Investigation of the Physiological Basis for Increased Exercise Threshold for Angina Pectoris after Physical Conditioning
Open accessAbstract
Eight patients with coronary heart disease and exertional angina pectoris successfully completed an 11-15 wk program of endurance exercise conditioning. Angina threshold was determined by upright bicycle ergometer exercise and by atrial pacing. The product of heart rate and arterial systolic blood pressure at the exercise angina threshold was higher after conditioning. suggesting that conditioning increased the maximum myocardial O(2) supply during exercise. However, when angina was induced by atrial pacing, heart rate, arterial blood pressure, coronary blood flow, and myocardial O(2) consumption at the angina threshold were the same before and after conditioning. Myocardial lactate extraction during atrial pacing was abnormal in the same five patients before and after conditioning. Conditioning caused no detectable changes in coronary collaterals as judged by coronary arteriograms. The increase in exercise angina threshold appeared to be due to a functional adaptation in either myocardial O(2) supply or the relationship between hemodynamic work and myocardial O(2) consumption. The adaptation was limited to exercise, and did not occur during a different stress to myocardial O(2) supply, atrial pacing.
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In one study, the increase in rate-pressure product at the onset of angina occurred only during exercise, whereas the rate-pressure product at the onset of angina with ventricular pacing was unchanged.
“In one study, the increase in RPP at the onset of angina occurred only during exercise, 32 whereas the RPP at the onset of angina with ventricular pacing was unchanged.”
From Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease: A Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity) (2003) · cites this paper as [32]
The Results report that RPP at the angina threshold rose after conditioning during exercise but was unchanged during pacing. The Methods identify that procedure as atrial pacing, not the ventricular pacing specified in the claim. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThese findings suggest that exercise training altered the coronary vasomotor response to exercise.
“These findings suggest that exercise training altered the coronary vasomotor response to exercise.32”
From Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease: A Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity) (2003) · cites this paper as [32]
In the Results/Discussion (page not supplied), the paper considers an exercise-specific coronary vasomotor response as one possible explanation for the higher angina threshold after conditioning. It also offers an alternative involving myocardial oxygen consumption and says it lacked the measurements during exercise needed to distinguish the two. The findings therefore do not specifically establish an altered vasomotor response. (LLM, conf=0.85)
Experimental — accuracy not yet measured
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- Authors
- Sim, D. N., & Neill, W. A.
- Affiliations
- Oregon Health & Science University (US)
- Venue
- Journal of Clinical Investigation
- Published
- 1974-09-01
- Volume
- 54
- Issue
- 3
- Pages
- 763-770
- ISSN
- 0021-9738 (ISSN-L)
- PMC
- PMC301610
- OpenAlex
- W1983766735
- Semantic Scholar
- 838dc53bbc8dea1798327c0a1234aaf1e2140d8e
- Cited by
- 81
- References
- 32
- Citations by year
- 2020: 1 · 2017: 1 · 2012: 2
- FWCI
- 4.08
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Investigation (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- angina pectoris, exercise threshold, coronary artery disease, myocardial oxygen supply, myocardial oxygen consumption, coronary blood flow, myocardial lactate extraction, atrial pacing, heart rate, systolic blood pressure, coronary collateral circulation
- MeSH terms
- Adaptation, Physiological, Adult, Angina Pectoris, Blood Pressure, Collateral Circulation, Coronary Circulation, Electric Stimulation, Physical Exertion, Heart, Heart Rate, Heart Ventricles, Humans, Middle Aged, Myocardium, Oxygen Consumption, Pacemaker, Artificial, Physical Education and Training
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