[Effect of labetalol on hemodynamics and oxygen consumption in patients in the early period of myocardial infarction]. / Vliianie labetalola na gemodinamiku i kislorodnoe obespechenie organizma u bol'nykh v rannie sroki infarkta miokarda.

Effects produced both by single intravenous drop-by-drop labetalol, 1 mg/kg (29 patients), sublingual obsidan, 20 mg (14 patients) and a 3-day course treatment with labetalol, 200-600 mg/day, and obsidan (80-160 mg/day) on systemic, intracardiac, and regional hemodynamics and oxygen supply of the body were comparatively studied in 43 patients in early periods of myocardial infarction. As compared with obsidan, labetalol caused favourable hemodynamic changes mostly pronounced in patients with concurrent arterial hypertension. The hemodynamic effects in arterial hypertension were found to come about by virtue of largely an alpha-adrenoblocking effect of the agent whereas in the absence of hypertension it was beneficial due to a combined alpha- and beta-adrenoblocking effect.

[Determination of the concentration of cytochrome c and its antibodies in the blood serum for the diagnosis and prognosis of complications in myocardial infarct patients]. / Opredelenie kontsentratsii tsitokhroma c i antitel k nemu v syvorotke krovi dlia diagnostiki i prognozirovaniia oslozhnenii u bol'nykh infarktom miokarda.

EIA was used to demonstrate that the development of acute ischemia of the heart muscle progressing to necrosis is accompanied by an increase of the concentration of cytochrome c and antibodies against cytochrome c in the blood serum. As regards its specificity and sensitivity, the alteration in the antibody concentration is comparable with that in the myoglobin concentration but it is marked 1 to 3 hours earlier. The high level of antibodies against cytochrome c remaining unchanged for 2 to 3 days in myocardial infarction patients attests to the possibility of a complicated, often relapsing course of the disease. The test for determining antibodies against cytochrome c may be recommended for the control over the patient's status and forecasting the course of myocardial infarction.

[Evaluation of obzidan efficacy in patients with unstable stenocardia]. / Otsenka éffektivnosti obzidana u bol'nykh nestabil'noi stenokardiei.

Altogether 75 patients (males aged 31 to 67 years) with unstable angina pectoris were subjected to transcutaneous pacing to measure the coronary reserve level before and after administration of obsidan (propranolol) in a dose of 40 mg. The area and depth of ischemia were found to be noticeably decreased, which was appraised according to 35 precordial leads on the ECG regardless of the unchanged "double product". It is concluded that not only the reduction of the heart rate and afterload but also their effect on the functional factors of angina pectoris are implicated in the mechanism of the anti-ischemic action of the beta-blockers.

[Coronary reserve and myocardial function in unstable stenocardia]. / Izuchenie koronarnogo rezerva i funktsional'nogo sostoianiia miokarda pri nestabil'noi stenokardii.

A total of 168 patients admitted to the intensive care department with the diagnosis of unstable angina pectoris (UA), were investigated. Proceeding from the clinical criteria, the patients were divided into 2 groups: with primary (the 1st group) and progressive (the 2nd group) angina. The diagnosis was confirmed by the transesophageal pacing test (TEPT) performed in parallel with two-dimensional echocardiography. Positive TEPT was noted in 84% of the patients in the 2nd group and in 39% of the patients in the 1st group. The volume and expression of ischemia at the height of stimulation (ECTG findings) did not differ in both groups. Some patients with negative TEPT (in both groups) demonstrated an unfavorable time course of volumetric indices: an increase in end systolic and end diastolic volumes, a decrease in the ejection fraction. However, the diagnosis of CHD could not be excluded. Patients need further examination.

[Unsolved problems of the diagnosis of acute focal dystrophy and microfocal myocardial infarction]. / Nereshennye problemy diagnostiki ostroi ochagovoi distrofii i melkoochagovogo infarkta miokarda.

The use of up-to-date diagnostic methods and the estimation of the extent of myocardial lesion in patients with intermediate coronary conditions (serial assays of CPK and MV-CPK activity with subsequent computation of the weight of affected myocardium, ECTG and myocardial 99mTc-Sn-pyrophosphate scintigraphy using a gamma-counter) demonstrated: the presence of necrotic foci in patients with acute focal myocardial dystrophy; a considerable variation in the weight of affected myocardium; and high diagnostic value of ECTG for the assessment of the extent of myocardial lesion in patients with intermediate coronary conditions. Objective criteria have been worked out for the differential diagnosis of various intermediate coronary conditions.

[Combined use of nitrates and beta-adrenergic blockaders in patients with acute myocardial infarct]. / Kombinirovannoe primenenie nitratov i beta-adrenergicheskikh blokatorov u bol'nykh ostrym infarktom miokarda.

