EXHIBIT 4.5


                                AMENDMENT NO.2 
                                      TO 
                     AMENDED AND RESTATED CREDIT AGREEMENT


     AMENDMENT dated as of October 24, 1997 to the Amended and Restated Credit 
Agreement dated as of May 30, 1997, as amended as of June 24, 1997 (the "CREDIT 
AGREEMENT") among VENCOR, INC. ("VENCOR"), the BANKS, SWINGLINE BANK, LC ISSUING
BANKS, MANAGING AGENTS and CO-AGENTS party thereto, MORGAN GUARANTY TRUST 
COMPANY OF NEW YORK, as Documentation Agent (the "DOCUMENTATION AGENT") and 
Collateral Agent, and NATIONSBANK, N.A., as Administrative Agent.

                             W I T N E S S E T H :

     WHEREAS, the parties hereto desire to amend the Credit Agreement to 
increase by $50,000,000 the amount of Restricted Payments that Vencor is 
permitted to make;

     NOW, THEREFORE, the parties hereto agree as follows:

     Section 1.  DEFINED TERMS; REFERENCES. Unless otherwise specifically 
defined herein, each term used herein which is defined in the Credit Agreement 
has the meaning assigned to such term in the Credit Agreement. Each reference to
"hereof", "hereunder", "herein" and "hereby" and each other similar reference 
and each reference to "this Agreement" and each other similar reference 
contained in the Credit Agreement shall, after this Amendment becomes effective,
refer to the Credit Agreement as amended hereby.

     Section 2.  AMENDMENT OF RESTRICTED PAYMENTS COVENANT. Section 5.11 of the 
Credit Agreement is amended to read as follows:

               Section 5.11. RESTRICTED PAYMENTS. Unless Vencor has an 
          Investment Grade Rating, Vencor will not, and will not permit any 
          Subsidiary to, declare or make any Restricted Payment on or after the 
          Initial Closing Date, except:

                    (a)  any distribution of shares of Ventech Systems, Inc. by 
               Vencor to its own shareholders;

                    (b)  dividends on Equity Securities of Vencor declared and 
               paid during the period from January 1, 1997 to March 31, 1998, 
               inclusive, in an aggregate amount not exceeding $10,000,000;

                    (c) Restricted Payments (other than dividends on Equity
               Securities of Vencor) made during the period from January 1, 1997
               to March 31, 1998, inclusive, in an aggregate amount not
               exceeding $100,000,000; and
               

 
                    (d) any other Restricted Payment declared and made after
               March 31, 1998 if, immediately after such Restricted Payment is
               declared or made, the aggregate amount of all Restricted Payments
               declared or made after March 31, 1998 does not exceed the sum of
               (i) the amount set forth below opposite the period in which the
               date of such declaration or payment occurs plus (ii) the amount
               by which $100,000,000 exceeds the aggregate amount of all
               Restricted Payments made pursuant to clause (c) above:

                         PERIOD                             AMOUNT
               April 1, 1998 through March 31, 1999    $10,000,000
               April 1, 1999 through March 31, 2000    $20,000,000
               April 1, 2000 through March 31, 2001    $30,000,000
               April 1, 2001 through March 31, 2002    $40,000,000

          provided that in no event shall Vencor or any Subsidiary declare or
          make any Restricted Payment pursuant to this Section if, immediately
          before or after giving effect thereto, any Default shall have occurred
          and be continuing.

     SECTION 3.  REPRESENTATIONS OF VENCOR.  Vencor represents and warrants that
(i) the representations and warranties of Vencor set forth in Article 4 of the 
Credit Agreement will be true on and as of the Amendment Effective Date and (ii)
no Default will have occurred and be continuing on such date.

     SECTION 4.  GOVERNING LAW.  This Amendment shall be governed by and 
construed in accordance with the laws of the State of New York.

     SECTION 5.  COUNTERPARTS.  This Amendment may be signed in any number of 
counterparts, each of which shall be an original, with the same effect as if the
signatures thereto and hereto were upon the same instrument.

     SECTION 6.  EFFECTIVENESS.  This Amendment shall become effective on the 
date (the "AMENDMENT EFFECTIVE DATE") when the Documentation Agent shall have 
received from each of Vencor and the Required Banks a counterpart hereof signed 
by such party or facsimile or other written confirmation (in form satisfactory 
to the Documentation Agent) that such party has signed a counterpart hereto.

                                       2

 
     IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be 
duly executed as of the date first above written.

                                        
                                        VENCOR, INC.

                                        By: /s/ Steven L. Monaghan
                                           ------------------------------------
                                           Title: Vice President

                              
                                        MORGAN GUARANTY TRUST
                                         COMPANY OF NEW YORK

                                        By: /s/ Diana H. Imhof
                                           ------------------------------------
                                           Title: Vice President


                                        NATIONSBANK, N.A.,

                                        By: /s/ Ashley M. Crabtree
                                           ------------------------------------
                                           Title: Senior Vice President


                                        BANK OF AMERICA NT & SA,

                                        By: /s/ Edward S. Han
                                           ------------------------------------
                                           Title: Vice President


                                        THE BANK OF NEW YORK

                                        By: /s/ Edward J. Dougherty, III
                                           ------------------------------------
                                           Title: Vice President

                                       3

 
                                   THE CHASE MANHATTAN BANK

                                   By: /s/ Dawn Lee Lum
                                      -----------------------------
                                      Title: Vice President

                                   PNC BANK, KENTUCKY, INC,
 
                                   By: /s/ Benjamin A. Willingham
                                      -----------------------------
                                      Title: Vice President

                                   TORONTO DOMINION (TEXAS), INC.

