[State of the atrial myocardium in patients with paroxysmal form of fibrillation arrhythmia]. / Sostoianie miokarda predserdii u bolnykh s paroksizmal'noi formoi mertsiatel'noi aritmii.

Seven two patients with coronary heart disease complicated with paroxysmal atrial fibrillation were studied by using accelerated atrial vector cardiography and M-mode echocardiography. Vector cardiography made it possible to reveal the signs of left atrial hyperfunction with normal left atrial echocardiographic dimensions. There were lower values for left ventricular myocardial contractility in parallel with higher echocardiographic dimensions of the left atrium. In the patients examined, progression of cardiosclerosis was accompanied by decreased amplitude values for the P loop on the vector cardiogram strip along with slower intraatrial conduction with an increase in the size of the left atrial cavity.

[Significance of echo- and vectorcardiographic studies of the heart atrium in the assessment of intracardiac hemodynamics and myocardial contractility]. / Znachenie ékho- i vektorkardiograficheskogo issledovaniia predserdii v otsenke vnutriserdechnoi gemodinamiki i sokratimosti miokarda.

Seventy three patients with coronary heart disease (CHD) complicated by paroxysmal atrial fibrillation (PAF) were examined. Vectorcardiography developed by I. A. Akulinichev and M-mode echocardiography were used to assess the status of left atrial and ventricular myocardia. An interrelationship was examined between the electrophysiological and echocardiographic parameters of myocardial performance, depending on the stage of circulatory insufficiency (CI). The patients with PAF-complicated CHD, unlike those with CHD alone, showed more severe myocardial conduction abnormalities despite the stage of CI. There were signs of compensatory left ventricular overload in the absence of clinical signs of CI. Comparison of ultrasound examination findings with high performance atrial vectorcardiographic ones increases the possibility of accurately assessing the cardiac performance by using noninvasive tools of examinations.

[The pharmacodynamics and pharmacokinetics of bonnecor in patients with different disorders of the heart rhythm]. / Farmakodinamika i farmakokinetika bonnekora u bol'nykh s razlichnymi narusheniiami ritma serdtsa.

The clinical pharmacokinetics and the effect of bonnecor on parameters of the pharmacodynamics were studied in 53 patients with cardiac rhythm disorders, including 23 patients in the acute period of myocardial infarction. At intravenous administration of bonnecor in a dose of 0.4-0.6 mg/kg there was noted a pronounced antiarrhythmic effect with respect to both ventricular and supraventricular cardiac rhythm disorders. Bonnecor exerted no significant effect on the hemodynamic parameters. The pharmacokinetic parameters of bonnecor possess a great variability, the mean values of the parameters are close to the corresponding ones for ethacizine. Along with the unchanged drug one can detect in the blood mono-N-demethylated metabolite. The ranges of effective concentrations and those inducing side effects of the drug are given.

[Use of ethacizine tablets in paroxysms of atrial flutter and fibrillation]. / Opyt ispo'lzovaniia étatsizina v tabletkakh pri pariksi'zmakh trepetaniia i mertsaniia predserdii.

Tablets of ethacizine (a phenothiazine series agent) were used for relieving paroxysms of atrial fibrillation and flutter in 30 patients during 103 attacks. The agent produced a favourable effect in 15 patients in 80 paroxysms of atrial fibrillation. The mean time of sinus rhythm recovery was 1.9 hours. It is effective when given in a single dose of 100 mg with its subsequent administration 6 hours later in the absence of the effect. This agent administered in 50 mg dose produced no results. This scheme of relieving paroxysms of atrial flutter was useful when they lasted not more than 7 days; it is not recommended in initial disturbances of intraventricular conduction. Ethacizine tablets can be used both under hospital and outpatient conditions.

[Results of the treatment of paroxysmal atrial fibrillation with ethacizine]. / Rezu'ltaty lecheniia paroksizma'lnoi mertsate'lnoi aritmii étatsizinom.

Ethacizine was given to 28 patients with frequent (at least once a week) paroxysms of cardiac fibrillation (PCF), the larger proportion of the patients was those with coronary heart disease. The long-term use of ethacisine was preceded by an acute drug test in which the drug was administered orally in a starting dose of 100 mg to assess its effects on myocardial conduction and contractility. Its positive effect as evidenced by reduction in PCF frequency by 70% per more was seen in 19 (68%) patients. The antiarrhythmic effect of the drug showed up on day 2 after initiation of the therapy. Analysis of the relationship between the drug's positive effect and the changes in the atrial myocardium showed that the most potent effect (up to 80%) was observed in patients with coronary heart disease complicated with PCF in the presence of "combined" changes in the atrial myocardium as compared to "hemodynamic" changes. The authors studied the most common adverse effects resulted from the therapy, the most dangerous of them included abnormal right bundle branch conduction (1 case) and sinoauricular block (1 case).

[Value of echocardiography and amplified atrial vectorcardiography for selecting the methods of therapy and prevention of paroxysmal atrial fibrillation]. / Znachenie EkhoKG i usilennoi predserdnoi VKG dlia vybora metoda terapii i profilaktiki paroksizma'lnoi mertsate'lnoi aritmii.

