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Biomedical subjects

F Mitu

Publications and source records attributed to F Mitu.

At least 19 recordsLinked to original sources
PubMedDate not supplied

[The role of physical training in left ventricular performance and exercise tolerance in patients with chronic myocardial infarct].

UNLABELLED: The aims of the complex rehabilitation of the patients with chronic myocardial infarction are the improvement of the left ventricular performance and the increasing of the exercise capacity. OBJECTIVES: The objectives of the study is the long-term evaluation of some hemodynamic parameters at rest and during the stress test, at patients with chronic myocardial infarction during the physical training. METHODS: We investigated 132 patients with chronic myocardial infarction, mean age 51.4 +/- 8.5 years, during 36.9 +/- 31 months of follow-up. 81 followed a programme of physical training (the study group); 51 did not follow the training. There were determined the following parameters: cardiac rate (CR), blood systolic and diastolic pressures (BSP,BDP), time-pressure index (TPI), the metabolic equivalent (MET), the ejection fraction (EF), by echocardiographic and systolic time intervals methods, at rest and the exercise test, for each step. There have been followed the CR, BSP, BDP during the physical training. RESULTS: At the study group there is a significant reduction of CR at rest (p < 0.05) and during the training (p < 0.001). The exercise testing reveals the following: at the study group, TPI does not modify (GR increases but BSP decrease); at the second group there are significant increases of CR, BP and MET at all the steps of the testing (p < 0.001-0.0001). EF improves significantly (p < 0.05) only at patients with inferior myocardial infarction who followed the training. There is a good correlation between the results of EF measured by echographic and by systolic time intervals methods. CONCLUSIONS: Patients who underwent physical training improved the CR at rest and TPI and MET at each step. There is a slight rise of EP at the study group with inferior myocardial infarction.

Chronic Disease↗
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[The evolution of glucose metabolic parameters in patients with chronic myocardial infarct who have undergone physical training].

UNLABELLED: Diabetes mellitus represents an important cardio-vascular risk factor, including patients with chronic myocardial infarction. OBJECTIVES: The objectives of the study is to assess the influence of the long-term physical training upon some parameters of glucidic metabolism. METHODS: There have been studied 132 patients with chronic myocardial infarction, mean age 51.4 +/- 8.5 years, for underwent regularly physical training at 60-70% from maximal cardiac rate achieved at the exercise testing. Another group (51 patients) did not followed the training. There have been studied blood glucose à jeun and patients with normal values followed the ingestion of 75 g glucose. There were following categories: normal; know diabetes mellitus (DM); DM revealed at the loading test; impaired glucose tolerance (IGT) and hyperinsulinism. Patients were included one of these categories at the beginning and the control. RESULTS: The results are summarised in the following table: [table: see text] The group who did not follow physical training revealed an increased frequency of IGT and DM. CONCLUSION: The physical training has a protective role preventing the development of the alterations of glucidic metabolism.

Blood Glucose↗
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[ANF--atrial natriuretic factor].

Is produced at the right atrium and is acting upon four types of receptors. The main effects of ANF are: renal effects, by rapid increasing and prolongation of glomerular filtration; neuroumoral effects--the inhibition of renin-angiotensin system and of the release of aldosterone; effects upon the vascular wall, with vasodilatation; another effect is the regulation of the hydrosalin balance. The therapeutical endpoints of ANF are related to its action in some diseases like: cardiac failure, arterial hypertension, myocardia infarction, paroxysmal arrhythmias; in some of them it is a very fiable predictive marker. ANF represents o neuroumoral mechanism which play an important role in functional regulation of the cardio-vascular system.

Animals↗
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[Chronic myocardial infarct with left ventricular dysfunction: the clinical aspects and exertion tolerance].

