Cardiovascular responses to low-intensity isometric handgrip exercise in coronary artery disease: effects of posture.

BACKGROUND: Coronary artery disease (CAD) lead to cardiovascular autonomic control disfunctions that can worsen exercise and/or posture adjustments. OBJECTIVES: To verify the cardiovascular responses to low-intensity isometric handgrip exercise performed in different postures in CAD patients. This study tested the hypothesis that the posture influences the cardiovascular responses during isometric handgrip exercise and that the presence of CAD leads to greater cardiovascular stress during this type of exercise. METHODS: We investigated cardiovascular responses to isometric handgrip exercise in 15 CAD patients (CADG) and 15 health matched-control (CG). The subjects performed isometric handgrip exercise at 30% of maximum voluntary contraction until exhaustion in SUPINE, SITTING and STANDING positions. Systolic arterial pressure, diastolic arterial pressure, mean blood pressure, heart rate, peripheral vascular resistance, cardiac output, stroke volume and double product were measured during rest (baseline), exercise (peak value) and recovery in the 1st minute (REC1). Delta PB (ΔPB, peak minus baseline) and PR1 (ΔPR1, peak minus REC1) were calculated. RESULTS: Higher ΔPB and ΔPR1 of systolic and mean arterial pressure and double product were observed in STANDING when compared to SITTING and/or SUPINE. CADG showed higher ΔPB of systolic and mean arterial pressure in all postures and higher ΔPR1 of strove volume in the SITTING. CONCLUSION: We concluded that the posture during isometric handgrip exercise influences the cardiovascular responses with STANDING leading to higher cardiovascular stress. CAD promoted higher arterial pressure responses however these responses were physiological and expected due to the presence of disease and type of exercise.

The additional impact of type 2 diabetes on baroreflex sensitivity of coronary artery disease patients might be undetectable in presence of deterioration of mechanical vascular properties.

Both deterioration of the mechanical vascular properties of barosensitive vessels and autonomic derangement lead to modification of baroreflex sensitivity (BRS) in coronary artery disease (CAD) individuals. Type 2 diabetes (T2D) reduces BRS as well even in absence of cardiac autonomic neuropathy. The aim of the study is to clarify whether, assigned the degree of mechanical vascular impairment and without cardiac autonomic neuropathy, the additional autonomic dysfunction imposed in CAD patients by T2D (CAD-T2D) decreases BRS further. We considered CAD (n = 18) and CAD-T2D (n = 19) males featuring similar increases of average carotid intima media thickness (ACIMT) and we compared them to age- and gender-matched healthy (H, n = 19) subjects. BRS was computed from spontaneous beat-to-beat variability of heart period (HP) and systolic arterial pressure (SAP) at supine resting (REST) and during active standing (STAND). BRS was estimated via methods including time domain, spectral, cross-spectral, and model-based techniques. We found that (i) at REST BRS was lower in CAD and CAD-T2D groups than in H subjects but no difference was detected between CAD and CAD-T2D individuals; (ii) STAND induced an additional decrease of BRS visible in all the groups but again BRS estimates of CAD and CAD-T2D patients were alike; (iii) even though with different statistical power, BRS markers reached similar conclusions with the notable exception of the BRS computed via model-based approach that did not detect the BRS decrease during STAND. In presence of a mechanical vascular impairment, indexes estimating BRS from spontaneous HP and SAP fluctuations might be useless to detect the additional derangement of the autonomic control in CAD-T2D without cardiac autonomic neuropathy compared to CAD, thus limiting the applications of cardiovascular variability analysis to typify CAD-T2D individuals. Graphical abstract Graphical representation of the baroreflex sensitivity (BRS) estimated from spontaneous fluctuations of heart period and systolic arterial pressure via transfer function (TF) in low frequency (LF) band (from 0.04 to 0.15 Hz). BRS was reported as a function of the group (i.e., healthy (H), coronary artery disease (CAD) and CAD with type 2 diabetes (CAD-T2D) groups) at REST (black bars) and during STAND (white bars). Values are shown as mean plus standard deviation. The symbol "*" indicates a significant difference between conditions within the same group (i.e., H, CAD, or CAD-T2D) and the symbol "§" indicates a significant difference between groups within the same experimental condition (i.e., REST or STAND). BRS cannot distinguish CAD and CAD-T2D groups both at REST and during STAND, while it is useful to distinguish experimental conditions and separate pathological groups from H subjects.

