運動負荷試験による心筋梗塞患者の退院後の心機能経過について

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The cardiac functin in patients with acute myocardial infarction (aMI) was succesively examined by graded exercise testing after discharge. The subjects were 51 male patients with average age of 58. At discharge and 6 months, 12 months and 2-3 years after the attack, intermittent multiple load tests (five minutes each at 25W, 50W, 75W and 100W) were performed using a bicycle ergometer in the upright position. The criteria for discontinuation of the tests included subjective symptoms such as appearance of chest pain, dyspnea and fatigue and objective symptoms such as ST changes of more than 2 mm compared to the level at rest and appearance of severe arhythmias on the electrocardiographic recordings.Exercise tests were carried out in 51,36,38 and 25 cases at discharge and 6 months, 12 months and 2-3 years after the attack, respectively. The cases in which loading was discontinued due to cardiac complications such as reinfarction, angina pectoris, heart failure and arhythmia accounted for 16%, 19% and 17% at 6 months, 12 months and 2-3 years after the attack, respectively.An increase was observed in physical work capacity (PWC) 6 months after the attack, which was maintained thereafter untill 2-3 years after the attack. The cardiac function assessed by PWC, physical fitness index (PFI), changes in ECG and subjective symptoms showed improvement in 53%, 62% and 70% of the patients 6 months, 12 months and 2-3 years after the attack, respectively. Thus, a remarkable improvement occurred within 6 months, and gradual improvement continued until 2-3 years after the attack.PWC at discharge was higher for the patients with ages younger than 59 years, limited infarction, initial attack and withut heart failure or arhythmia in the acute stage, in whom more increase in PWC was recorded after discharge. Among these patients, there were few in whom loading was obliged to be discontinued due to cardiac complications.With 50W load, a significant increase was seen in PFI, respiratory efficiency, O_2-consumption and O_2-pulse at every check point after discharge comparing to the values at discharge, while a decrease was observed in heart rate. However O_2-debt and cardiac output was slightly improved.One year after the attack of aMI, 50% of the patients could return to full time job, 26% to part time and 24% could not return to work.The greater was the PWC of the patients at discharge, the higher was the rate of the retun to work. From these data, it was concluded that the patients with lesser clinical findings in the acute stage and greater PWC at discharge could rehablitate in earlier period after the attack.
社団法人日本リハビリテーション医学会の論文
1981-01-18

運動負荷試験による心筋梗塞患者の退院後の心機能経過について

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