[Silent myocardial ischemia. The practice of sports in coronary patients].

In 1988 we retrained for exercise 800 coronary patients who had suffered a myocardial infarction or had benefited from revascularization surgery. Twenty per cent of these patients under anti-anginal treatment have silent myocardial ischaemia (SMI). Four per cent still have exercise-induced angina. The influence of SMI on the prognosis, frequently through an acute coronary accident or through the slow development of an ischaemic cardiomyopathy, has prompted us to determine a heart rate that should not be exceeded by coronary patients while practising sports. We learned by experience that coronary subjects with SMI should not practise sports immediately they get up; they should proceed gradually and always after a mandatory warming up period. Outdoor activities in periods of severe cold or strong winds should be banned and replaced by indoor games which should take place outside the digestion period. Finally, all concepts of competition, endurance or performance should be excluded from their practice of sports. The finding that two out of three coronary patients underestimate their rate by 20% should, in the absence of atrial or thoracic capillary feelers, lead to the conclusion that the heart rate not to be exceeded must be underestimated by 20%.