Acute effects of oral propranolol on hemodynamic responses to upright exercise

Bruce, Robert A.; Hossack, Kenneth F.; Kusumi, Fusako; Clarke, Lauren

doi:10.1016/0002-9149(79)90262-5

Cited by 61 publications

(13 citation statements)

References 19 publications

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“…This point may be worth pursuing as we know o f no study which has specifically looked at the value of an exercise program in patients taking j3-blocking therapy and degree of improvement in such a group compared to training in a group on no therapy. The mechanisms o f improving exercise tolerance are different (2). Both mechanisms involve a widening o f the A V 0 2 difference but with exercise arterial content increases with compensatory erythrocytosis, whereas venous oxygen content decreases from greater peripheral extraction in patients treated with propranolol.…”

Section: Discussionmentioning

confidence: 99%

Influence of Propranolol on Exercise Prescription of Training Heart Rates

Hossack¹,

Bruce²,

Clarke³

1980

Cardiology

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Review of a longitudinal study of the effects of 40 mg of propranolol orally in 14 patients with coronary heart disease demonstrated a minor but not statistically significant change in the relationship of percentage of maximal oxygen uptake to percentage of maximal heart rate. In a cross-sectional comparison of several hundred patients who showed no other significant difference in initial findings in relation to propranolol, significant differences were present with respect to resting heart rate and responses to symptom-limited exercise, nevertheless the relationship of percentage of maximal oxygen uptake to the percentage of maximal heart rate was similar. Accordingly, we recommend maximal exercise testing in all patients prior to undertaking an exercise program so that their maximal heart rate can be determined accurately and rational training heart rates advised. The exercise test should be performed with the patients taking medications they anticipate continuing during the period of physical training, and if a change in medications is subsequently made then the exercise test should be repeated.

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Section: Discussionmentioning

confidence: 99%

Influence of Propranolol on Exercise Prescription of Training Heart Rates

Hossack¹,

Bruce²,

Clarke³

1980

Cardiology

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“…Studies in normal subjects and patients with ischemic heart disease have shown that subjects with normal ventricles reach a lower peak VQ0 while taking A blockers, while subjects with reduced left ventricular function from ischemia can sometimes obtain a higher peak VO2. 21 There is also a decrease in the peak pressure-rate product.2' Although the limitation to peak V02 and cardiac output apply to any exercise, fi blockers could reduce some of the greater blood pressure rise per work load that occurs during swimming and allow a greater peak VO2 than without. The other important drug was digoxin, which does not affect the peak V02,22 but does make the ECG interpretation of ischemia less dependable.…”

Section: Resultsmentioning

confidence: 99%

The effect of swimming on patients with ischemic heart disease.

Magder¹,

Linnarsson²,

Gullstrand³

1981

Circulation

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SUMMARY Swimming is frequently recommended for cardiac rehabilitation, but little is known of its physiologic consequences in ischemic heart disease. Eight males who had had a myocardial infarction 8-17 months before the study were exercised to exhaustion or angina with 10 W/min-1 ramp on a cycle ergometer in sitting and supine positions. Oxygen uptake (V02) was continuously measured to monitor the physiologic power requirement. All eight patients were taking fl blockers and four were taking digoxin. During sitting cycling, angina occurred in four and ST depression in five; during supine cycling, angina occurred in five and ST depression in six. VO2 was then measured while they swam at their own comfortable speed (mean 0.43 m/sec-') in a swimming flume at water temperatures of 25.5°C and 18°C. In six, the water speed was gradually increased until they were limited by symptoms. Comfortable swimming at 25.5°C was 87% (1.28 1/min-m) and at 18°C 89% (1.30 1/min-m) of sitting peak V02, while heart rates were 92% and 91% respectively. The mean peak VO2 and heart rate did not differ significantly between bicycle and swim tests (peak VO2 sitting 1.49 ± 0.23, supine 1.42 ± 0.24, 25.5°C 1.60 ± 0.17, 18°C 1.52 ± 0.19 1/min-'). Only two patients reported angina while swimming in warm water and one in cold water, although ST depression occurred in six in both swims. The subjective comfort and large muscle groups involved make swimming a good exercise, but the high relative energy cost and failure to identify ischemic symptoms indicate caution in cardiac patients, especially if their swimming skills are poor.THE PHYSIOLOGY of swimming in fit normal subjects and trained swimmers, both young and old, has been described,1-3 but the pathophysiology of swimming in patients with ischemic heart disease has been studied little.4' 5 Our understanding of this condition raises theoretical concerns. Immersion in water6 and a horizontal body position both increase the central blood volume,7 which could stress the limited reserves of patients with ischemic heart disease.8 The large contribution of work from the arms, which results in a higher peripheral vascular resistance than leg work at the same work load,9 the compressive effect of the water on the extremities" 6 and the decreased skin blood flow" 6 all increase the left ventricular afterload and thus might decrease the subjects' peak work level.10 The swimming flume, a kind of "swimming treadmill," offered a controlled and safe environment for evaluating such patients."" Oxygen uptake (VO2) was used as an objective measure of the amount of work performed, and the ECG as an indicator of ischemic changes. The swimming results were related to the subjects' performance in the sitting and supine positions on a bicycle ergometer. Further, swimming tests were performed with water temperatures of 18°C and 25°C to assess the effect of different water temperatures. Patients and MethodsWe selected eight males, ages [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66] Prefere...

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“…The ECG is recorded using a Frank XYZ lead system. Oxygen uptake is calculated by collecting expired air and measuring oxygen content before and after C 0 2 absorption (5). Observations are made at rest in the supine and sitting positions.…”

Section: Methodsmentioning

confidence: 99%

“…In ( It was reported that the most consistent hemodynamic changes during exercise and following a single oral dose of 40 mg of propranolol was a reduction in pressure rate product and heart rate (5). Changes were also observed in maximal oxygen uptake.…”

Section: Time (Ms)mentioning

confidence: 98%

Comprehensive analysis of exertional ECG changes before and after oral propranolol

Hossack

Bruce

Kusumi

1979

Clinical Cardiology

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Summary:In 12 patients with symptomatic coronary heart disease and three normal persons, comprehensive analyses of the electrocardiographic changes associated with symptom-limited upright exercise are made by computer analysis of the electrocardiogram recorded using a Frank XYZ lead system. This analysis provided a display of the 12 lead ECG, vectorcardiogram, polarcardiogram, and spatial cardiogram and measurements of spatial magnitudes of heart vectors. The effect of 40 mg of oral propranolol was assessed by repeating the exercise protocol 60-90 min later. There is evidence that propranolol reduces the electrocardiographic features of myocardial ischemia. This reduction in myocardial ischemia correlates with reductions in pressure rate product and heart rate. The presence of infarct criteria with exercise is variable and not apparently influenced by propranolol.

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Acute effects of oral propranolol on hemodynamic responses to upright exercise

Cited by 61 publications

References 19 publications

Influence of Propranolol on Exercise Prescription of Training Heart Rates

Influence of Propranolol on Exercise Prescription of Training Heart Rates

The effect of swimming on patients with ischemic heart disease.

Comprehensive analysis of exertional ECG changes before and after oral propranolol

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