Predictive value of symptom-limited exercise testing for life expectancy in inoperable coronary patients with disabling angina.

100 inoperable coronary patients defined by severe angina, multistenosed vessels and narrowed or thrombosed distal beds performed a symptom-limited exercise test before coronary angiogram. During a 46 +/- 30 month period of follow-up 29 died, 25 of whom by cardiac cause. Among the exercise test data, the most discriminant for long-term survival was the exercise capacity, in spite of a poor correlation parameter for prediction of life expectancy.

[Preventive action on stable exercise-induced angina of a topical nitroglycerin gel and of an oral slow-release nitroglycerin compound (Lénitral) in low and high dosage (author's transl)]. / Action préventive dans l'angor d'effort stable, d'un gel de trinitrine à absorption cutanée et de doses faibles et fortes de trinitrine à libération intestinale progressive (Lénitral).

A nitroglycerin gel applied to the skin in doses of 15 to 30 mg prevents or delays the anginal pain induced by an excise tolerance test. The effects of the drug after a single application lasted 3 hours irrespective of the dose. Improvement in terms of increased heart rate, decreased S-T segment displacement and increased exercise capacity was the same as that observed after 0,75 mg sublingual nitroglycerin. A single 2.5 mg dose of an oral compound slowly released from the intestine (Lénitral) had no measurable effect during a 3-hour observation period. In contrast, a single 7.5 mg dose of the same compound produced, after 3 hours, the same overall improvement as that obtained with 0.75 mg sublingual nitroglycerin.

[Wolff-Parkinson-White syndrome. Correlation between the results of electrophysiological investigation and exercise tolerance testing on the electrical aspect of preexcitation]. / Syndrome de Wolff-Parkinson-White. Corrélations entre l'exploration électrophysiologique et l'effet de l'épreuve d'effort sur l'aspect électrocardiographique de préexcitation.

Fourteen patients with permanent electrocardiographical features of the Wolff-Parkison-White syndrome in sinus rhythm referred for electrophysiological investigation also underwent maximal exercise tolerance tests. The working hypothesis was that in patients with the Wolff-Parkinson-White syndrome with accessory pathways of longer effective refractory periods than the normal pathway (group I) the delta wave should disappear on exercise, whilst in patients with accessory pathways with shorter refractory periods than the normal pathway (group II) the delta wave should persist. Of the 9 patients in group I,the delta wave regressed in 8 and persisted in 1 patient; of the 5 patients in group II, the delta wave persisted in 4 of them. Three patients had attacks of tachycardia during or just after the exercise tolerance test. These results suggest that the exercise tolerance test may help in the identification of patients with accessory pathways with long refractory periods, less susceptible to rapid ventricular rhythms should atrial fibrillation occur, and therefore with better prognoses.

[Prinzmetal's angina initiated by interruption of exercise. 5 cases with normal coronary radiograms]. / Angor de Prinzmetal déclenché par l'arrêt de l'effort. Cinq cas à coronarographie normale.

Five male patients, aged between 31 and 58 years, presented with anginal chest pain with nausea and sweating after the interruption of exercise. Prinzmetal variant angina was observed during the recovery phase of exercise tolerance testing. Coronary arteriography and selective left ventricular angiography were normal in all cases. Ergonovine, used in one case, induced coronary artery spasm. The angina was eased by Nifedipine in three patients and passed off with time in the other two patients. In one case attack occurred with amiodarone therapy and in another with glyceril trinitrate, after normal exercise tolerance tests. Vagotonia, all the more pronounced when sympathetic tonus is increased, and hyperventilation seem to be the causative factors of what probably results from coronary artery spasm. Nifedipine, a calcium-blocking agent would appear to be the treatment of choice.