                                   By: /s/ Darlene Riedel
                                      ------------------------------
                                      Title: Vice President

                                   THE BANK OF NOVA SCOTIA

                                   By: /s/ W. J. Brown
                                      -------------------------------
                                      Title: Vice President 
          
                                   CREDIT LYONNAIS NEW YORK BRANCH

                                   By: /s/ Farboud Tavangar
                                      -------------------------------
                                      Title: First Vice President

                                       4

 
                                             CREDIT SUISSE FIRST BOSTON

                                             By:  /s/ Christian Bourqui
                                                --------------------------------
                                                 Title: Associate

                                             By:  /s/ Thomas G. Muoio
                                                --------------------------------
                                                 Title: Vice President

                                             DEUTSCHE BANK AG NEW YORK
                                              AND/OR CAYMAN ISLAND BRANCHES

                                             By:  /s/ Iain Stewart
                                                -------------------------------
                                                 Title: Vice President

                                             By:  /s/ Susan L. Peterson
                                                -------------------------------
                                                 Title: Vice President

                                             FLEET NATIONAL BANK

                                             By:  /s/ Ginger Stolzenthaler
                                                -------------------------------
                                                 Title: Senior Vice President

                                             THE INDUSTRIAL BANK OF JAPAN
                                              TRUST COMPANY

                                             By:  /s/ Takuya Honjo
                                                -------------------------------
                                                Title: Senior Vice President

                                             WACHOVIA BANK, N.A.,

                                             By:  /s/ John B. Tibe
                                                -------------------------------
                                                Title: Assistant Vice President

                                       5


 
                                        ABN AMRO BANK N.V.
                                        
                                        By: /s/ Steven L. Hipsman
                                           ------------------------------------ 
                                           Title: Vice President
                                        
                                        By: /s/ Linda K. Davis
                                           ------------------------------------ 
                                           Title: Vice President
                                        
                                        
                                        BANK OF MONTREAL
                                        
                                        By: /s/ Peter W. Steelman
                                           ------------------------------------ 
                                           Title: Director
                                        
                                        
                                        BANK ONE, KENTUCKY, NA
                                        
                                        By: /s/ Dennis P. Heishman
                                           ------------------------------------ 
                                           Title: Senior Vice President
                                        
                                        
                                        COMERICA BANK
                                        
                                        By: /s/ Colleen M. Murphy
                                           ------------------------------------ 
                                           Title: Assistant Vice President

                                       6

 
                                        CORESTATES BANK, N.A.

                                        By: /s/ Elizabeth D. Morris
                                           -----------------------------------
                                           Title: Vice President


                                        THE FUJI BANK, LIMITED

                                        By: /s/ Tetsuo Kamatsu
                                           -----------------------------------
                                           Title: Joint General Manager


                                        LTCB TRUST COMPANY

                                        By: /s/ Hiroshi Kitada
                                           -----------------------------------
                                           Title: Senior Vice President


                                        NATIONAL CITY BANK OF KENTUCKY,

                                        By: /s/ Deroy Scott
                                           -----------------------------------
                                           Title: Vice President


                                        NBD BANK, N.A.

                                        By: /s/ Christine M. Morrison
                                           -----------------------------------
                                           Title: Vice President


                                        UNION BANK OF CALIFORNIA, N.A.

                                        By: /s/ Patricia A. Samson
                                           -----------------------------------
                                           Title: Assistant Vice President

                                       7



 
                                        AMSOUTH BANK OF ALABAMA

                                        By: /s/ Keith S. Law
                                           -----------------------------------
                                           Title: Vice President


                                        BANQUE PARIBAS

                                        By:___________________________________
                                           Title:

                                        By:___________________________________
                                           Title:


                                        FIRST UNION NATIONAL BANK OF
                                         NORTH CAROLINA

                                        By: /s/ Ann M. Dodd
                                           -----------------------------------
                                           Title: Senior Vice President


                                        U.S. BANK OF WASHINGTON, N.A.

                                        By: /s/ Arnold J. Conrad
                                           -----------------------------------
                                           Title: Vice President


                                        CIBC, INC.

                                        By: /s/ Judith A. Kirshner
                                           -----------------------------------
                                           Title: Executive Director

                                       8



                     



 
                                        KREDIETBANK, N.V.

                                        By: /s/ Robert Snauffer
                                           ------------------------------------
                                           Title: Vice President

                                        By: /s/ Tod R. Angus
                                           ------------------------------------
                                           Title: Vice President


                                        THE MITSUBISHI TRUST AND BANKING
                                        CORPORATION    

                                        By: /s/ Nobuo Tominaga
                                           ------------------------------------
                                           Title: Chief Manager


                                        THE SAKURA BANK LIMITED
                                        NEW YORK BRANCH

                                        By:____________________________________
                                           Title:


                                        SOCIETE GENERALE, CHICAGO
                                         BRANCH

                                        By:____________________________________
                                           Title:


                                        FIRST AMERICAN NATIONAL BANK

                                        By: /s/ Kent D. Wood
                                           ------------------------------------
                                           Title: Assistant Vice President

                                       9

 
                                        BANK OF LOUISVILLE
                                        

                                        BY: /s/ Roy L. Johnson, Jr. 
                                           -------------------------------------
                                            Title: Senior Vice President  



                                        THE DAI-ICHI KANGYO BANK, LTD.
                                        CHICAGO BRANCH


                                        By: /s/ Takeo Teramura
                                           -------------------------------------
                                            Title: Vice President  


                                        FIFTH THIRD BANK


                                        By: /s/ Judy R. Semaria
                                           -------------------------------------
                                            Title: Assistant Vice President  

                                      10