Zeitschrift für Kardiologie
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While aerobic endurance training has been a substantial part of international recommendations for cardiac rehabilitation during the last 30 years, there is still a rather reserved attitude of the medical community to resistance exercise in this field. Careful recommendations for resistance exercise in cardiac patients was only published a few years ago. It has been taken for granted that strength exercise elicits a substantial increase in blood pressure and thus imposes, especially in cardiac patients, a risk of potentially fatal cardiovascular complications. ⋯ Therefore, an integration of dynamic resistance exercises in cardiac rehabilitation can only be recommended without hesitation for CHD patients with high physical capacity (good myocardial function, revascularized). Since patients with myocardial ischemia and/or low left ventricular functioning might develop wall motion disturbances and/or dangerous ventricular arrhythmia when performing resistance exercises, prevalence of the following conditions is recommend: moderate to high LV-function, high physical performance (>5-6 metabolic equivalents= >1.4 watts/kg body weight) in absence of angina pectoris symptoms or ST-depression, by maintained current medication. In the proposed recommendations, a classification of risks for resistance training in cardiac rehabilitation is being made based on current data and is complemented by specific recommendations for particular groups of patients and detailed guidelines for setup and completion of the therapy program.
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Cardiovascular diseases are systemic processes frequently involving multiple vascular beds. Cardiovascular multimorbidity, arbitrarily defined as a clinically relevant disease of at least two major vascular beds in a single individual is frequent occurring in 30% to 70% of patients depending on the patient population. Management of patients with cardiovascular multimorbidity is complex requiring an interdisciplinary consensus and coordination. A panvascular concept of an interdisciplinary integrated management of these patients is introduced.
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Based on the medical and economical data of 137 German hospitals including 12 university hospitals, the Institut für das Entgeltsystem im Krankenhaus (InEK) was again authorized by the German Ministry of Health to calculate and develop a refined version of the German diagnosis related groups (G-DRG) for the year 2004. The catalogue of these updated GDRGs was published on October 15' 2003. Furthermore, the grouper programs containing the current algorithms and the cost data on which the new G-DRGs were based have been published in the last few weeks. ⋯ In conclusion, a number of improvements have been implemented in the updated G-DRG system which had in part been suggested by several national medical societies. These provide the basis for more precise and detailed DRGs but require on the other hand, a precise and complete coding to allow correct grouping procedures. From an economical point of view, it could hardly be summarized whether these improvements would lead to an adequate reimbursement for the treatment costs of patients with cardiovascular diseases since the case-mix of the various departments may vary widely.
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The Fontan operation causes an acute decrease of volume overload of the univentricular heart followed by changes in ventricular geometry. The postoperative increase of myocardial mass-volume-index (MVI) may alter ventricular diastolic function. In this study, we analysed whether the increase in MVI and changes of the ventricular geometry have an effect on the decrease of the exercise capacity in patients with Fontan surgery. ⋯ Myocardial hypertrophy may influence the myocardial performance of the univentricular heart and thereby the physical performance in children and adults with Fontan circulation.