The role of rest and exercise in congestive heart failure

SELECTED

Historically the importance of cardioclynamic of, and circulatory mechanisms involved in tension, central versus peripheral failure, right roidism, and polycythemia is stressed. It has been found to group decompensated hlood volume readings. are

From the practical in the following:

studies in explaining the nature certain clinical conditions; hyperversus left heart failure, hyperthy-

useful from the diagnostic cardiacs into plus and viewpoint,

the

639

ABSTRACTS

greatest

and minus

uses

therapeutic forms of

made

of

points failure,

of view based on

cardiodynamic

studies

1. Borderline cases of hyperthyroidism, where an increased cardiac output, increased blood volume and rapid circulation time distinguish this condition from neurocirculatory asthenia or incipient tuberculosis (in which the above values are normal). 3. In polycythemia vera the very high blood volume and hematocrit reading are usually sufficient to distinguish it from the symptomatic polycythemias, which do not yield such high figures. 3. In the differentiation between right and left heart failure, aside from clinical differences, the lengthened arm-to-lung circulation time in right-sided failure is of distinct value. By subtracting the arm-to-lung circulation time from the total pulmonary circulation time (arm-to-head) one can estimate the speed through the left heart circuit. 4. In decompensation, often the very first sign of right, heart failure is an increase in the venous pressure. AUTHORS. Davis, land

D.: The Role of Rest and Exercise J. Med.

219:

412,

in Congestive

Heart

Failure.

New

Eng

1938.

There is no agreement in the literature as to the length of time patients should rest after evidence of congestive failure has disappeared, or as to the advisability of exercise in convalescence. The historical aspect of these questions is considered. The question of the advisability of exercise in convalescence is discussed at length. No data were found to support the contention that this therapy improves the capacity of the heart. The results of prolonged bed rest in eleven cases are compared with those in a control group treated in the accepted manner. The course in these eleven cases was appreciabIy better than that in the control group. These results call for a program which will take into initial period of rest, adequate subsequent reduction prophylactic bed rest. Such a program is outlined.

consideration in activity,

an adequate and periodic AUTHOR.

Wolferth,

Charles

Deposits in Heart

C., and Margolies, Valve Areas.

Alexander: Movements of Am. J. M. Se. 197: 197, 1939.

Roentgen-Opaque

A cardiac roentgenkymogram timed by an electrocardiogram was made in such a way as to demonstrate the movements, toward and away from each other, of the apex and of a calcium deposit in the region of the aortic valve. From the data obtained in this case and four others (three previously published) in which roentgenkymograms were made of calcium deposits in either the mitral valve or aortic valve area, the following points are emphasized. The change in size and shape of the left ventricle during due more to shortening of the long axis than to movement

contraction of the lateral

is probably wall.