[The regression of left ventricular hypertrophy during the treatment of hypertension with different classes of beta blockers]. / Regresiia na levokamernata khipertrofiia pri lechenie na khipertonichnata bolest s razlichni klasove beta-blokeri.

156 patients with hypertension II stage according to the WHO classification and left ventricular hypertrophy proved by echocardiographic examination were treated in the course of one year with various class beta-blockers. At the end of the first month of treatment the thickness of the interventricular wall, of the posterior wall and of the left ventricular muscular mass does not change. Till the end of the 6th month the thickness of all these three decreases (p less than 0.0001). The additional decrease at the end of the 12-ve month of treatment is insignificant to that at the 6th month. The mean percentage decrease is greater by treatment with beta-blockers without inner sympathomimetic activity than with beta-blockers with such activity. There is no difference in relation to the cardioselectivity of the drug. Till the end of the 12-ve month of treatment the left ventricular muscular mass becomes normal in 35.9% of the patients on the background of normalized arterial pressure. In 6.4% of the patients the left ventricular muscular mass does not change in spite of the decrease of the arterial pressure. The percentage reduction of the left ventricular muscular mass correlates with the percentage decrease of the systolic (r = 0.603), diastolic (r = 0.457) arterial pressure and the heart rate (r = 0.636).

[Long-term treatment of hypertension with a selective beta-1-blockader without sympathomimetic activity. II. Changes in the structure and function of the left ventricle]. / Dulgotraino lechenie na khipertonichnata bolest sus selektiven beta-1-bloker bez simpatikomimetichna aktivnost. II. Promeni v strukturata i funktsiiata na liavata kamera.

The effect of the 6 months long treatment with the Hungarian selective beta-1-blocker Betaloc (Metoprolol) on the structure and function of the left ventricle was studied in 30 hypertensive patients--II stage (with echocardiographically proved left ventricular hypertrophy) by means of simultaneous recording of M-type echocardiogram, ACG, PCG and ECG. The telediastolic thickness of the septum and the posterior wall and the left ventricular muscular mass decrease at the end of the 6-th month (p less than 0.0001). The telesystolic dimension and volume decrease (p less than 0.0001) in the 6-th month without changes in the telediastolic dimension and volume (p greater than 0.32). The shortening fraction and the ejection fraction increase (p less than 0.0001), Vcf increases insignificantly (p greater than 0.05). The isovolumetric relaxation shortens (p less than 0.0001), the active suction period lengthens (p less than 0.0001) as well as the fast filling period (p less than 0.0027). By controlling the arterial pressure and suppressing the sympathetic stimulation of the heart the prolonged Betaloc treatment leads to reversion of the hypertrophy and improves the left ventricular function.

[The prognostic value of an early bicycle ergometry test and the management of patients with uncomplicated acute myocardial infarct]. / Prognostichna stoinost na ranniia veloergometrichen test i povedenie pri bolni ot neuslozhnen ostur miokarden infarkt.

In 75 men with uncomplicated acute myocardial infarction early symptom-limited submaximum bicycle ergometric test was performed 24-48 hours before discharge from hospital. 32 patients (42.7%) showed a positive test (ST-depression greater than 0.1 mV with duration of greater than or equal to 0.08 s and/or angina pectoris). The prognosis assessed by the number of cases with unstable angina pectoris, recurrent myocardial infarction or sudden death in the patients with positive test is significantly worse (p less than 0.0001). The patients with positive early bicycle ergometric test are indicated for direct examination and are potential candidates for aortocoronary bypass or percutaneous transluminal coronary angioplasty. An algorithm for attitude toward patients with uncomplicated acute myocardial infarction is presented.

[An apex cardiographic method of determining the moment of mitral valve opening and duration of its isovolumetric relaxation]. / Apekskardiografski metod za opredeliane momenta na otvariane na mitralnata klapa i produlzhitelnostta na izovolumetrichnata relaksatsiia.

By analyzing the simultaneous recordings of M-type echocardiogram of the mitral valve, apexcardiogram (ACG) phonocardiogram (PCG) in 49 healthy persons, 30 patients with II stage hypertension and 39 patients with unstable angina pectoris was established that the opening of the mitral valve coincides with the moment in which the discending arm of the ACG deviates from its tangent (determined by two points--the first is the point of intersection of the ACG with the perpendicular raised from the initial highfrequency vibrations of the aortic component of the II tone: the second is 20 ms from the first on the discending arm of the ACG). The method allows the determination of the exact moment of the opening of the mitral valve and the duration of the isovolumetric relaxation and of the period of the active suction by the ACG and the PCG only. This increases the apexcardiographic potentialities in the functional diagnosis of the left ventricle.

