In this study we compared different dietary constituents and their effect on the angina threshold. We compared carbohydrate-rich, fat-rich and balanced liquid diets on effort tolerance in 14 patients of mean (range) 61 (41-73) years of age with chronic stable angina. On four different occasions at least 1 week apart, patients had exercise treadmill tests after an overnight fast and then after a rest period of 1 h ingested one of three different approximately isocalorific (about 4000 kJ) liquid drinks of 600 ml consisting mainly of: fat, carbohydrate or a balanced meal with an equal volume of water as control. Meals were given in random order. Analysis of the mean (SD) differences in heart rate between fasting and the post-prandial state for the different meals revealed a significant increase between water and the other meals, fat (+4(6) beats.min-1 P < 0.002), balanced (+9(17) beats.min-1 P < 0.004), and carbohydrate (+10(12) beats.min-1 P < 0.0002). There was no significant difference between the groups as regards systolic or diastolic blood pressure. Cardiac output increased following the meals but decreased after water; however, there was a significant difference between water and balanced meals. Exercise tolerance fell following all the meals but was significantly greater after a balanced (mean (SD) -108(129) s P < 0.01) and carbohydrate meal (-92(52) s P < 0.001). The reduction in exercise duration following a fat meal (-36(53)s) was not significantly different from that following water (-8(43) s) but was significantly smaller than after a carbohydrate meal (P < 0.02). Time to 1 mm of ST depression showed similar changes to that of total exercise duration, being significantly lower after a carbohydrate (mean (SD) -76(77) s P < 0.01) and balanced meal (-76(63) s P < 0.005). Time to 1 mm ST depression, although reduced by a fat meal (-15(84) s) was significantly less than after a carbohydrate meal (P < 0.02). In conclusion, patients with chronic stable angina have impaired effort tolerance and a lower angina threshold after high calorie containing liquid meals. Meals rich in carbohydrate have greater effects than meals where the majority of calories are derived from fat. Patients should be advised to avoid exercise in the first 30 min after eating.
Pronounced episodic oxygen desaturation in the postoperative period: its association with ventilatory pattern and analgesic regimen.
No abstract
Br Heart3' 1995;73:488 LETTERS TO THE EDITOR * The British Heart J7ournal welcomes letters commenting on papers that it has published within the past six months . * All letters must be typed with double spacing and signed by all authors. * No letter should be more than 600 words. * In general, no letter should contain more than six references (also typed with double spacing).Nocturnal hypoxaemia after myocardial infarction SIR,-Galatius-Jensen and colleagues' chose to monitor the arterial saturation and the electrocardiogram on days two to six after acute myocardial infarction (AMI). It is not clear why they did not study changes in the first 24 hours. We have communicated with all coronary care units in the UK and found that few prescribe oxygen in the first 24 hours and none routinely measures oxygen saturation. In a pilot study we also have found a high incidence of hypoxaemia in these patients (83% of those who did not receive oxygen) but we studied this in the initial 24 hours after admission with AMI. SIR,-We chose nocturnal monitoring because we expected more episodes of hypoxaemia at night. We chose to monitor the patients 2-6 days after acute myocardial infarction (AMI) and not during the first 24 hours partly for practical reasons but mainly because the finding of hypoxaemia and coincident electrocardiographic abnormalities in the subacute phase after infarction in a group of patients who were not predisposed to hypoxaemia would be a much more important finding. This is because oxygen saturation is not usually monitored 2-6 days after AMI. Unlike our study and other studies in patients with AMI,' with severe left ventricular heart failure,2 and postoperatively3 Wilson and colleagues surprisingly found no arrhythmias coincident with hypoxaemia in 50 patients with AMI.The high incidence of hypoxaemia after AMI may partly be explained by the use of opiates, as pointed out by Wilson et al: but we also found a high incidence late in the subacute phase of AMI when the use of opiates is limited. Also Hung et a14 often found hypoxaemia in 101 men 6-61 days after AMI, which suggests that there may be other important explanations for this phenomenon.We would be cautious about recommending monitoring with pulse oximetry and treatment of moderate hypoxaemia after AMI as standard procedure until their value has been evaluated. Trier Moller found a high incidence of hypoxaemia perioperatively, and though treatment reduced the extent of hypoxaemia it did not reduce the postoperative complications including those affecting cognitive function.
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