Aims:To determine the effects of combined in-patient rehabilitation with a home-based program on function and quality of life.Setting and Design:Tertiary care, university teaching hospital, randomized controlled trial.Patients and Methods:Thirty admitted patients with congestive heart failure with New York Heart Association class II -IV. A five step individualised phase-1 cardiac rehabilitation program followed by a structured home based rehabilitation for eight weeks was given to the experimental group while the control group only received physician directed advice. Six minute walk distance was assessed at discharge and follow-up, while quality of life (SF36) was assessed at admission, discharge, and follow-up.Statistical analysis used:Independent t-test, paired t-test and repeated measures ANOVA with Bonferroni post-hoc analysis.Results:At admission patients in both the groups were comparable. After the phase-1 cardiac rehabilitation, there was a change in the six minute walk distance between control and experimental group (310 m vs. 357 m, respectively; P = 0.001). Following the eight week home-based program, there was a greater increase in six minute walk distance in the experimental group when compared to the control group (514 m vs. 429 m; P < 0.001). Quality of life as measured by the SF-36 at the end of 8-weeks showed a statistically significant difference (P < 0.05) in the experimental group for both the mental and physical components.Conclusion:Early in-patient rehabilitation followed by an eight week home based exercise program improves function and quality of life in patients with congestive heart failure.

Infection with Coxsackie B2 virus is described in a 49-year-old farmer in whom myopericarditis and pneumonitis was followed over a period of 10 months by constrictive pericarditis.The differentiation between restrictive cardiomyopathy and constrictive pericarditis was not achieved without exploratory thoracotomy. The adherent pericardium was successfully excised with complete relief.The literature is reviewed and it is suggested that the development of constriction following Coxsackie pericarditis must be considered at subsequent examinations of the patient. CASE REPORTThe patient, a farmer born in 1920, was well until October 1967, when he developed a feverish illness with an ache in the right chest and shoulder, a dry cough, generalized myalgia, and lassitude. The illness subsided after two days, with persistence of the dry cough for a few weeks. A week after the onset there was a mid-systolic click, widely heard over the precordium, followed at the apex by a short systolic murmur. A chest radiograph was normal and an electrocardiogram showed non-specific T wave flattening from inferior leads.He remained well until June 1968, when he developed epigastric discomfort, a feeling of fullness in the neck, an unproductive cough, pyrexia, profuse night sweats, and increasing dyspnoea on effort. There was an elevation of the jugular pressure to 10 cm., persistent sinus tachycardia, a blood pressure of 100/ 70 mm. Hg, low-grade pyrexia, pericardial friction, fine inspiratory pulmonary basal crepitations, ankle and sacral oedema, and tender liver enlargement. The ESR was 38 mm./hour, rising to 72 mm./hour during the next 10 days. The WBC was 11,600/cu. mm., neutrophils 78%, lymphocytes 18%, and monocytes 4%, and haemoglobin 119 g./100 ml. Blood cultures and tests for antinuclear factor were negative. The aspartate aminotransferase was 115 units/ml. and hydroxybutyrate dehydrogenase 333 units/ml. Both enzymes were normal 14 days later. Mantoux tests at dilutions of 1/1,000 and 1 /100 were negative and the antistreptolysin 0 titre was less than 100 Todd units/ ml. A serial electrocardiogram showed no change. The chest radiograph showed cardiac enlargement, pulmonary congestion, and consolidation in the right lower lobe.

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