[Long-term treatment of hypertension with a selective beta l-blocker without sympathomimetic activity. I. Antihypertensive and hemodynamic effects]. / Dulgotraino lechenie na khipertonichnata bolest sus selektiven beta 1-bloker bez simpatikomimetichna aktivnost. I. Antikhipertenziven i khemodinamichen efekt.

The antihypertensive and hemodynamic efficacy of Betaloc (Egys-Hungary) was studied in 30 hypertensive patients in the II stage of the disease. The drug was applied in a single daily dose of 100 mg in the course of 6 months. The systolic and diastolic pressure and the heart rate decreased reliably (p less than 0.0001) at the end of the first month. The stroke volume increased (p less than 0.045) at the end of the sixth month but the minute volume and the cardiac index did not change (p greater than 0.32). The peripheral vascular resistance dicreased reliably (p less than 0.02) at the end of the sixth month--the degree depending on the initial type of circulation--and it determined the longstanding antihypertensive efficacy of Betaloc. No untoward reactions were registered.

[Relaxation and rapid filling of the left ventricle in essential hypertension during treatment with a non-selective beta blocker]. / Relaksatsiia i burzo pulnene na liavata kamera pri khipertonichna bolest v khoda na lechenieto s neselektiven beta-bloker.

Some indices of relaxation and rapid filling were evaluated in the course of a six-month treatment with non-selective beta-blocker in 30 patients with hypertonic disease, (HD), degree II, with echocardiographically confirmed left-ventricular hypertrophy and normal systolic function. The phase analysis of the early diastole, performed according to Alvarez and Goodwin, reveals a progressive shortening of the period of isovolumetric relaxation and lengthening of the period of active suction with no change in the summed up period of rapid relaxation; the period of rapid filing is lengthened on account of the active suction. The evaluated via computer analysis (echo-computer--NIEMT-MA, Sofia) parameters of rapid filling of M-type echogram of left ventricle (maximum velocity of increase of left-ventricular dimension, mean velocity of fraction of rapid filling) increase progressively. The dynamics of the indices of diastolic function described, reflect the diminution of the restriction of ventricular filling and its shifting to the early diastole.

[Early diastolic changes in patients with unstable angina pectoris]. / Promeni v rannata diastola pri bolni ot nestabilna angina pectoris.

The length of the time intervals of the early diastole was studied by the method of Alvares and Goodwin in 30 patients with unstable angina pectoris by means of simultaneous recordings of M-type echocardiogram, ACG,PCG and ECG before and after medicamentous treatment (beta blockers, nitrites with prolonged action, calcium antagonists). The control group was of 33 healthy men. The isovolumetric relaxation period was greatly prolonged in the patients and the active aspiration period was shortened (p less than 0.001). At the end of hospital treatment the interrelations between these two periods changed--the isovolumetric relaxation period shortened (p less than 0.001) and the active aspiration period lengthened (p less than 0.01) without change of the total period of fast relaxation. The slow relaxation period during the time of fast filling and the total fast filling period before and after treatment did not differ from those of the control group. The changes of the time intervals are probably related to the diminished compliance due to myocardial ischemia. The dynamic changes in the course of medicamentous treatment of unstable angina pectoris reflect the lowered restriction of left ventricular filling.

[Treatment of ectopic ventricular activity with palpitin (disopyramide)]. / Lechenie na ektopichnata kamerna aktivnost s palpitin (dizopiramid).

The therapeutic effect of palpitin (Gedeon Richter) was examined in an open clinical experiment with 30 patients with ectopic ventricular activity. The mean number of ventricular extra-systoles, established for one hour, was reduced from 573.7 to 149.7(p less than 0.001)--in 30.0% of the treated it completely disappeared, in 56.7% it was reduced with more than 50% and in 13.3%--there was no effect. The adverse effects are often (33.3%) but light, rarely necessitating the discontinuation of the treatment.

[Clinical study of the beta-blocker chlorpropanol (tobanum) in hypertension patients]. / Klinichno prouchvane na beta-blokera khlorpropanol (tobanum) pri bolni ot khipertonichna bolest.

The antihypertensive effect and tolerance of chlorpropanol was determined in 30 patients with hypertonic disease. The treatment was carried out only with tobanum as an open experiment with a dose from 10 to 30 mg. Before and towards the end of the treatment, the following indices were calculated from the simultaneous record of M-echocardiogram of left ventricle, ACG, PhCG and ECG: stroke volume (SV), minute volume (MV) cardiac index (CI), ejection fraction (EF), mean velocity of circumferential fibres shortening (Vcf), and peripheral vascular resistance (PVR). Chlorpropanol normalized the pressure in 83.3% of the treated, reducing the systolic pressure with 14.9%, and the diastolic--with 15.1%. The reduction of the pressure in hyperkinetic type of circulation is associated with the reduction of CI (p less than 0.05) as result from the slowed down cardiac rate (p less than 0.001), in hypokinetic type--with the reduction of PVR (p less than 0.05), and in eukinetic--with the normalization of the ratio between those two parameters. EF was not changed during the treatment, Vcf was reduced (p less than 0.045), but remained within the physiological limits. Chlorpropanol is with pronounced negative chronotropic effect. It has a good tolerance.

