To evaluate the compliance of the elderly with cardiac rehabilitation (CR) after myocardial infarction, 370 consecutive patients greater than or equal to 65 years of age, admitted to our Coronary Care Unit over a period of 2 years, were examined: 48 died in the hospital, 34 were transferred to other wards and 29 were unable to perform a submaximal exercise test before discharge. Out of the remaining 259 patients, 43 began the CR and 32 completed it with a good outcome. Eleven patients interrupted the CR because of associated diseases. A social investigation was carried out on 83 of the 259 patients discharged from our ward. In addition to associated diseases and an extremely low exercise tolerance (41% of cases), the lack of participation was due to socioeconomic problems (9.5%), to lack of motivation (52.3%) and to inadequate information (38.1%). Nevertheless, 76% of patients indicated that they attained their previous way of life in a relatively short period of time. It is concluded that: CR is useful in patients who complete it; low compliance is due mainly to medical problems and lack of motivation; better information might slightly increase the compliance in our Center; most patients can, in any case, reach their previous way of life. It is debatable whether CR is advisable in old age, or should be directed towards selected groups of patients.
To determine the antiarrhythmic efficacy of beta-blockers (beta-B) and verapamil (V) in exercise-induced ventricular tachycardia (Ex-VT), nine patients with reproducible Ex-VT (in two consecutive exercise tests) were studied by means of electrophysiologic study (EPS) in basal conditions and serial exercise testing after beta-B (metoprolol 25 mg tid to 100 mg qid; oxprenolol 40 mg tid) and/or V (80-160 mg tid). Ejection fraction was normal in four cases and depressed in five. Of these nine patients, four developed Ex-VT during chronic amiodarone treatment, which was continued. During EPS, VT was induced at a critical atrial pacing rate in one case, and with the extrastimulus technique in four. Ventricular tachycardia was not inducible with either technique in four patients. Five of the six patients on beta-B and none of the seven on V developed Ex-VT, although they achieved the same or higher work-loads as compared to the basal exercise tests. In the case with rate-dependent VT, beta-B and V prevented VT at work-loads, sinus rates and double products significantly higher than those obtained in basal conditions. In the others, maximal heart rate and double product were lower on beta-B and showed a wide variability on V. V and beta-B appeared to be highly effective in preventing Ex-VT, in patients with normal heart as well as in those with greatly depressed ejection fraction. Both of the drugs appeared to suppress re-entry or triggered activity in the patient with rate-dependent Ex-VT.(ABSTRACT TRUNCATED AT 250 WORDS)
A patient with primary angina showed intermittent ST elevation (with and without chest pain), during two exercise tests performed on consecutive days; the same ST changes were also seen during the recovery phase. The electrocardiographic changes recorded in this patient may be considered an example of myocardial response to spasm-related ischemia.
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