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Update in Cardiology
- Joseph S. Alpert, MD; and
- Howard R. Horn, MD
- 1997-98 Series. John Roberts, MD, Editor. From the University of Arizona Health Sciences Center, Tucson, Arizona, and the University of Tennessee, Memphis, Tennessee. Requests for Reprints: Joseph S. Alpert, MD, Department of Medicine, University of Arizona Health Sciences Center, 1501 North Campbell Boulevard, Room 6334, Tucson, AZ 85724. Current Author Addresses: Dr. Alpert: Department of Medicine, University of Arizona Health Sciences Center, 1501 North Campbell Boulevard, Room 6334, Tucson, AZ 85724.
Important advances made in the field of cardiology in the past year fall into three major disease categories, all of which are responsible for a disproportionate amount of death, disability, and cost in the United States and around the world. Congestive heart failure affects 1% of persons older than 65 years of age; acute coronary artery syndromes are the number one cause of death in the United States; and chronic coronary syndromes are increasingly responsible for hospitalizations, presumably because of the aging U.S. population and better survival after acute heart injuries.
Congestive Heart Failure
Five notable advances occurred in this area in the past year. The first is the finding of the efficacy of exercise therapy, and the other four concern drug treatment with digoxin, amlodipine, carvedilol, and amiodarone.
Exercise Was Effective Treatment for Congestive Heart Failure
Keteyian SJ, Levine AB, Brawner CA, Kataoka T, Rogers FJ, Schairer JR, et al. Exercise training in patients with heart failure. A randomized, controlled trial. Ann Intern Med. 1996; 124:1051-7.
Left ventricular volume and stroke volume increase in anyone who exercises. Muscle arterioles also dilate during exercise, and oxygen is delivered and extracted more efficiently. Once fitness improves, heart rate, blood pressure, sympathetic tone, and exercise-induced platelet activation also improve. For these reasons, most cardiologists recommend exercise for patients with congestive heart failure. Only about one third of eligible patients are actually enrolled in cardiac rehabilitation programs, however, and only about one third of primary care physicians mention exercise to patients with congestive heart failure. Keteyian and colleagues assessed the benefit of exercise training in patients with heart failure caused by left ventricular systolic dysfunction.
In a clinical trial, 40 men with compensated congestive heart failure were randomly assigned to formal exercise training or usual care. All had resting ejection fractions of 35% or less, were clinically classified as belonging to New York Heart …
