular exertion]. / Adaptation du coeur normal et du coeur ischémique à l'exercice musculaire.

The response of the cardiovascular system to muscular exertion whether dynamic or static, depends on several factors, such as sex, age, position, level of training, etc. If some physiological responses of the heart are well known, others remain debatable, especially the behavior of the telediastolic volume of the left ventricle. The ejection fraction of this ventricle is increased, essentially by improvement of the myocardial contractility. In ischemic cardiopathies, the behavior of the hemodynamic variables is more disputed than in the normal patient, and of course, depends before all on the area of the ischemic zone: the total performance of the heart depends on the interactions between zones which are little or not contractile and normal zones. Physical training could, in addition to its peripheral action have an action on the myocardial function on coronary patients.

[Contra-indications to sports activities in cardiac patients]. / Contre-indications à la pratique du sport chez le cardiaque.

The cardiologist is faced with the problem of eliminating a subject with heart disease from a sports competition and of prescribing beneficial physical activity to patients with heart disease. The difficulty in the prescription (or contra-indication) is due to the need for an individual assessment of each case. Several general rules can be proposed for cases of heart disease with a high risk of mortality or with a poor haemodynamic status. In most cases, the beneficial or detrimental effect can not be predicted. In this review, the authors present various approaches, based on data from the literature, for different types of heart disease and for different sports. They conclude that each case requires a thorough investigation in order to reduce the number of victims of the sports stadium.

[Early exercise test after myocardial infarction]. / Epreuve d'effort précoce aprés infarctus du myocarde.

Exercise tests of coronary function at the tenth day of an uncomplicated myocardial infarction offer objective evaluation of short-term benefits of an early accelerated physical retraining program. They also allow better individual adaptation of exercises prescribed at the start of convalescence at home. Exercise test results show significant correlation with clinical data and bicycle ergometer tests carried out two months after infarction, with respect to physical aptitude, reasons for discontinuation of test and lethality risk two months after infarction. This suggests that exercise tests performed after the acute phase of myocardial infarction are of diagnostic and prognostic value.