A combination of isosorbide dinitrate (40-120 mg daily) and propranolol (80-160 mg) was administered to 146 patients during the early hours of myocardial infarction. The therapeutic effect was assessed for 10 days and compared to the effect observed in a control group of 70 patients selected at random. The combination used was shown to relieve the pain syndrome and extrasystolic arrhythmia during the early days of the disease. The occurrence of signs of heart failure was twice as low during the observation period, as compared to the control group. The treatment evoked typical hemodynamic changes: rhythm deceleration (by an average 7%), a fall in systemic arterial blood pressure (by 19%) and in "double product" (by 25%), a moderate reduction of cardiac output (by 15%) coupled with a marked drop in left-ventricular filling pressure (by 25%). The spread of infarcted area in the first days after the attack, as evidenced by serial electrocardiotopograms and the activity of serum CPK and its MB fraction, was recorded in 13.9% of the treated patients and in 44% of the controls (p less than 0.001).

[Graded volume loading in the diagnosis of early heart failure among myocardial infarct patients]. / Dozirovannaia ob"emnaia nagruzka v diagnostike rannei serdechnoi nedostatochnosti u bol'nykh ostrym infarktom miokarda.

The method of graded physical exercise with the plotting of the functional curves and calculating of the functional coefficient (FC) was used in the study. No relationship was detected between the initial level of the cardiac output and the direction of the functional curve. A negative FC was more frequently recorded in patients with Q-index 25.

[Effect of the combined use of nitrates and beta-adrenergic blockaders on hemodynamics in patients with acute myocardial infarction]. / Vliianie kombinirovannogo primeneniia nitratov i beta-adrenergicheskikh blokatorov na gemodinamiku bol'nykh ostrym infarktom miokarda.

The effect of combined treatment with nitrosorbide and obsidan on major hemodynamic parameters was studied in 47 myocardial infarction patients within the first 24 hours of the disease. Intravenous drip injection of 0.15 mg/kg obsidan simultaneously with the administration of 20 mg nitrosorbide reduced heart rate by 12.7%, systemic blood pressure by 23.5%, and diastolic pulmonary arterial pressure by 38.4%. The cardiac index decreased by 22.8%, mainly due to reduced heart rate. The treatment improved myocardial function as evidenced by and increased number of positive post-treatment "functional curves". This method is safe and efficient, provided it is applied under careful hemodynamic control.

[Use of obzidan in the acute period of myocardial infarct]. / Primenenie obzidana v ostrom periode infarkta miokarda.

Forty-four patients with acute myocardial infarction were given 0.15 mg/kg propranolol (obsidan) by intravenous drip, after which 80--160 mg of the drug were given daily by mouth for 4--5 days. The extent of the ischemic damage and the dynamics of the infarction zone were judged according to the results of electrocardiotopogram recorded from 35 leads and serial tests for creatine phosphokinase activity in blood serum. The hemodynamic shifts occurring under the effect of the treatment were determined in the same patients. The results were compared with those in a control group (37 patients) identical in clinical and hemodynamic signs. It is established that obsidan given by the schedule proposed reduces significantly the electrocardiographic signs of ischemic damage to the myocardium (according to the ST segment) and the spread of the zone of necrosis in the first days of the follow-up. This is attended by deceleration of the cardiac rhythm and a decrease in systemic arterial pressure and cardiac output. The hemodynamic shifts occur within the ranges of admissible fluctuations and do not cause circulatory insufficiency as a rule.

[Assessment of the dimensions and dynamics of the necrosis zone in acute myocardial infarct]. / Otsenka razmerov i dinamiki zony nekroza u bol'nykh ostrym infarktom miokarda.

In 165 patients with myocardial infarction admitted to the clinic within the first 24 hours of the disease, the size of the zone of affection and its dynamics in the immediate 4--5 days were appraised. Three methods were used for this purpose: cartographic analysis of the ECG in 35 precordial leads; vectorcardiography and serial determination of creatine phosphokinase activity (CPK) in blood plasma with calculation of the size of the necrosis in units of weight (grams). It is shown that ECG-cartography and serial determination of serum CPK activity are valuable methods in quantitative appraisal of the size of the necrotic focus in patients with myocardial infarction. Study of the ECG-cardiogram and vectorcardiogram in dynamics and analysis of CPK activity curves enables one to appraise the spreading of the zone of the necrosis in the first days of the infarction. According to the results of these methods, in most patients (68 to 82%) with macrofocal myocardial infarction the zone of the necrosis spreads in length and in depths in the first days of the disease.

[Hemodynamic variants of acute myocardial infarct]. / Gemodinamicheskie varianty ostrogo infarkta miokarda.

In 165 patients with myocardial infarction admitted to the clinic within the first 24 hours of the disease the size of the zone of the lesion and its dynamics were appraised in the immediate 4-5 days. Cartographic ECG analysis and study of the vectorcardiogram in dynamics and analysis of the creatine phosphokinase activity curves make it possible to appraise the dynamics of the necrotic zone in the first days of myocardial infarction. It was found that in most patients with macrofocal myocardial infarction the zone of the necrosis increases both in length and in depth in the first days of the disease.