UNLABELLED: The objective of the study is the assessment of the exercise functional capacity of the patients with chronic myocardial infarction and left ventricular disfunction and the relevance of some clinical peculiarities of them in contrast with patients without left ventricular performance. METHODS: There have been studied 105 patients with chronic myocardial infarction, in a period of time between 1992-1995. There has been taken, as an objective criterium of the assessment of LV disfunction, the ejection fraction (EF) measured by echo 2D at 52 patients. There were created the groups with EF 50%(32p), EF = 35-50% (12p) and EF = 35% (8p). The clinical parameters were: the number of coronary risk factors (CRF), the NYHA class, the exercise test and the assessment of VO2max. The statistical comparison has been made by using an IBM computer 486, programme FoxPro and EPI/INFO. RESULTS AND DISCUSSIONS: 50% of the patients with EF > 50% (16/32) had a good exercise tolerance (MET > 5); 13 patients (65%) from the patients with EF < 50% had MET < 5. Similarly, there is no correlation between the low EF (50%) and VO2max. The analysis of the exercise tolerance correlated with the functional class NYHA shows its diminution at patients with cardiac failure (classes I and II) compared with those without dyspnea (67% vs 42%, p < 0.01 and respectively 80% vs 42%, p < 0.05). There are similar differences in the assessment of VO2max at patient from classes III (p < 0.01) and II (p < 0.03) compared with class 0. Dyspnea, as a clinical parameter, does not correlate with low EF, but has significant association with VO2max. The study of the degree of charge in CRF at patients with EF < 50% reveals the following: older age (p < 0.02), the presence of arterial hypertension (p < 0.01) and the greater prevalence of DM (p < 0.05). CONCLUSION: 1. There is no correlation between the degree of the left ventricular disfunction and the exercise capacity. 2. VO2max is significantly lower at patients with dyspnea, especially from classes II and III. 3. Patients with myocardial infarction and LV disfunction have statistically more CRF, like older age, HTA, DM.

Chi-Square Distribution↗
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[Peripheral vascular remodelling and changes to the skeletal muscles in heart failure].

The syndrome of heart failure causes besides a deterioration in the contractile function of the heart significant alterations of peripheral circulation and skeletal muscles. The distribution of the regional blood flow is influenced by systemic and local neurohumoral factors. The local factors are released by the vascular endothelium or are of nonendothelial origin. The diminution of cardiac output leads to neurohumoral alterations which eventually influence the blood flow distribution: in vital organs, such as the heart and the brain, it is preserved; in the splanchnic, kidney, muscle and skin territories it is diminished. Muscles changes (muscle atrophy, reduction of type I fibres and a relative increase of type IIb fibres) are the main cause restricting the exercise. Techniques of physical rehabilitation associated with proper medication may lead to the improvement of these alterations.

Blood Vessels↗
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[Heart failure due to ischemia--the adaptive mechanisms].

Chronic myocardial ischemia is the leading cause of disturbances in myocardial contractility (myocardial infarction) or hemodynamic overload upon the left ventricle. The heart reactions consist in a series of adaptative mechanisms in order to maintain its pump function: Frank-Starling mechanism, myocardial hypertrophy and neurohumoral activation. In heart failure, the cardiac output is maintained by an increase of the preload which enhances the contractility (Frank-Starling law). Myocardial ischemia influences the systolic and diastolic function. The decrease of cardiac output leads to neurohumoral responses which, in the initial stages of cardiac failure are compensatory; along with the progression of the disease, they exert adverse effects. Increased activity of the sympathetic nervous system induces high cardiac rates, chronotropic incompetence. Activation of the renin-angiotensin system held to myocardial and vascular hypertrophy, vasoconstriction, fluid retention. Endothelin is the most powerful vasoconstrictor; its plasmatic concentrations correlate with the severity of the disease. Vasodilator mediators released in cardiac failure are the natriuretic peptide, nitric oxide, dopamine, prostacicline, bradikinin.

Adaptation, Physiological↗
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[The assessment of the exertion capacity of patients with ischemic heart failure].

Functional capacity is reduced in heart failure; this lowering is not directly related to the severity of the disease. The intensity of the impairment of exercise capacity is an independent prognostic factor, together with the severity of left ventricular disfunction and the degree of neurohormonal activation. That is the reason why the assessment of a patient with heart failure must include also the determination of exercise capacity by exercise testing. The cardio-pulmonary testing remains "the gold standard"; if this is not available, the testing at the ergometric bicycle and the 6 minutes walk test offer valuable information concerning functional capacity in heart failure.

Electrocardiography↗
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[Goldenhar syndrome in adults].

The paper presents the case of a 43 year old female patient with multi-malformations syndrome (facio-auriculo-vertebral syndrome), distinguished by alterations of the skeleton, face, sensorial organs and the heart. The syndrome is dominant at young ages and scarce at adults, and the explanation of the favorable evolution could be the lack of severe visceral or central nervous system involvement. The peculiar anomalies of this case are: asymmetric face, epibulbar dermoid, dysplastic ears, auricular tags, conductive and sensorineural deafness, fusion of vertebrae, hemivertebrae, ventricular septal defect.

Adult↗
PubMedDate not supplied

[Is the age a limiting factor of functional capacity and cardiac performance in patients with chronic myocardial infarction ?].

