Myocardial infarct size and cardiac performance at exercise soon after myocardial infarction

Abstract

Infarct size was estimated from serial serum CK MB measurements in a series of 101 patients admitted less than 15 hours after the first acute myocardial infarction. A maximal symptom limited exercise test comprising impedance measurements for the estimation of stroke volume at rest and at different levels of exercise was performed early after admission by 26 patients. There was a slight, though not significant, negative correlation between infarct size and physical capability as measured by the duration of work. The rise in systolic blood pressure during exercise showed a significantly negative and the increase in heart a significantly positive correlation to infarct size. This suggests that the rise in blood pressure, which is less in patients with the larger infarcts, is compensated by an increase in heart rate, so that the same maximum of cardiac performance and myocardial oxygen consumption is reached. The increase in cardiac stroke volume during exercise was negatively correlated with infarct size. Stroke volume only increased during lower levels of exercise; the increase in cardiac output at higher levels of exercise was achieved entirely by an increase in heart rate. The magnitude of ST segment elevation during exercise showed a significantly positive correlation with infarct size, whereas the occurrence of arrhythmias during exercise was independent of it.