[Lipid peroxidation and the major factors of its activation in patients with myocardial infarction]. / Perekisnoe okislenie lipidov i osnovnye faktory ego ektivatsii u bo'lnykh infarktom miokarda.

A dynamic study of 97 patients with primary macrofocal myocardial infarction (MI) has demonstrated that activated lipid peroxidation (LPO) is an important pathogenetic element of MI, with LPO level reflecting major stages of the disease and its complications. In acute MI, LPO activation depends on the magnitude of the stress syndrome and the severity of arterial hypoxia and is mediated by gas exchange disorders in the pulmonary circulation network. The passage of LPO products from ischemized myocardium to systemic circulation is also of significance. In the scarring phase, LPO activation is due to circulatory hypoxia associated with reduced cardiac contractility. The markedness of leucocytic response is an important factor of MI-associated LPO activation. The extent of LPO disorders is largely limited by the antioxidant system of the body.

[Stimulation of reparative processes in myocardial infarction: comparative evaluation of the effects of piracetam and inosine]. / Stimuliatsiia reparativnykh protsessov pri infarkte miokarda: sravnitel'naia otsenka vliianiia piratsetama i inozina.

A study of 102 patients with primary macrofocal myocardial infarction, admitted to hospital within the first 6 hours after the onset of the disease, and experimental evidence obtained in 110 Wistar rats are reported. In a control group of myocardial infarction patients, collagen synthesis was depressed in the presence of the activation of free-radical lipid oxidation and circulatory hypoxia. Piracetam and inosine treatment was associated with the inhibition of free-radical lipid oxidation and a reduction of hypoxia, those being accompanied by increased collagenogenesis and accelerated postinfarction scar formation. Piracetam, as compared to inosine, had a more marked stimulating effect on the development of compensatory myocardial hypertrophy, thus contributing to rapid recovery of cardiac contractility and reducing manifestations of circulatory insufficiency.

[Effect of dibunol and isoptin on the creatine kinase and myoglobin content of the blood serum in dogs undergoing postischemic coronary reperfusion]. / Vliianie dibunola i izoptina na soderzhanie kreatinkinazy i mioglobina v syvorotke krovi sobak pri postishemicheskoi koronarnoi reperfuzii.

The effect of an antioxidant dibunol and calcium antagonist verapamil on postperfusion release of myoglobin (Mb) and MB-creatine kinase (MB-CK) has been assessed in 30 dogs with experimental coronary occlusive myocardial infarction. It has been shown that reperfusion after 3-hour ischemia does not only accelerate the release of intracellular proteins, but also leads to pronounced myoglobinemia and blood enzymes. In postischemic blood flow recovery with combined dibunol and verapamil preliminary injections, an almost threefold decrease in MB-CK and Mb blood content, as compared to "reperfusion" indexes, was observed by the 10th minute of reperfusion.

[Rate of development and the size of the necrotic focus in patients with myocardial infarct treated by intracoronary thrombolysis]. / Skorost' formirovaniia i velichina ochaga nekroza u bol'nykh infarktom miokarda pri provedenii vnutrikoronarnogo trombolizisa.

Streptokinase intracoronary thrombolytic therapy (ITT) was given to 68 of 135 patients with large-focal myocardial infarction (MI) admitted to hospital within 6 hours of the attack. Coronary flow was recovered in 31 MI patients. The size of the necrotic focus was assessed on the basis of precordial cartograms from 35 ECG leads and serial measurements of MB CPK activity. ITT achieving successful thrombolysis is conducive to rapid formation and accelerated repair of the necrotic focus in MI patients. The recovery of coronary circulation after 3 hours of infarction was accompanied by the reperfusion syndrome, i. e. rapid necrotization of the ischemized region, a considerable release of MB CPK into the circulation, complex cardiac rhythm and conductivity disorders, and signs of transient heart failure.

[1st attempt at using the antioxidant dibunol in the acute stage of a myocardial infarct]. / Pervyi opyt primeneniia antioksidanta dibunola v ostrom periode infarkta miokarda.

Results of dibunol use in 31 patients with progressive myocardial infarction (MI) are presented. The effect of the drug was studied by precardial charting and serial determination of creatine phosphokinase activity, integral rheography and phase analysis of the cardial systole. It was established that in the acute phase of MI, dibunol significantly reduced the ischemic damage to the myocardium and limited the focus of necrosis. Prolonged total intake of the drug throughout the acute period of MI stimulated cardiac activity without a statistically significant improvement in the contractile capacity of the myocardium, however. Patients treated with dibunol in the acute period of MI tended to show a lower frequency of pain recurrences and a decrease in such parameters as the development of heart failure, and/or rhythm disturbances and the mortality rate.