UNLABELLED: Actually the old age is not considered a contra-indication of cardiac rehabilitation, although it influences the prognosis of patients with chronic myocardial infarction. The objective of the paper is the study of age as a limiting factor of the cardiac performance and exercise capacity at patients with myocardial infarction at the admission in rehabilitation programmes. METHODS: Among the patients admitted in the Department of Internal Medicine of Rehabilitation Hospital of Iasi there were selected 132 with chronic myocardial infarction; they were divided into two groups: group A of 56 patients more than 55 years old and group B of 76 under 55. There were analysed the clinical features (risk factors, symptoms), the cardiac performance (by echographic study of the regional and global abnormalities of myocardial contractility) and the functional capacity (by exercise testing at the ergometric bicycle). RESULTS: Both groups were similar by the point of view of the prevalence of the risk factors and location of the infarction. The ejection fraction, although smaller at the group A (45% vs 50%), did not reach the statistical significance. The exercise testing revealed a lower capacity of the group A, marked by higher levels of the cardiac rate and time-tension index at similar levels of exercise. The metabolic equivalent (MET) and VO2max were significantly lower (p = 0.001 respectively 0.002). There can be concluded that the age diminishes the exercise capacity of the patients with myocardial infarction without a marked influence of the cardiac performance. The last one depends on the infarction size and the myocardial status while the lowering of the functional capacity is influenced by noncardiac factors as well.

Age Factors↗
PubMedDate not supplied

[Clinical characteristics of patients with ischemic heart failure].

UNLABELLED: A major cause of heart failure is coronary heart disease with an increasing prevalence and progression to heart failure. The objective of the study is the analysis of the clinical peculiarities, coronary risk factors and some resting hemodynamic parameters at patients with ischemic heart failure. METHODS: There have been studied 189 patients with ischemic heart disease. The ejection fraction (EF) assessed by echocardiographic examination was used to divide them into three groups: group A of 106 with EF above 50%, group B of 55 with EF between 40-49% and group C of 28 with EF below 40%. RESULTS: The mean age increased from group A (58 +/- 13 years) to group C (64 +/- 11 years, p = 0.05). Ischemic cardiomyopathy was higher at group C (32% vs 13% at group A and 24% at group B, p = 0.01) and old myocardial infarction was more frequent at group A (44% vs 45% at group B and 36% at group C, p = 0.009). Group C revealed a greater incidence of dyspnea (100%) and a greater resting heart rate (83 +/- 12/min, p = 0.03). The radiologic cardiomegaly was present at group C and at 42% at group A (p = 0.001). The echocardiographic findings show a greater prevalence of kinetic abnormalities and diastolic dysfunction at group C (p = 0.002 respectively 0.009). CONCLUSION: Patients with myocardial dysfunction are older, with a lower prevalence of myocardial infarction in contrast with a higher prevalence of cardiomyopathy. Dyspnea is the dominant symptom and the resting heart rate is higher. Systolic dysfunction is present at all patients and diastolic dysfunction at the majority. There were not differences concerning the prevalence of the coronary risk factors.

Adult↗
PubMedDate not supplied

[The role of exercise testing in evaluation of functional capacity at patients with ischemic ventricular dysfunction].

UNLABELLED: The assessment of functional capacity represents an important parameter in the prognostic stratification of patients with heart failure. The objective of the paper is the testing of exercise capacity at patients with ischemic ventricular dysfunction. METHODS: There have been selected 80 patients with coronary heart disease (old myocardial infarction, angina pectoris, ischemic cardiomiopathy) admitted in the Department of Internal Medicine, Rehabilitation Hospital, Iasi, during 1.01.1998-31.12.1999. They were divided into two groups: group A (46 patients) with proper ventricular function and ejection fraction (EF) above 50% and group B (34 patients) with EF under 50%. They underwent exercise testing at the ergometric bicycle. RESULTS: Patients of group B had higher values of resting heart rate (74 +/- 9 vs 70 +/- 11, p = 0.04). There were registered similar levels at the maximal exercise at both groups (time-tension index, watt, MET). The evolution of the group with ventricular dysfunction is distinguished by a lower length of time of exercise (8.6 +/- 4.4 vs 9.8 +/- 5.2 min, p = 0.05) and by a significantly greater value of the ST depression (1.6 +/- 1.4 vs 0.9 +/- 1.1 mm, p = 0.01). DISCUSSION AND CONCLUSIONS: The higher resting heart rate at patients with heart failure suggests the activation of neuroumoral mechanisms, especially the adrenergic activation. These patients reach maximal levels similar to those with good systolic function but in a shorter length of time, due to a physical deconditioning or to the same neuroumoral mechanisms. Ischemia is higher at these patients.

Adult↗
PubMedDate not supplied

[Clinical aspects of the left ventricular diastolic dysfunction at patients with coronary heart disease].

