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[Use of the bicycle ergometric test as a method of identifying functional cardiac insufficiency in ischemic heart
Insights
The pulse-pressure index identifies myocardial oxygen consumption limits in chronic ischemic heart disease patients. This helps determine safe exercise levels to prevent further ischemic disorders and acidosis.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Chronic ischemic heart disease (IHD) poses significant challenges in managing cardiac reserve.
- Assessing the limits of myocardial oxygen consumption is crucial for patient management and exercise prescription.
Purpose of the Study:
- To determine the pulse-pressure index's utility in identifying ischemic manifestations.
- To evaluate the relationship between cardiac reserve, homeostasis mechanisms, and exercise tolerance in IHD patients.
Main Methods:
- Step-wise bicycle ergometry tests were performed on 146 IHD patients and 90 controls.
- Analysis included electrocardiogram (ECG), pulse rate, spiroergometry, cardiac volumes, and ultrasonic assessment of the left ventricle posterior wall.
Main Results:
- The pulse-pressure index reliably indicated the limit of oxygen consumption by the myocardium in all IHD patients.
- Limited cardiac reserve led to early activation of compensatory mechanisms like elevated arterial pressure and blood viscosity.
- These compensatory responses were inefficient, contributing to ischemic disorders, acidosis, and reduced oxygen consumption.
Conclusions:
- The pulse-pressure index is a valuable tool for assessing myocardial oxygen supply limits in IHD.
- Understanding these physiological responses is vital for selecting optimal training exercise intensities.
- The findings underscore the importance of tailored exercise programs to prevent adverse outcomes in IHD.
Abstract:
A total of 146 patients with chronic ischaemic heart disease and 90 normal persons were subjected to step-wise bicycle ergometry tests with an analysis of ECG, pulse rate, spiroergometry, cardiac volumes, and ultrasonic location of the posterior wall of the left ventricle. It was demonstrated that the pulse-pressure index that results in ischaemic manifestations can be determined in every patient, i.e. this index reflects the limit of oxygen consumption by the myocardium. Considerable limitations of the cardiac reserve result in early initiation of extracardiac mechanisms of homeostasis preservation--arterial pressure elevation, increasing dynamic viscosity of the blood, relatively moderate pulse rate increase. The noneconomic nature of such a response to the additional load predisposes the development of ischaemic disorders, acidosis and reduction of total oxygen consumption. The obtained data illustrate the importance of the test for the selection of optimum levels of training exercises.