Ratings of perceived exertion at anaerobic threshold in patients with coronary artery disease / Percepción subjetiva del esfuerzo en el liminar anaeróbico en pacientes con enfermedad arterial coronaria / Percepção subjetiva do esforço no limiar anaeróbio em pacientes com doença arterial coronariana

The study aimed to identify and compare the ratings of perceived exertion (RPE) at the ventilatory anaerobic threshold (VAT) in healthy subjects and patients with coronary artery disease (CAD). A total of 30 male subjects took part in the study and were divided into three groups: a control group (CG) composed of 10 healthy participants; a group composed of 10 participants diagnosed with CAD beta-blocker user (G-DACb); and a group composed of 10 participants with CAD non-beta-blocker user (G-DAC). The participants performed a cardiopulmonary exercise test (CPET) with continuous type ramp protocol to determine the VAT, through the visual graphical analysis (loss of parallelism between the oxygen uptake and the carbon dioxide output). During CPET, before the end of each one-minute period, the subjects were asked to rate dyspnea (RPE-D) and leg fatigue (RPE-L) on the Borg CR-10 scale. After the VAT was determined, the score that the participants gave on the Borg CR10 scale was verified. CG participants showed higher workload, oxygen uptake, carbon dioxide output, ventilation and heart rate at the VAT compared to the G-DAC and G-DACb (p<0.05). However, regarding the RPE-L and the RPE-D, no significant difference between the groups were observed (p<0.05). Values between five and six on Borg CR-10 scale matched the VAT in the subjects studied. However, other parameters must be concomitantly used for prescribing exercise intensity in physical training protocols, at levels close to the VAT for patients with CAD.

El objetivo del estudio fue identificar y comparar la percepción subjetiva del esfuerzo (PSE) en el liminar anaeróbico ventilatorio (LAV) en sujetos sanos y con enfermedad arterial coronaria (EAC). Fueron estudiados 30 hombres siendo10 sanos que constituyeron el grupo control (GC) y 20 diagnosticados con EAC, de los cuales 10 utilizaban medicamento betabloqueante (G-DACb) y 10 no utilizaban (G-DAC). Los voluntarios fueron sometidos a una prueba de ejercicio cardiopulmonar (TECP) con protocolo continuo tipo rampa para la determinación del LAV, a través del análisis gráfico visual (pérdida del paralelismo entre el consumo de oxígeno y producción de dióxido de carbono). Durante la realización del TECP, se pidió a los voluntarios que informaran al final de cada minuto la percepción subjetiva del esfuerzo de los miembros inferiores (PSE-M) y la percepción subjetiva del esfuerzo respiratorio (PSE-R) a través de la escala de Borg CR-10. El GC presentó mayores valores de potencia, consumo de oxígeno, producción de dióxido de carbono, ventilación y frecuencia cardiaca en el LAV comparado con los grupos G-DAC y G-DACb (p<0,05). La PSE-M fue menor en el G-DACb comparado con el GC (p<0,05). Después del ajuste por la covariable potencia, no hubo diferencia significativa entre los grupos para PSE-M y PSE-R (p>0,05). Los valores entre cinco y seis en la escala CR-10 de Borg correspondieron al LAV en la muestra estudiada. Sin embargo, otros parámetros deben ser utilizados simultáneamente para la prescripción de la intensidad del ejercicio en los protocolos de entrenamiento físico, en niveles cercanos al LAV para pacientes con EAC.

O objetivo do estudo foi identificar e comparar a percepção subjetiva do esforço (PSE) no limiar anaeróbio ventilatório (LAV) em indivíduos saudáveis e com doença arterial coronariana (DAC). Foram estudados 30 homens, sendo 10 saudáveis que constituíram o grupo controle (GC) e 20 diagnosticados com DAC, dos quais 10 faziam uso de medicamento betabloqueador (G-DACb) e 10 não faziam uso (G-DAC). Os voluntários foram submetidos a um teste de exercício cardiopulmonar (TECP) com protocolo contínuo tipo rampa para determinação do LAV, através da análise visual gráfica (perda do paralelismo entre o consumo de oxigênio e a produção de dióxido de carbono). Durante a realização do TECP, foi solicitado aos voluntários que relatassem ao final de cada minuto a percepção subjetiva do esforço de membros inferiores (PSE-M) e a percepção subjetiva do esforço respiratório (PSE-R), através da escala CR-10 de Borg. O GC apresentou maiores valores de potência, consumo de oxigênio, produção de dióxido de carbono, ventilação e frequência cardíaca no LAV comparado aos grupos G-DAC e G-DACb (p<0,05). A PSE-M foi menor no G-DACb comparado ao GC (p<0,05). Após ajuste pela covariável potência, não houve diferença significativa entre os grupos para PSE-M e PSE-R (p>0,05). Valores entre cinco e seis na escala CR-10 de Borg correspondeu ao LAV na amostra estudada. Entretanto, outros parâmetros devem ser utilizados concomitantemente para a prescrição da intensidade de exercício nos protocolos de treinamento físico, em níveis próximos ao LAV para pacientes com DAC.

