SUMMARY1. Blood pressure, cardiac function and forearm blood flow following voluntary maximal upright bicycle exercise were studied in thirteen normal volunteers in a cross-over design against a control day.2. After exercise there was a short-lived (5-10 min) increase in systolic blood pressure, peak aortic blood velocity and aortic acceleration suggesting a persistence of the positive inotropic influence of exercise.3. Systemic vasodilation, which was seen immediately exercise stopped, lasted at least 60 min. This was associated with a reduction in diastolic blood pressure for the whole hour. After 30 min systolic blood pressure was also reduced. Heart rate and cardiac output were still significantly elevated and systemic vascular resistance still reduced at 60 min post-exercise.4. A non-exercising limb vascular bed (forearm) showed a marked vasodilation for 1 h after predominately leg exercise indicating the presence of a vasodilatory influence affecting vascular beds other than the exercising muscle groups.

1. It is known that acute exercise is often followed by a reduction in , compared with the control day. Systolic and mean pressure also fell (non-significantly) after 45 min; heart rate was significantly elevated for the whole hour of recovery (at 60 min, +7'23 beats min'). No changes in post-exercise blood pressure and heart rate were observed on the days of moderate and minimal exercises. 4. An increase in cardiac index was observed after maximal exercise compared with control (at 60 min, 2'6 + 0'3 vs. 1'9 + 0'2 1 min' m-2). This was entirely accounted for by the persistent increase in heart rate, with no significant alteration in stroke volume after exercise on any day. 5. Systemic vasodilatation was present immediately after maximal exercise compared with control (after a 5 min rest, total peripheral resistance was 17'9 + 3S5 vs.27'8 + 3-4 mmHg (1 min')-' on the control day) and lasted at least 60 min (at 60 min, 23'3 + 3'5 vs. 31'0 + 3'8 mmHg (1 min`)`o n the control day). No significant changes in total peripheral vascular resistance were observed after moderate or minimal exercise days. 6. After this predominantly leg exercise, minimal and moderate loads significantly increased forearm vascular resistance with respect to baseline pre-exercise resistance (at 60 min, +26'7 % and +20'5%, respectively), but there were no significant differences with respect to the control day; maximal leg exercise significantly decreased the forearm vascular resistance for 1 h (at 60 min, -17'2 % vs. baseline pre-exercise value and -46'0 % compared to the control day). This suggests that prolonged forearm vasodilatation occurred only after higher exercise loads.Hypotension has been shown to follow short periods of exercise

Ivabradine in CS complicating AMI is safe, is associated with a short-term favourable outcome and can be effectively administered by nasogastric intubation.

Among subjects with prehypertension, those with masked hypertension are at higher cardiovascular risk than those with true prehypertension. Out-of-office BP should be known in individuals with prehypertension, preferably by ambulatory BP monitoring or alternatively by home BP measurement, to obtain a better prognostic stratification.

No abstract

The haemodynamic changes during 4 h following maximal upright bicycle exercise were evaluated in six normals in a randomized controlled crossover design. Total peripheral resistance was reduced to 2 h (-6.7 mmHg min l-1, P < 0.05); exercising and non-exercising vascular beds were vasodilated for 2 h (-24.1 and -23.8 mmHg min ml-1 100 ml-1 tissue, respectively, P < 0.05), associated with reductions in systolic (-5.8 mmHg, P < 0.05) and diastolic pressure (-8.3 mmHg, P < 0.05). Rise in cardiac index for 1 h (+0.51 min-1 m-2, P < 0.05) was accounted for by an elevated heart rate (+14.4 beats min-1, P < 0.01) as stroke volume was unchanged. Body temperature was elevated until 40 min (+0.20 degrees C, P < 0.05). The return of all haemodynamic variables to control by 3 h suggests a 3 h limit for a hypotensive effect of exercise. Rise in body temperature is not the only factor responsible for the hypotension.

Seven cases of infective endocarditis (IE) in patients with hypertrophic obstructive cardiomyopathy (HOCM) are presented in this report. The previous literature is critically reviewed, and the following points are discussed: (a) IE complicates HOCM in 5-9% of cases; (b) anatomical and haemodynamic alterations of HOCM cause microtraumas on heart valves and the endocardium; the resulting endocardial lesions represent sites for bacterial seeding as well as other congenital or acquired heart disease; (c) prognosis is worse in patients with IE associated with HOCM than in patients with IE alone or associated with congenital heart disease; (d) the most frequently isolated organisms are saprophytes; (e) most patients were exposed to bacteraemias before the onset of IE.

This study sought to determine whether patient characteristics such as age, sex, blood pressure, and pulse pressure differently affect the accuracy of an oscillometric (SpaceLabs 90207) and a microphonic (TM2420 version 7) blood pressure monitor. Blood pressure recorded by two oscillometric and two microphonic ambulatory monitors was compared with simultaneous readings by two pairs of trained, blinded observers using random-zero sphygmomanometry. One hundred and eighteen subjects (53 men and 65 women, aged 17 to 94 years; systolic pressure, 89 to 211 mm Hg; diastolic, 44 to 116 mm Hg) were studied. There were no significant differences within each observer pair or between the two observer pairs as well as no correlation between interobserver differences and patient characteristics. The differences between the monitor and trained observers' readings were 2.8 ±9.9 mm Hg systolic and 3.9 ±6.8 mm Hg diastolic for the SpaceLabs and 5.0±5.2 mm Hg systolic and 3.4±6