[Clinical-morphological changes of venous system of the heart in dependence on the stage of chronic heart failure].

Cardiac venous system (CVS) in chronic heart failure (CHF) undergoes whole row of morpho functional changes, but investigations of CVS are practically absent. We studied CVS of patients with Doppler echocardiography and magnetic computer tomography of the heart. The state of peripheral venous system was assessed by measurement of peripheral venous pressure (PVP) with Waldman apparatus. Morphological changes of VCS were studied with light microscopy. All patients were distributed in groups in dependence on CHF stage. We assessed coronary sinus (CS) and large cardiac veins. In CHF PVP was significantly elevated, dimensions of CS and lumen of large cardiac veins substantially increased, and significant morphohystological changes of cardiac veins were noted. Detected changes of VCS in these patients depended on the stage of CHF.

[The peripheral and intracardiac venous system of the heart in chronic heart failure].

AIM: To evaluate the cardiac venous system (CVS) and its changes in chronic heart failure (CHF), by applying noninvasive studies. SUBJECTS AND METHODS: CVS was studied by Doppler echocardiography in 160 patients and by multispiral computed tomography (MSCT) in 41. For evaluation of the peripheral venous system (PVS), a Wildman apparatus was used to measure peripheral venous pressure. According to the stage of CHF, all the patients with this condition were divided into 3 groups. The cardiac venous sinus and cardiac veins were evaluated in control and CHF groups. RESULTS: In CHF, PVS and CVS substantially change and significantly depend on the stage of CHF. CONCLUSION: These investigations give more insight into the pathogenesis of CHF. On treating a patient with CHF, the CVS should be studied thoroughly and by all available techniques.

[Modification of coronary sinus in patients with chronic cardiac insufficiency].

Both venous and arterial beds undergo a number of morphofunctional changes in patients with cardiovascular pathology, but they rarely attract attention of researchers. The available data indicate that the cardiac venous system (CVS) plays an important role in the development of chronic cardiac insufficiency (CCI) and dictate the necessity of its in-depth studies. We examined CVS in 160 patients by Doppler echo-CG and in 41 ones by spiral CT. The patients were allocated to 3 groups depending on the stage of CCI (IIA, IIB and III stages, III-IV functional class). The state of their coronary sinus (CS) was compared with that of healthy subjects. The state of CS varied considerably depending on the stage of CCI. It is concluded that patients with CCI need their CVS to be studied by all available methods.

[Effects of endotheline and nitric oxide on vascular tonicity in patients with chronic cardiac failure].

AIM: To examine effects of endotheline-1 (ET-1) and nitric oxide (NO) on endothelium-dependent mechanisms of vascular tonicity regulation in patients with chronic cardiac failure (CCF) of FC I-IV (NYHA). MATERIAL AND METHODS: Vascular reactions of 94 patients with CCF of FC I-IV were examined according to D.S. Celermajer method using ultrasound of high resolution. Tissue oxygenation was studied with transcutaneous polarography (TCM-2, Radiometer). Parameters of circulating erythrocytes were studied by impurity spectrum. Endothelial NO-synthase expression was determined with application of monoclonal antibodies to endothelial NO-synthase. NO metabolites were studied with colorimetric method using Griss reagent. ET-1 was measured in plasma by enzyme immunoassay. The control group consisted of 28 healthy men aged 20 to 54 years. RESULTS: Patients with CCF of FC I-IV have reduced endothelium-dependent vascular reactions progressing with aggravation of CCF. The causes of the disorders lie in altered metabolism of ET-1 and NO in CCF. CONCLUSION: CCF patients demonstrate changes in endothelium-dependent mechanisms of vascular tonicity regulation caused by disturbed metabolism of ET-1 and NO developing in abnormal regime of tissue oxygenation and depending on CCF severity.

[Experience in treating patients with cardiovascular diseases by means of adaptation to periodic barochamber hypoxia]. / Opyt lecheniia bol'nykh serdechno-sosudistymi zabolevaniiami metodom adaptatsii k periodicheskoi barokamernoi gipoksii.

Adaptation to periodic hypoxia (decompression 490 mm Hg) in a multiplace medical pressure chamber of patients with hypertension, cardial neurocirculatory asthenia, coronary heart disease produced a persistent hypotensive effect with improvement of central and peripheral hemodynamics, oxygen homeostasis, electrolyte balance of blood. In patients with neurocirculatory asthenia associated with ventricular and supraventricular extrasystole positive hemodynamic changes accompanied a persistent antiarrhythmic effect. In addition to the latter, CHD patients experienced improvement in myocardial contractility. Clinical effect of baroadaptation to hypoxia manifesting in symptom relief permitted the physicians to diminish the intensity of chemotherapy and to abolish it in patients with neurocirculatory asthenia.

