[Signs of extreme vagotonia in the electrocardiogram of an Olympic 5km running champion]. / Známky extrémní vagotonie v elektrokardiogramu olympijského víteze v behu na 5 km.

Hypokinesia (lack of exercise)--a disease caused by lack of physical activity leads among others to a predominance of the sympathetic nerve in the circulation. Its manifestations are briefly described according to Kraus-Raab's hypothesis of 1961. The opposite of a hypokinetic man are trained (hyperkinetic) sportsmen, in particular long-distance runners. Their neurovegetative balance is shifted to the side of the vagus (parasympathetic nerve). This is described as training vagotonia. On the example of ECG tracings of an Olympic 5 km runner, the Tunisian Mohamed Gammoudi, the author describes its manifestations at rest, during the orthostatic test and during work, i.e. the step test. These manifestations include in particular bradycardia of 32 beats per minute, prolonged atrioventricular conduction > 0.2 sec., a long period of the electric systole = 0.44 sec. and an enormously prolonged electric diastole T-P = 1.1 sec. This long diastolic filling stage makes it possible in particular during physical work to increase the systolic and diastolic output to double the values of a healthy non-trained heart. Training vagotonia is usually not the source for manifestation of dangerous arrhythmias, as it may be the case in constitutional vagotonia. So far expert comparison of these two types of change to parasympathic tonus is lacking, similarly as a comparative study with medicamentously influenced vagotonia by means of beta-blockers.

Hospice care for a terminally-ill child in the school setting.

In our society, the words "dying" and "school" are not a natural fit. Recently they have occurred together all too frequently. When this happens, horror, fear, and confusion often prevail. The death of a child is always a tragedy, but handled well, it can bring positive growth and maturity to the school community. The death of a class member, teacher, or student affects the class in a way that no other event does. Accidental deaths, shootings, and other violent deaths cause multiple and complex problems within the school community. These dramatic and tragic events are present in the media and leave people with a violent concept of death. However, death sometimes comes in slow and lingering ways. In this article, the case study of a student named "Tyler" illustrates the painful but positive experiences of his class. This type of death--of a school-age child--brings a prolonged grief and struggle for students, teachers, and the school community.

Changes of blood pressure and lipid pattern during a physical training course in hypertensive subjects.

Among 77 hypertensive subjects with a previous predominantly sedentary way of life we followed the changes of several cardiovascular and biochemical parameters during a 5-week physical training course. A highly significant drop in both systolic and diastolic blood pressure (BP) was observed in 58 subjects (75%, p less than 0.001). There was a strong negative correlation between initial uricaemia and the diastolic BP decrease (r = -0.382; p less than 0.001). The decrease of systolic as well as diastolic BP correlated positively with the increase of maximum oxygen uptake per kilogram (VO2max/kg) during the intervention (for systolic BP: r = 0.282, p less than 0.05; for diastolic BP: r = 0.286, p less than 0.05). Serum total cholesterol (TC), triglycerides (TG), HDL-cholesterol (HDL-C), uricaemia levels and body mass index (BMI) decreased (p less than 0.01 for uricaemia; p less than 0.001 for the rest), whereas the HDL-C/TC ratio increased significantly (p less than 0.001). These positive changes disappeared already 3-7 months after the intervention except for BMI, TG and uricemia, where the lower levels persisted. Thus, the 5-week intensive physical training had a favourable but short-time effect on BP and lipid pattern in the majority of hypertensives.

Non-pharmacological control of blood pressure and physical fitness in subjects with arterial hypertension.

In a group of 60 men and 17 women aged 54 +/- 9 yrs. suffering from mild and moderate arterial hypertension (i.e. 90 greater than DBP less than 120 mmHg), a five-week non-pharmacological intervention programme in spa led to a reduction in body weight by 5 kg, an increase in maximum tolerated workload by 4 W, a decrease in blood pressure at rest by 12/6 mmHg on average, and a decrease in heart rate during exercise and in the recovery phase. The training effect persisted in a certain degree for a long time (i.e. 14 months on average after spa treatment). The reduction in weight, heart rate and systolic blood pressure at rest persisted as well. The therapy resulted in a decrease in minute ventilation and there was no increase in aerobic capacity. No change in the number of pathological ECG changes at rest and during exercise was observed during spa treatment. The regimen and training measures enable to reduce pharmacological therapy in 60% of originally treated hypertensives. This kind of spa treatment constitutes a model of a rational lifestyle for persons with arterial hypertension.

Calf blood flow and vascular resistance during reactive hyperaemia in young athletes and trained middle-aged subjects.

The effect of training on dilatation capacity in the lower limbs was evaluated by studying the blood flow and vascular resistance in the calf in 10 young athletes aged 19-29 years and 15 trained middle-aged subjects aged 52-58 years during post-ischaemic reactive hyperaemia. The control groups comprised untrained subjects of approximately the same ages, i.e. 16 men aged 18-29 and 37 aged 40-60. The calf blood flow as determined plethysmographically and the blood pressure was measured on the arm by auscultation. Vascular resistance was calculated from the mean blood pressure and from the maximal calf blood flow measured during hyperaemia. A significantly higher maximal blood flow and significantly lower resistance in the calf were found in young athletes than in untrained subjects. In athletes, the flow debt was significantly overpaid. In middle-aged subjects, the effect of training was manifested only in significant overpayment of the flow debt, while vascular resistance and the maximal blood flow were the same as in the controls. It can be concluded from these findings that significant improvement of vasodilatation ability in association with training occurs primarily in young subjects. The findings also correspond to the known ability of young athletes to give a higher maximal performance than veteran athletes.

Haemodynamic effects of physical training in essential hypertension.

The haemodynamic effects of four weeks of daily intensive training on bicycle ergometer were studied in 10 men with essential hypertension of grade II (WHO). Three weeks before training all medication was replaced by placebo. Five days before onset of training all patients underwent a haemodynamic examination using floating catheter and direct brachial arterial pressure at rest and during effort. The same examination was repeated within five days after the completion of the training. Resting measurements did not demonstrate any effect of the training on systemic pressure or central haemodynamics. At the given load, however, a significant decrease for the pressor response occurred, i.e. lowering of systolic, mean and diastolic arterial pressure. Peripheral vascular resistance was not affected. Cardiac output (Fick) decreased insignificantly both at rest and during effort after training. Heart rate decreased significantly only during exercise. The training lowered significantly both tension time index and left ventricular stroke work index. No adverse clinical or haemodynamic effects of short intensive training were detected in hypertensive patients. There was no evidence of changes in pulmonary artery diastolic pressure considered as an indicator of the left ventricular filling pressure. The heart volume remained unchanged after training.