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After a review of the different central and peripherical factors limiting exercise capacity in chronic heart failure, the authors report the mechanisms of these increment with exercise training. The different indications for clinical training techniques of segmental training on a specific bench are discussed; but it appears that both aerobic and repetitive weight programs seem to have short term favorable and complementary effects.

The use of sublingual nitroglycerin in the stress test is a precious tool in everyday clinical cardiology. It has several indications in this context: 1) Confirmation of the diagnosis of myocardial ischaemia by eliminating a large number of false-positives with no marked variation of ST depression and performance after sublingual nitroglycerin in contrast with patients presenting authentic myocardial ischaemia on effort. 2) Teaching of the preventive and opportunistic use of nitroglycerin before intense effort and before physical training which, in the long-term, is one of the most effective treatments of exertional angina pectoris. 3) Demonstration of potentiation of the effect of certain antianginal drugs such as beta-blockers. 4) In therapeutic trials, the stress test performed with sublingual nitroglycerin is used as a reference and to select patients capable of a fairly marked progression, so that they can be included in a protocol. It has the advantage of demonstrating a functionally measurable improvement of the stress test with an appropriate drug. 5) Progression with sublingual nitroglycerin during the stress test is related to regression of ischaemia i.e. restoration of functional viability of hibernating or shocked ischaemic segments of myocardium. It is probably the only realistic way to predict possible improvement after revascularization compared to other tests, which may be over-sensitive, as they detect zones with little capacity of regaining a viability which really contributes to cardiac output on exertion.

The authors report the case of an elderly sportsman presenting with the electrical signs of the syndrome described by Brugada. The absence of any serious clinical events in this patient questions the pejorative prognosis usually reported and the specific identity of this syndrome in relation to right ventricular arrhythmogenic dysplasia.

The authors report a case of myxoma of the left atrium unusual by its clinical presentation, very calcified radiological appearance and histological findings. The topographic description, facilitated by transoesophageal echocardiography, is also emphasized.

Triangular and rectangular rehabilitation techniques were assessed by comparative exercise performance and respiratory evaluation in twenty six phase II post-myocardial infarction patients. Patients all performed a standard exercise test with measurement of VO2, before and after 40 rehabilitation sessions. Clinical, exercise and ventilatory parameters were identical in the two groups before rehabilitation (triangular--n = 13; rectangular--n = 13). Exercise capacity was increased by 18% and 19% respectively after rehabilitation. Maximum aerobic capacity nevertheless remained unchanged (27.6 +/- 7.1 before; 28.3 +/- 6.7 ml/kg/min after) in all patients. Analysis of variance failed to reveal superiority of one of the two rehabilitation techniques over the other.

28 children (age: 7.5 +/- 4.6 years) and five adults with a subvalvular aortic stenosis were evaluated by TM and bidimensional echography. Long axis parasternal and apical two cavities-aorta views seem the most reliable to determine the anatomical varieties (type I in diaphragm: 25 cases; type II fibromuscular: 5 cases; tunnel: 1 case; isolated mitral abnormalities: 2 cases). 24 patients were catheterized. Among the various echocardiographic parameters that were measured, the ratio parietal thickness/left ventricular diameter in telesystole appears best correlated to the hemodynamic gradient (r = 0.65).

The anti-ischemic activity of Verapamil (360 mg/24 h) is compared with a cardioselective betablocker, Atenolol (100 mg/24 h), in a single blind study with computerized stress tests. Although acting through different mechanisms, and are evaluated indirectly by measurements with equal cardiac work and frequency, the improvement of the performance, the decrease of the sub-denivellation at the end of the stress and the frequency of interruption because of pain, seem approximately similar for both medications.