[The use of the delayed-action form of korinfar in arterial hypertension, stenocardia and hypertrophic cardiomyopathy]. / Primenenie retardirovannoi formy korinfara pri arterial'noi gipertonii, stenokardii i gipertroficheskoi kardiomiopatii.

Corinfar-retard (CR) was tried in 146 patients, the acute test was performed in 26 cases. The findings confirm antihypertensive activity of the drug, reduced frequency of sharp changes in blood pressure and of hypertensive crises, side effects, its ability to diminish platelet aggregation. As for coronary heart disease. CR is more beneficial in non-severe angina of effort, spontaneous angina, associated hypertension. In hypertrophic cardiomyopathy prolonged administration of CR resulted in moderate subjective response. A CR two-month course did not induce noticeable changes in serum lipids. Hypertensive subjects on the acute test improved some hemodynamic and diastolic parameters.

[The nondrug treatment of hypertension patients by their adaptation to periodic hypoxia in a barochamber]. / Nemedikamentoznoe lechenie bol'nykh gipertonicheskoi bolezn'iu metodom adaptatsii k periodicheskoi gipoksii v usloviiakh barokamery.

Patients with essential hypertension were exposed to periodic hypoxia in a pressure chamber. It is shown that adaptation to periodic hypoxia results in improvement of general condition of patients who exhibited a decline in blood pressure, minute blood volume, serum sodium concentrations as well as better microcirculation and tissue oxygen tension. Reduced concentrations of total serum cholesterol and atherogenic index were achieved in hypercholesterolemia patients. The changes obtained permitted reduction of hypotensive maintenance treatment. In view of positive results in hypertensive subjects, adaptation to periodic hypoxia in a pressure chamber is recommended for inclusion into combined regimens of hypertension therapy.

[Loss of creatine in the body in cardiac insufficiency and prevention of this pathology with alpha-tocopherol]. / Poteria organizmom kreatina pri serdechnoi nedostatochnosti i preduprezhdenie étoi patologii s pomoshch'iu alpha-tokoferola.

Peculiarities of creatinemia and creatinurea have been studied in patients with different stages of the heart failure. Administration of alpha-tocopherol, an antioxidant, promotes normalization of these changes. Antioxidants are discussed in the aspect of their possibility prevent the creatine loss by the heart and skeletal muscles in case of the heart failure.

[Changes in antioxidative enzyme activity in patients with chronic heart failure]. / Izmenenie aktivnosti antiokislitel'nykh fermentov u bol'nykh s kronicheskoi serdechnoi nedostatochnost'iu.

Primary (dienic conjugates) and secondary (malonic dialdehyde) products of plasma lipid peroxidation were measured and the activity of antioxidative enzymes (glutathione peroxidase and superoxide dismutase) in erythrocytes was determined in 96 patients with chronic heart failure due to ischemic heart disease and rheumatic heart disease. Heart failure was found to show elevated plasma lipid peroxidation product levels, mostly in Stages I and IIA. Whereas in Stage IIB, the product levels became lower and in Stage III, they reached the control values. Similarly, the activity of superoxide dismutase varied with the stages of heart failure. That of glutathione peroxidase increased with circulatory decompensation development, reaching the maximal level in Stage IIB, then decreased down to the values observed in the control groups of patients without heart failure. The changes detected were not related to the causes of heart failure.

[Mathematical approach to the problem of early diagnosis in heart failure]. / Matematicheskii podkhod k probleme rannei diagnostiki serdechnoi nedostatochnosti.

A tool set for early detection of heart failure (HF) and its criteria for mass population survey in the polyclinic setting was developed. A two-stage screening programme was carried out. At the first stage, patients with cardiac abnormalities were detected. At the second stage, the patients underwent a complex instrumental study. Fourteen most informative signs of HF were identified. A programme was developed for analysis of their baseline values and adoption of solutions by applying a procedure for inhomogeneous sequential statistic recognition, significantly promoting the diagnosis by employing diagnostic tables.

[Effect of calcium on the diastolic phases in healthy persons and in patients with cardiac insufficiency]. / Vliianie kal'tsiia na fazy diastoly u zdorovykh i bol'nykh s serdechnoi nedostatochnost'iu.

Variations in the duration of diastolic phases under acute calcium loading were studied in normal subjects and patients with heart failure, using left ventricular apexcardiography (ACG). Certain changes in diastolic phases were revealed in patients with heart failure as compared to normal subjects, which corresponded to the severity of heart failure. The phase of isometric relaxation as well as those of rapid and slow filling showed the most dynamic variation. The calcium test brought out differences in the effects of calcium on normal and affected myocardium. The established variations may be due to changes in mechanisms of calcium fixation in and the elimination from sarcoplasmatic reticulum.