[Treatment of hypertension with urapidil (Ebrantil)]. / Lechenie na khipertonichnata bolest s urapidil (Ebrantil).

Ebrantil has been added to the beta-blockers and/or diuretics in the treatment of 32 patients with moderate and severe hypertension under the conditions of 3-month open clinical experiment. A very good antihypertensive effect was obtained in 31.3% of the treated, moderate--in 65.6% and unsatisfactory--in 3.1%. Ebrantil does not change the heart rate and is, in fact, without any adverse effects.

[Treatment of hypertension with obsilazin]. / Lechenie na khipertonichnata bolest s obsilazin.

Obsilazin was established to have a good to moderate hypotensive effect in 75% of the treated 36 patients with moderate and severe hypertension under the condition of a 6-month open clinical experiment, not changing the heart rate. The adverse effects are often 69.4%), usually transitory but in 11.1% they proved to be the cause for discontinuation of the treatment.

[Treatment and prevention of paroxysmal atrial fibrillation and flutter with quinidine retard]. / Lechenie i profilaktika na pristupnoto predsurdno muzhdene i treptene s khinidin retard.

The ability of quinidine retard of restoring sinus rhythm and further maintenance after successful regulation were checked in 42 patients with flutter and fibrillation in an open clinical trial. Quinidine retard restores the sinus rhythm in less patients (60.0%) than quinidine sulphate (81,8%). At the same time, it maintains sinus rhythm in 91,4 per cent of the cases in anti-recurrence treatment. That makes quinidine retard adequate for long-term administration.

[Treatment of paroxysmal supraventricular tachycardia and tachyarrhythmia with verapamil]. / Lechenie na paroksizmalnite supraventrikularni takhikardii i takhiaritmii s verpamil.

The antiarrhythmic effect of isoptin was verified in 47 patients--30 with paroxysmal supraventricular tachycardia and 17--with paroxysmal ventricular fibrillation: in case of paroxysmal supraventricular tachycardia with 5--10 mg isoptin i.v. for the restoration of sinus rhythm and with 240--320 mg orally for maintaining the effect and in case of ventricular fibrillation--i. v. for the slowing down the heart rate. Isoptin, i. v. applied, restores the sinus rhythm in 93,3 per cent of the patients with paroxysmal supraventricular tachycardia and in 17,6 per cent--with ventricular fibrillation and slowsdown the heart rate in 94,6 per cent among those with ventricular fibrillation. The oral isoptin reduces the paroxysms of the supraventricular tachycardia in 86 per cent and slowsdown the sinus rate and lengthens PQ.

[Relationship between the indicators of the lung rheogram and pulmonary artery pressure in mitral valve stenosis]. / Sootnoshenie pokazatelei reogrammy legkogo i davleniia v legochnoi arterii u bol'nykh mitral'nym stenozom

In 32 patients with rheumatic mitral stenosis a set of quantitative rheographic pulmonary data was compared with the values of pulmonary artery pressure obtained by way of pulmonary artery catheterization. The diagnostic value of the mean rate of slow filling (Vm.s) and of the Q--a interval was shown for the diagnosis of pulmonary hypertension, their introduction into everyday practice was substantiated. Appropriate regression equations for Vm.s and mean pulmonary artery pressure were compiled: y equals 83.7--94.x, and for the Q--a interval: y equals 4.46.281 300x. In mitral stenosis cases a reduction of the rheographic systolic index was established, as well as of the amplitude-frequency index and of the maximum rate of fast filling.

[Observation of 2 families with idiopathic hypertrophic subaortic stenosis]. / Nabliudenie vurkhu dve familii s idiopatichna khipertrofichna subaortna stenoza

The authors describe five patients from two families with idiopathic hypertrophic subaortic stenosis, among them a brother and sister -- twins. Based on literature data and their experience, they stress the importance of the clinical and electromechanocardiographic criteria in the diagnosis of the family form of that disease, prior to the direct cardiac examination. The possible mechanisms in the genesis of predominantly local septum hypertrophia and left ventricle are discussed, an explanation being sought in the genetically conditioned changes of mitochondria and plentiful utilization of adenosine triphosphate by the defective myofibrils. Autosome mode of handing down with an incomplete penetration of the dominant gen is admitted. The differentitation of the family form of idiopathic hypertrophic subaortic stenosis is backed up as a separate nozological entiety bearing in mind another possible etiopathogenetic mechanism.