UNLABELLED: Is is known that, besides the systolic disfunction, the presence of diastolic disfunction influences the prognosis of patients with coronary heart disease. The aim of the paper is to study the influence of the presence of diastolic disfunction upon the clinical profile and the functional capacity of the patients with coronary heart disease. METHODS: 189 patients with ischemic heart disease (chronic myocardial infarction, stable angina, ischemic cardiomiopathy) underwent an echocardiographic examination. The diastolic disfunction was assessed at the Doppler examination, by the the ratio of the E and A velocities. Consequently, 138 patients had a E/A ratio under 1 or above 2 and were considered with diastolic disfunction (group A); the other 47 with E/A ratio between 1-2 were included in group B. After the clinical evaluation, 80 patients underwent an exercise testing (47 of group A and 33 of group B). RESULTS: Group A had a greater mean age (62.8 +/- 11.7 vs 51.5 +/- 11.6 years, p = 0.00006) and more females (72.5% vs 46.8%, p = 0.001); dyspnoea was more frequent and severe (NYHA II-IV), the arterial pressure higher (146/85 +/- 25/13 mmHg vs 136/79 +/- 26/15 mmHg, p = 0.004) and cardiac rate higher (82 +/- 18 vs 69 +/- 11/min, p = 0.0003). The echocardiographic assessment revealed a more severe systolic disfunction and a lower ejection fraction (50.3 +/- 10.6% vs 55.7 +/- 10.6%, p = 0.003). At the exercise testing, the maximum level and the duration of exercise were lower at group A than group B (5.41 +/- 2.07 MET vs 7.23 +/- 2.78 MET, p = 0.001 respectively 8.4 +/- 4.5 min vs 11.4 +/- 4.9 min, p = 0.01). CONCLUSIONS: The presence of diastolic disfunction is higher at older patients and at those with associated arterial hypertension. Dyspnoea correlates with the presence and severity of diastolic disfunction and the exercise capacity is lower at these patients.

Aged↗
PubMedDate not supplied

[Ischemic left ventricular diastolic dysfunction at females: clinical aspect].

UNLABELLED: The prevalence of the coronary heart disease at females becomes close to that of the male gender at older ages. However, studies of the assessment of ischemic cardiac disfunction include a few women. The objective of the paper is the analysis of the clinical profile of women with ischemic heart disfunction. METHODS: There have been studied 189 patients with coronary heart disease (chronic myocardial infarction, stable angina, ischemic cardiomyopathy): 63 females and 126 males. The prevalence of the coronary diseases, risk factors, symptoms, lipidic profile, radiologic and echocardiographic alterations were analysed. RESULTS: Mean age of the male group was 56.8 +/- 12.2, and of the female was 66.3 +/- 10.9 years, significantly older (p = 0.00001). Ischemic cardiomyopathy had a greater prevalence at women (33.3% vs 11.9%, p = 0.0004), while myocardial infarction dominated at the male gender (61.9% vs 28.6%, p = 0.0001); stable angina had similar rates (20.6%, respectively 19%). Episodes of cardiac decompensation were more often at women (20.6% vs 7.1%, p = 0.0003). Arterial hypertension prevailed at females (77.8% vs 60.3%, p = 0.01), and smoking at males (72.2% vs 7.5%, p = 0.00001). Women declared more often dyspnoea (p = 0.02) and the resting heart rate was higher (87 +/- 23/min vs 75 +/- 13/min, p = 0.0007). Mean values of cholesterol were higher at women, particularly LDL: 165 +/- 49 mg% vs 149 +/- 46 mg%, p = 0.04. At X-ray examination, cardiomegaly and pulmonary congestion were dominant at females. At echo examination, the ejection fraction had similar values (52.3 +/- 9.3% at women and 51.2 +/- 11.6% at men), but left ventricular hypertrophy and diastolic disfunction were prevalent at women (87.3% vs 69.1%, p = 0.01). CONCLUSIONS: Ischemic heart disfunction at females appears at older ages, with the dominance of ischemic cardiomyopathy and angina. At similar levels of sistolic disfunction, the diastolic disfunction, the left ventricular hypertrophy and the cardiac decompensations are more frequently at female gender.

Aged↗
PubMedDate not supplied

[Clinico-functional particularities of cardiac dysfunction in the elderly].