[Treatment of patients with myocardial infarct and hyperdynamic syndrome with propranolol]. / Lechenie propranololom bol'nykh infarktom miokarda s giperdinamicheskim sindromom.

A total of 139 patients with myocardial infarction (MI) and the hyperdynamic syndrome were investigated. To 67 of those, the beta-adrenoblocker propranolol was administered intravenously on the first day of the disease, with a series of further injections over the next 9 days, on average, under central hemodynamic control. Hemodynamic parameters were assessed by means of integral rheography and polycardiography, the MI size was measured by precardial charting (from 35 ECG leads) and serial evaluations of CPK and MB (the latter's isoenzyme) activity. Propranolol administered in the early hours after the infarction reduced heart performance and hence functional load on the myocardium, which improved the latter's contractility. The efficiency of propranolol treatment was dependent on the time of first administration. When administered early (within 5 hours of the attack), the drug reduced the MI size by 56% as compared to the controls, whereas late administration (12-24 hours after the attack) produced a 12% reduction. Regular propranolol treatment in patients with the hyperdynamic syndrome reduced the frequency of certain MI complications, such as prolonged course with relapses, acute congestive failure, rhythm and conductivity disorders, and total mortality.

[Hyperdynamic syndrome in myocardial infarct]. / Giperdinamicheskii sindrom pri infarkte miokarda.

A total of 172 patients with myocardial infarction were investigated. The hyperdynamic syndrome was revealed in 72 patients within the first days of the disease, as manifested in increased cardiac performance, while 100 patients, whose hemodynamics were of normodynamic type, made up the control group. The hyperdynamic syndrome was shown to develop in the presence of elevated blood catecholamine and 11-OCS content and enhanced energy metabolism, reflecting a more pronounced response to stress. The development of the hyperdynamic syndrome increases the rates of complications associated with myocardial infarction, prolongs the duration of the disease and builds up the risk of fatal outcome due to cardiorrhexis.

[Information value of different blood serum chemiluminescence indices in acute myocardial infarct]. / Informativnaia tsennost' razlichnykh pokazatelei khemiliuminestsentsii syvorotki krovi bol'nykh ostrym infarktom miokarda.

The study of informativeness of varying parameters of induced chemifluorescence reflecting the intensity of free-radical oxygenation of lipids and their dependence on the degree of necrotic damage of the myocardium, determined by the activity of creatine phosphokinase and its cardiospecific isoenzyme MB. 19 patients and 20 healthy individuals were examined. The results show that inhibition of induced chemifluorescence of the blood serum in the period of developing necrotic changes is directly dependent on the content of products of the ischaemic destruction of the myocardium.

[Use of beta-adrenoblockaders in the therapy of the syndromes accompanying acute myocardial infarct]. / Ispol'zovanie beta-adrenoblokatorov v terapii nekotorykh sindromov, soprovozhdaiushchikh ostryi infarkt miokarda.

The use of beta-adrenoblockers in patients with acute myocardial infarction, accompanied by hypertension and hyperdynamia, leads to normalization of the arterial pressure, of parametres of haemo- and cardiodynamics, to a decrease of the degree of ischaemia of the damaged myocardium and to an increase of the heart work efficacy.

[Early diagnostic possibilities in heart failure in myocardial infarct]. / Vozmozhnosti rannei diagnostiki serdechnoi nedostatochnosti pri infarkte miokarda.

In 57 patients on different days of myocardial infarction a comparison of haemodynamic and myocardial contractility parameters was made with their predicted values which were calculated with due consideration of oxygen utilization, arterial pressure and the heart rate. It is established that the majority of patients with myocardial infarction have insufficiency of cardiac output and of contractile activity of the heart beginning with the 1-2d day of illness. At the same time, absolute values of the parameters, stress-caused, can exceed the analogous parameters in patients with ischaemic heart disease outside the period of exacerbation, at rest. It is concluded that the comparison of figures of haemodynamics and contractility with the predicted values constitute an important part in the early diagnosis of cardiac insufficiency.

[Differential use of glucagon in acute period of myocardial infarct]. / Differentsirovannoe primenenie gliukagona v ostrom periode infarkta miokarda.

