The pathophysiology of several conditions including heart failure is partly attributable to a failure of the cell energy metabolism. Studies have shown that exercise training (ET) improves quality of life (QOL) and is beneficial in terms of reduction of symptoms, mortality and duration of hospitalization. Increasingly, ET is now achieving acceptance as complimentary therapy in addition to routine clinical practice in patients with chronic heart failure (CHF). However, the mechanisms underlying the beneficial effects of ET are far less understood and need further evaluation. Evidence suggests that while CHF induces generalized metabolic energy depletion, ET largely enhances the overall function of the heart muscle. Hence, research efforts are now aiming to uncover why ET is beneficial as a complimentary treatment of CHF in the context of improving endothelial function and coronary perfusion, decreasing peripheral resistance, induction of cardiac and skeletal muscle cells remodeling, increasing oxygen uptake, substrate oxidation, and resistance to fatigue. Here we discuss the current evidence that suggest that there are beneficial effects of ET on cardiac and skeletal muscle cells oxidative metabolism and intracellular energy transfer in patients with CHF.

Aortic dissection is an uncommon but very lethal disease. Majority of cases are found in elderly patients with a history of hypertension. Young patients usually have other risk factors such as vasculitis, Marfan syndrome, unrecognized coarctation of the aorta, and a bicuspid aortic valve. We present a case of a young patient who presented with epigastric pain mimicking peptic ulcer disease that was later on proved to be type B dissection of the aorta. The patient had a unique combination of hypertension, a bicuspid aortic valve, and postductal coarctation.