UNLABELLED: Ischaemic left ventricular dysfunction is more frequent at the elderly and has a series of clinical and functional peculiarities. The aim of the paper is to define the clinical, biochemical, and echocardiograph features of the older patients with ischaemic heart disease. METHODS: 189 patients with ischaemic heart disease (old myocardial infarction, angina, ischaemic cardiomiopathy) have been parted, according to age, in Group A (n = 101) over 60 years old and Group B (n = 88) < 60 years old. Symptoms, cardiovascular risk factors, lipid profile, echocardiograph findings, and the exercise testing (at the bicycle) were analyzed. RESULTS: Ischaemic heart dysfunction appears earlier at the male gender, who is dominant at Group B (83%) in comparison with Group A (48%, p = 0.009). Myocardial infarction is more frequent at Group B (61 vs 42%, p = 0.006), and ischaemic cardiomiopathy at Group A (34% vs. 2%, p = 0.004). At Group A, symptomatic heart failure (dyspnoea of III or IV NYHA class) is prevalent (20% vs. 1%, p = 0.002). Arterial hypertension was dominant at Group A (73% vs. 58%, p = 0.02). At the echocardiograph examination, regional and diffuse contractility abnormalities were dominant at Group A, and the ejection fraction was lower (49 +/- 10%) in comparison to Group B (53 +/- 9%, p = 0.005). Diastolic dysfunction was found in 63% at Group A and 36% at Group B (p = 0.001). At the exercise testing there were not reported significant differences concerning the mechanical load according to age (87% of maximum heart rate at Group A and 83% at Group B). CONCLUSIONS: At the old patients with ischaemic left ventricular dysfunction the presence of a myocardial infarction is not so frequent. Systolic and diastolic dysfunction of the left ventricle is more severe, the ejection fraction is lower, but the exercise capacity did not differ significant.

Aged↗
PubMedDate not supplied

[Is physical training useful for elderly patients with ischemic heart disease?].

UNLABELLED: The aim of the paper is the study of the effects of a supervised physical training at old patients with ischaemic heart disease. METHODS: 74 patients with ischaemic left ventricular dysfunction have been followed during a supervised physical training consisting of a daily programme of exercise over a period of 21 +/- 10 days. They were parted in Group A (n = 26) over 60 years old and Group B (n = 48) under this age. The heart rate (HR), systolic and diastolic heart pressure (SHP respectively DHP), the time-tension index (TTI) were registered during the rest, the peak intensity of exercise and the recovery. These parameters were compared in evolution at each group and also between the groups. RESULTS: At Group A, at the end of the period, SHP at the peak intensity decreased (from 146 +/- 19 to 137 +/- 14 mmHg, p = 0.01), also SHP in the recovery period (from 119 +/- 10 to 116 +/- 10 mmHg, p = 0.01) and HR during the recovery time (from 77 +/- 8/min to 73 +/- 6/min, p = 0.03). The total length of the session time increased (from 12 +/- 4 min to 21 +/- 6 min, p = 0.01) and also the duration of the peak exercise time (from 3.6 +/- 1.0 min to 7.7 +/- 2.9 min, p = 0.03), in the condition of maintaining a HR at the peak exercise of about 75-76% of the maximum HR obtained at a previous exercise testing. The improvement of the training parameters was similar with Group B, except the duration of the session, longer at the last group (21 +/- 6 min at Group A vs. 25 +/- 7 min at Group B, p = 0.02) and the duration of the peak intensity (7.7 +/- 1.0 min at Group A vs. 9.1 +/- 2.9 min at Group B, p = 0.02). CONCLUSIONS: Old patients with ischaemic left ventricular dysfunction improve their exercise capacity as well as the younger ones; the benefits of a supervised physical exercise are evident regardless of age.

Adult↗
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[Physical exercise and vascular endothelium].

Physical exercise has positive effects at patients with atherosclerotic cardiovascular diseases. These benefits are explained not only by the action upon the cardiovascular risk factors, but also by the improvement of the endothelial dysfunction. Physical exercise has vasodilator, antiplatelet, antioxidative, antiadhesive, antiproliferative and antiapoptotic effects upon the vascular endothelium. It improves the endothelium-mediated vasodilation in coronarian and peripheral beds in coronary heart disease, arterial hypertension, heart failure, diabetes mellitus, and also at sedentary and smokers, thus exerting a vasculoprotective action against atherosclerotic disease.

Arteriosclerosis↗
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[Osler--Rendu Disease: an example of a family clustering in a genetic disorder].

The case of a 75 years old woman with hereditary hemorrhagic telangiectasia (HHT) is presented. This condition is an autosomal dominant mucocutaneous and visceral fibrovascular dysplasia in which telangiectasia, arteriovenous malformations and aneurysms may be widely distributed throughout the cardiovascular system. It is usually recognized as a "triad" of telangiectasia, recurrent epistaxis and a family history of the disorder.

Aged↗