Comprometimento arterial coronariano e função pulmonar em homens de meia idade / The involvement of the coronary arteries and pulmonary function in middle-aged men

Introdução: Redução da função pulmonar tem sido associada a eventos coronarianos, contribuindo para o aumento da incidência de morte por doença cardiovascular. Objetivo: Comparar a função pulmonar entre sujeitos aparetemente saudáveis e com comprometimento arterial coronariano. Materiais e Métodos: Participaram de estudo 46 homens de meia idade, com baixo nível de atividade física, os quais foram divididos em quatro grupos: aparetemente saudáveis (GS,n=10); com obstrução do diâmetro luminal coronariano menor que 50% nas artérias comprometidas (GDAC-,n=12); e com infarto agudo do miocárdio (IAM), classificação clínica KIllip 1 (GIAM n=12). Todos foram submetidos à avaliação da função pulmonar por meio da espirometria. Resultados: Tanto para a capacidade vital forçada (CVF) como para o volume expiratório forçado no primeiro segundo (VEF1), o GS apresentou maiores valores quando comparado aos grupos Dac+ e IAM (p<0,05). Na comparação dos resultados entre os grupos com comprometimento arterial coronariano, tanto a CVF com VEF, o GDAC- e o GDAC+ apresentaram maiores valores quando comparados ao GIAM (p<0,05). A análise de regressão linear múltipla mostrou que a variável de maior associação com o VEF, foi o comprometimento arterial coronariano (r2=0,50, p<0,0001), não tendo o tabagismo apresentado significância (p>0,67). Conclusão: redução nos valores de CVF e VEF1 está relacionada ao grau de compropmetimento coronariano neste grupo de pacientes, independentemente do tabagismo, sugerindo que o processo aterogênico pode ter impacto negativo sobre a função pulmonar de pacientes com DAC.

Introduction: Reduction of pulmonary function has been associated with coronary events, contributing to the increased incidence of death by cardiovascular disease. Objective: To compare the pulmonary function among apparently healthy subjects with arterial coronary obstruction. Materials and Methods: A group of 46 middle-aged men with low levels of weekly physical activity, which were divided into: apparently healthy (AH,n=10); with obstruction of coronary luminal diameter less than 50% obstruction arteries (GCAD-,n=10); with coronary obstruction greater than or equal to 50% in at least one artery (DCAD+,n=12); and with acute myocardial infarction (AMI) clinical classification KILLIP I (GAIM,n=12). All were submited for the evaluation of pulmonary function by spirometry. Results: Both for the forced vital capacity (FVC) and forced experiratory volume in one second (FEV1), The AH presented greater values when compared to CAD+ and AMI group (p<0.005). Comparison of results between the groups with arterial coronary obstruction, both for the CVF as to the VEF1, the GCAD- and the larger values when GCAD+ feature compared to the GAIM (p<0.05). Multiple linear regression analysis showed that the largest association with FEV1 was the coronary obstruction (r2=0.50p<0.0001), not having smoking presented significance (p>0.67). Conclusion: The reduction in values of FVC and FEV1 is related to the degree of coronary obstruction in this group of patients, independent of smoking, suggesting that the atherogenic process can have a negative impact on pulmonary function of patients with CAD.

Prevalência de amputação em membros inferiores de causa vascular: análise de prontuários / Prevalence amputation on inferior members from vascular cause: analyses of promptuary

A amputação é o procedimento cirúrgico mais antigo e significa retirada, geralmente, cirúrgica, total ou parcial de um membro. A amputação não deve ser considerada como fim, e sim como o início de uma nova fase, que tem como principal objetivo manter e/ou devolver a dignidade e funcionalidade do paciente. Acredita-se em que, dentre todas as amputações, as de membros inferiores ocorrem em 85 por cento dos casos, sendo suas causas mais comuns: insuficiência vascular periférica como conseqüência de diabetes, aterosclerose, embolias, tromboses arteriais, traumatismos e tumores malignos. Das causas vasculares que levam a amputação, o diabetes corresponde a 80 por cento, e as taxas de mortalidade associada à amputação variam de 6 a 17 por cento. Acredita-se em que o prognóstico é pios em pacientes idosos, pois está associado a uma habilidade física desfavorável e uma maior dependência social. As amputações podem levar a complicações como: hematoma, infecções, necrose, contraturas, neuromas, sensação fantasma e dor fantasma, além das complicações psicológicas. Foi realizado um levantamento de dados dos prontuários dos anos de 2002 e 2003 do Hospital Regional da cidade de Cascavel-PR, e coletados dados referentes à idade do paciente, sexo, motivo vascular da amputação, nível glicêmico e número de amputações sofridas pelo mesmo paciente