The work demonstrates the efficacy of glucagon in acute myocardial infarction and its complications, particularly in bradycardia, hypotension, disorders of cardiac rhythm and conduction, cardiogenic shock, cardiac insufficiency in complete atrioventricular heart block and recurrent forms of ventricular fibrillation. A differential approach and dynamic control over the effect of the drug on the values of hemodynamics, respiration, and metabolism are necessary under the conditions of units of intensive therapy and cardioresuscitation.

[Experience in using integral rheography for evaluating the hemodynamic indices in emergency states in cardiology]. / Opyt ispol'zovaniia integral'noi reografii dlia otsenki gemodinamicheskikh pokazatelei pri neotlozhnykh sostoianiiakh v kardiologii.

The work deals with the comparative assessment of integral rheography, a modern method for studying hemodynamic indices. As compared to the method of dye dilution and radiocardiography, integral rheography has proved to be sufficiently precise and at the same time has definite advantages as a method of express diagnosis in patients with acute cardiovascular diseases. As compared with the other method of indirect determination of the cardiac output, tetrapolar rheography, integral rheography is more suitable for being used in emergencies, particularly in cases with disorders of the rhythm of the cardiac activity.

[Certain characteristics of central hemodynamics in acute period of myocardial infarct]. / Nekotorye osobennosti tsentral'noi gemodinamiki v ostrom periode infarkta miokarda.

Changes in the indices of central hemodynamics and contractility of the heart muscle in the acute period of macrofocal myocardial infarction were studied. In many cases heart ejection and performance of the left ventricle in the first 24 hours of the disease were greater than those in the control group of patients with ischemic heart disease in the period of remission. The increase coincided in time with sharp activation of the sympathico-adrenal and other systems of the organism in myocardial infarction, occurred on a background of deteriorated cardiac contractility, and ended by the third day of the acute period. Such changes in the first day of the disease were less manifest in the group of individuals in whom preceding cardiac failure had been more severe.

[Therapy and prevention of different forms of ventricullar fibrillation in myocardial infarct]. / O terapii i profilaktike razlichnykh form fibrilliatsii zheludochkov u bol'nykh infarktom miokarda

Data on 80 cases of myocardial infarction complicated by different forms of ventricular fibrillation (VF)--primary, secondary and recurrent--are analysed. VF was shown to be accompanied by distinct disorders in respiration, metabolism and haemodynamics. Metabolic disorders are characterized by acid-base and electrolyte balance changes, increased activity of the adrenal glands, and increased release of catecholamines and glucocorticoids into the blood. The latter proves that VF increases the stress reaction of the body caused by acute myocardial infarction. The success of prevention and treatment of VF depends on the early hospitalization of acute myocardial infarction patients in specialized intensive care and resuscitation units where emergency reanimation measures can be taken, controlled therapy rendered, and VF prevented by influencing the altered metabolism and stress state. Special attention is paid to repeated VF for which the authors employ, along with routine therapy, Glucagon that produces an antiarrhythmic and cardiotonic effect.

[Use of glucagon in cardiac insufficiency]. / Primenenie gliukagona pri serdechnoi nedostatochnosti

Data derived from a study into the efficacy of glucagon in 50 patients with acute and chronic cardiac insufficiency are offered. In all of these cases there existed a grave cardiac insufficiency refractory to therapy with cardiac glycosides, mostly attended by deranged rhythm and conduction. Clinical and instrumental investigations (basic hemodynamic indices established through the dye-dilution method and integral rheography, polycardiography) proved glucagon to be a truly cardiotonic agent in dealing with patients of this category. A greater effect was achieved in cases involving acute cardiac insufficiency associated with myocardial infarction than it could be obtained in instances of a long-standing chronic decompensation. The use of glucagon is particularly indicated in cases when cardiac glycosides produce complications, or cannot be employed due to the already existent derangements of the rhythm and conduction.

[Certain problems of intensive therapy of acute myocardial infarct]. / Nekotorye voprosy intensivnoi terapii ostrogo infarkta miokarda

Using the whole set of modern methods of examinations of the external respiration function, acid-base balance, as well as of the determination of various biologically active substances--catecholamines, glucocorticoids, aldosterone, kinines, the authors were guided in conducting intensive therapy for myocardial infarction by the measurable functional and metabolic disturbances. This permitted to optimatize the employment of therapeutic neuroleptanalgesia in the acute period, to assess the efficacy of some new drugs, glukagon including to give recommendations as to the perfection of the organizational principles of intensive therapy.