[Influence of rehabilitation on the natural history of myocardial infarct].
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Biomedical subjects
Publications and source records attributed to C Vecchio.
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The aim of this study was to verify the evolution of the psychological characteristics of a group of patients with recent myocardial infarction, during a supervised physical training procedure. The study group consisted of 70 males, aged from 35 to 65 (mean 50 +/- 9). Every patient underwent a psychometric test battery before and after his rehabilitation program. The following tests were used: - Minnesota Multiphasic Personality Inventory - 16 Personality Factors Inventory - IPAT Anxiety Scale - Eysenck Personality Inventory. No patient had psychotherapic nor pharmacological treatment. Comparing the test results before and after training, a significant reduction of deviances from normal patterns was found. A clear trend towards normal values of both high and low scores was found after rehabilitation. Our data are in agreement with the concept that a supervised physical training program is able to promote psychological benefits in patients with recent myocardial infarction. These benefits can be summarized both in stronger emotional stability and in better adaptative capability. This makes their return to normal life easier.
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The results of the same rehabilitation protocol are compared in two groups of patients with recent transmural myocardial infarction. The first group consists of 63 males, aged from 40 to 49 (mean 44.5); the second one of 63 males, aged from 60 to 74 (mean 64.7). The age is the only difference between the groups. The training does increase the mean value of the Total Work Performed from 5126 +/- 2201 to 7505 +/- 2455 Kgm (p < 0.001) in the young patients and from 3340 +/- 1414 to 4793 +/- 1598 Kgm (p < 0.001) in the old ones. The amount of increase is 46.4 and 43.5 per cent, respectively. The Heart Rate at fixed level of 75 W decreases from 125 +/- 2 to 119 +/- 1.6 beats per minute (p < 0.001) in the young group and from 119.2 +/- 2.2 to 111.3 +/- 2.2 (p < 0.001) in the old group of patients. The O2 Pulse at 75 W increaes from 8.8 +/- 0.2 to 9.7 +/- 0.25 cc per beat (p < 0.001) in the young subjects and from 9.4 +/- 0.4 to 10.3 +/- 0.4 (p < 0.001) in the old ones. The Double Product at 75 W decreases from 23.6 +/- 0.7 (X 10(3)) to 21.4 +/- 0.5 (p < 0.001) in the young patients and from 24.4 +/- 0.8 to 21.6 +/- 0.7 (p < 0.001) in the old ones. A control performed in 26 subjects of both groups 1 year later, shows a good persistance of the training effect as in young as in old patients. The AA. come to conclusions that: a) The age does not represent a limiting factor for the indication to the rehabilitation after a myocardial infarction; b) the rehabilitation can provide similar results in young and in old patients and the achieved benefits can be similarly maintained; c) the risk of any complication during training is higher in old than in young patients. It compels us to a careful choice of patients and control of the rehabilitation procedure.
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The Authors report the results of a coronary angiographic study in 12 patients with acute myocardial infarction in which the necrosis was extended to the dorsal wall of the heart. The electrocardiographic and vectorcardiographic criteria applied in order to assess the involvement of the dorsal wall have been those suggested by Perloff and by Hoffman and coll. and Massie and Walsh, respectively. The diagnosis of dorsal involvement has been also confirmed by the esophageal electrocardiogram. Discussing their results, the Authors consider the variants of blood supply of the posterior wall of the heart. On the basis of their angiographic findings, they underline that significant lesions of the circumflex artery, either alone or associated with narrowing of other main coronary arteries, are the most frequent finding in cases of myocardial infarction involving the dorsal wall of the heart.
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