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Title: A study of the mechanisms underlying the cardiac effects of exercise training in angina pectoris
Author: Todd, Iain Charles
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 1989
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This thesis investigates the use of exercise training as a therapy in the management of angina pectoris. The hypothesis underlying this work is that in the presence of ischaemia the myocardium will, if possible, respond in such a way as to minimise the effects of ischaemia. Improved collateral function was felt to be the most likely mechanism. A series of non-invasive investigations was developed in such a way as to make them useful for the detection of any possible improvement in myocardial ischaemia. These investigations included treadmill exercise tolerance testing, Thallium scintigraphy, Technetium ventriculography, exercise echocardiography and 24 hour ambulatory ECG monitoring. These techniques were refined for use in this study by the development of computerised analysis where appropriate. Forty male patients under 60 years of age with angina pectoris and no prior myocardial damage were recruited and randomised into exercise and control groups. Both groups were followed up over a one year period, the exercise group carrying out a brief daily home-based exercise programme, using the Canadian Airforce PBX Program for Physical Fitness. The techniques developed proved to be effective follow up tools in this group. Using them significant improvements in treadmill performance were demonstrated in the exercise group. These improvements were found to be partly due to changes in the peripheral control of exercise induced heart rate increases but also due to myocardial improvements. The peripheral effects were compared to and contrasted with betablockade. Within the myocardium significant reductions in ischaemic area were demonstrated, particularly in the territory of the left anterior descending coronary artery. These improvements in perfusion were accompanied by improvements in left ventricular function and regional wall motion. The improvements demonstrated in the laboratory were also evident during ambulatory ECG monitoring. The results demonstrated support the hypothesis outlined that controlled myocardial ischaemia can induce improvements in myocardial perfusion due to collateral enhancement and furthermore support the use of these techniques in such follow up studies.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available