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A 62-year-old woman with activity-dependent two-to-one atrioventricular block (2:1AVB) and a normal left ventricular ejection fraction was referred to our department for the evaluation of exclusively exercise-induced marked symptoms. The treadmill test helped establish a clear correlation between 2:1AVB and symptoms. The test results demonstrated that exercise-induced marked symptoms were attributed to abrupt transient hypotension combined with relative bradycardia, probably due to increased diastolic mitral and tricuspid regurgitation because of 2:1AVB during moderate-to-heavy exercise. After pacemaker implantation for 2:1AVB, the symptoms and transient hypotension disappeared, and her exercise capacity improved.

The improvement of exercise tolerance and quality of life (QOL) are essential in the treatment of patients with heart failure. The influence of physical exercise training on QOL was investigated in patients with left ventricular dysfunction.Health-related QOL was evaluated using the Medical Outcomes Study Short-Form 36 Health Status Survey (SF-36) before and 3 months after individualized exercise training determined by cardiopulmonary exercise testing in 65 patients. The 44 patients who could carry out more than two-thirds of the prescribed exercise were classified into two groups: Group A (11 patients)with left ventricular ejection fraction40% and Group B (33 patients) with left ventricular ejection fractionor = 40%. The remaining 21 patients served as the control group.The mean value of SF-36 improved significantly with exercise training only in Group A (50.8 +/- 25.3 to 62.1 +/- 22.2, p0.05). Group A also had an increase in peak Vo2 (18.9 +/- 3.5 to 21.4 +/- 3.6 ml/min/kg, p0.005) and a decrease in brain natriuretic peptide. The 24 patients (9 in Group A, 15 in Group B) with improved SF-36 values after the exercise training showed a negative correlation between the change of the mental component summary and the peak Vo2 (r = - 0.606, p0.05).Exercise training improves both the QOL, especially the mental component, and the exercise tolerance in patients with left ventricular dysfunction.

Although stents reduce the rate of vessel restenosis, in-stent restenosis is a recognized clinical problem and it appears that patients positive for allergic patch-test reactions to the stent components nickel and molybdenum have increased rates of it. A patient with angina pectoris had repeated episodes of restenosis after stent implantation and histological examination demonstrated granulation tissue with eosinophil infiltration in the restenotic lesion of the coronary artery. The patient was positive for an allergic reaction to the stent components.

Although stents reduce the rate of vessel restenosis, in-stent restenosis is a recognized clinical problem and it appears that patients positive for allergic patch-test reactions to the stent components nickel and molybdenum have increased rates of it. A patient with angina pectoris had repeated episodes of restenosis after stent implantation and histological examination demonstrated granulation tissue with eosinophil infiltration in the restenotic lesion of the coronary artery. The patient was positive for an allergic reaction to the stent components.