Atrial and left-ventricular myocardial activity was assessed in 85 coronary patients with paroxysmal atrial fibrillation. Their age varied between 43 and 88 years. The methods used included ECG, amplified atrial vectorcardiography after I. T. Akulinichev's schedule (amplification: 1 mv = 100 mm) and M-scan echocardiography. The comparison of these methods has substantiated criteria for the selection of differential treatment and preventive measures in these patients, on the basis of the prevailing type of atrial myocardial changes ("arrhythmic", "hemodynamic" or "combined" ones). A supportive treatment with cardiotonic agents is advisable in cases of the "hemodynamic" type with apparent signs of the overstrain (dilation) of the left atrium or both atria. In the "arrhythmic" variant, where conductivity, automatism and excitation disorders are predominant, antiarrhythmic agents (cordaron, quinidine, adrenoblockers) are indicated while the "combined" type calls for combined treatment with cardiotonic and antiarrhythmic agents.

[Effect of cordarone on the eye (results of long-term follow-up of the treatment and prevention of arrhythmia)]. / Vliianie kordarona na organ zreniia (rezul'taty dlitel'nogo nabliudeniia pri lechenii i profilaktike narushenii ritma serdtsa).

Thirty-one patients who received a prolonged maintenance therapy with cordarone to treat and prevent cardiac arrhythmias underwent an ophthalmologic examination. The treatment lasted 1.5 to 51 months. The signs of keratopathy were detected in 24 (77.4%) patients using a slit lamp biomicroscopy. There is a relationship between the severity of keratopathy and a daily dose of cordarone: in most cases signs of stage I keratopathy were detectable when the daily dose was up to 200 mg. Keratopathy appears to be reversible after the drug has been discontinued.

[Differential drug therapy and prevention of different types of atrial fibrillation in ischemic heart disease patients]. / Differentsirovannaia medikamentoznaia terapiia i profilaktika razlichnykh tipov mertsatel'noi aritmii u bol'nykh s ishemicheskoi bolezn'iu serdtsa.

Clinical and instrumental examination using enhanced atrial VCG and ECG in 140 patients with coronary heart disease complicated by frequent atrial fibrillation paroxysms (AFP) identified 3 types of atrial myocardial change: the "hemodynamic" or secondary atrial fibrillation, "arrhythmic", or primary atrial fibrillation, and "ischemic" ones, the former 2 types being particularly common. These pathogenetic differences taken into account, long-term differential therapy and prevention of AFP became possible where cordaron proved the most effective agent (74% response rate). Its effectiveness approached 83% in primary AFP and was somewhat lower (42%) in secondary AFP, while digoxin proved more efficient in the latter group (52%). Cordaron treatment was associated with a 9.2% side effects rate; low doses of the drug produced no side effects.

[Development of methods for research on the clinical pharmacology of drugs used in cardiovascular diseases]. / Razrabotka metodov issledovaniia klinicheskoi farmakologii lekarstvennykh sredstv, primeniaemykh pri serdechno-sosudistykh zabolevaniiakh.

Repeated pharmacodynamic studies of more than 30 drugs with hypotensive, antianginal and antiarrhythmic effects were performed in over 1,200 patients suffering from cardiovascular diseases, predominantly ischemic heart disease and hypertensive disease. The result of the work was optimization of the drug dosage regimen during course treatment; real diagnostic possibilities of functional research methods were revealed.

[Dependence of myocardium function on the degree of coronary bed involvement in chronic ischemic heart disease patients with and without previous myocardial infarct]. / Zavisimost' funktsional'nogo sostoianiia miokarda ot stepeni porazheniia kronarnogo rusla u bol'nykh khronicheskoi ishemicheskoi bolezn'iu serdtsa, perenesshikh i ne perenesshikh infarkt miokarda.

A total of 104 patients with chronic ischaemic heart disease were examined. The left ventricle myocardial function was studied by determining the signs of overload of the atria by the method of enhanced atrial vectorcardiography, which were compared to the data of heart catheterization, and of left ventriculography. This showed the reliability of the non-invasive methods of investigation. The degree of lesions of the coronary bed was determined in the bicycle ergometric tests and by selective coronarography. A group of patients who had not suffered myocardial infarction showed trends of progressing signs of myocardial insufficiency corresponding to the degree of the damage of the coronary bed. In a group of patients, who had suffered myocardial infarction, myocardial insufficiency was more manifest, however, even in them the degree of myocardial lesion was closely associated not only with the presence of the scar changes but also with the degree of the damage of the coronary bed.

[Interpretation of the ECG atrial P wave]. / Ob interpretatsii predserdnogo zubtsa P EKG.

High + PV1 waves are analyzed in a group of patients with chronic ischemic heart disease who had no other ECG signs of right-atrial hypertrophy; they all had more or less pronounced signs of left-atrial affection. Changes in wave P on the ECG of patients with chronic ischemic heart disease and marked circulatory insufficiency, rheumatic mitral stenosis, cor pulmonale and in healthy individuals were compared. It is concluded that a high + PV1 wave on the ECG in the absence of other ECG signs of right-atrial hypertrophy reflects delayed conduction in the left atrium.