[The use of the orthostatic test in practical medical flight expertise in civil aviation]. / Ispol'zovanie ortostaticheskoi proby v praktike vrachebno-letnoi ékspertizy v grazhdanskoi aviatsii.

Comparison of results from HDT administered with different techniques showed that 5-10 min in vertical position are enough to adequately evaluate mechanisms of circulation control. By that time hemodynamic shifts get stabilized. More precise assessment of the circulation regulation can be made when HDT is administered from initial supine rather than sitting position. Analysis of the ECG dynamics allows to elicit latent myocardial injuries. The exact quantitative characteristic of orthostatic disturbances makes it possible to give their pathophysiological estimate.

[ Combined therapy with isosorbide dinitrate, propranolol and nifedipine in patients with chronic ischemic heart disease]. / Primenenie kombinirovannoi terapii izosorbida dinitratom, propranololom i nifedipinom u bolnykh khronicheskoi ishemicheskoi bolezníu serdtsa.

Forty six patients with stable effort angina were treated with a combination of propranolol, nifedipine, and isosorbide dinitrate which produced a more profound anti-antianginal effect than each of them given alone. The combination also exerted more marked antihypertensive and antiarrhythmic effects. The combined therapy with the three drugs caused a moderate reduction in heart rate and peripheral resistance, but failed to result in clear-cut disturbances in the orthostatic regulation of the circulatory system. There was a more infrequent and less pronounced ST-segment depression, less marked pressor responses and higher heart rate with the combined therapy during exercise; the cardiac index also increased as before therapy. Physical fitness increased to a greater extent than with monotherapy. The combined therapy with three drugs is indicated when monotherapy fails and that with two agents is indicated when patients have concurrent essential hypertension and cardiac arrhythmias.

[Hemodynamic shifts during physical exercise in patients with ischemic heart disease]. / Gemodinamicheskie sdvigi pri fizicheskoi nagruzke u bol'nykh ischemicheskoi bolezn'iu serdtsa.

In 82 CHD male patients aged 35-54 years with well-preserved working capacity (threshold load, 600-750 kgm/min) who had underwent bicycle ergometer test, the time course of changes in the major hemodynamic parameters was found to be significantly similar to that of healthy individuals. The cases who stopped performing bicycle ergometer tests because of anginal attacks, and ST segment depression or either showed a more significant elevation in systolic and diastolic blood pressure at the maximum load rate and lower increase in heart rate than in healthy subjects, which may be regarded as a compensatory mechanism that prevents a further decrease in coronary flow. Diminished increase in stroke index and cardiac index suggests reduced myocardial contractility.

[Hemodynamic changes in healthy persons and in patients with arterial hypertension during hyperventilation]. / Izmeneniia gemodinamiki u zdorovykh lits i bol'nykh arterial'noi gipertoniei pri giperventiliatsii.

Hemodynamic changes in response to the hyperventilation test were examined in normal males and females of varying age, and in patients with first- and second-stage essential hypertension, renal arterial hypertension and hypertensive neurocirculatory dystonia. Normal subjects showed increased heart rate (HR) and cardiac index (CI), and lowered specific peripheral resistance in response to hyperventilation, the magnitude of HR and CI changes declining with age. The increase in HR and CI during the test was somewhat more pronounced in patients with essential hypertension as compared to normal subjects, whereas in hypertensive neurocirculatory dystonia hemodynamic shifts were similar to those of normal subjects.

[Central hemodynamics in chronic alcoholics]. / Sostoianie tsentral'noi gemodinamiki u bol'nykh khronicheskim alkogolizmom.

Central hemodynamics were assessed in 86 chronic alcoholic patients in relation to the stage of the disease and the kind of alcoholic dependence. The values of major hemodynamic parameters were shown to depend on both the stage of the disease, and clinical manifestations of abstinence. The abstinence syndrome developing after a 3-5-day abstinence is associated with a gradual transition from eukinetic- to hypokinetic-type circulation, as the disease progresses. Hemodynamic shifts following recovery from acute delirium tremens are not related to the stage of the disease, and tend to hypokinetic-type circulation. During remission, hemodynamic parameters approach those of normal subjects.

[Circulatory system reaction to loading tests in patients with the climacteric syndrome in relation to the phase of the climacteric and the presence of cardialgia]. / Reaktsiia sistemy krovoobrashcheniia na proby s nagruzkoi u bol'nykh s klimaktericheskim sindromom v zavisimosti ot fazy klimakteriia i nalichiia kardialgii.

Female patients with the menopausal syndrome (MS) manifestations showed a steeper increment of diastolic arterial blood pressure (ABP) and heart rate, as compared to normal subjects, in both phases of the menopause, irrespective of whether cardialgia was present or not; moreover, half of the patients showed negative electrocardiographic dynamics. Hemodynamic shifts in response to bicycle ergometry were similar in both menopausal phases and showed steeper increments in ABP and heart rate, as compared to those of normal subjects. Excessive ABP rise in response to exercise is mostly associated with cardialgias. Exercise-related ECG can usually improve or return to normal in premenopausal patients, while ischemic ST depression is associated with postmenopausal conditions. Physical working capacity of premenopausal women is only impaired in the presence of cardialgias, whereas that of postmenopausal women is reduced in the absence of cardialgia as well.

[Sex and age-dependent differences in the circulatory response to the exercise test]. / Razlichiia v reaktsii sistemy krovoobrashcheniia na proby s nagruzkoi v zavisimosti ot pola i vozrasta obsleduemykh.

The testing of normal males and females of different age revealed no intersexual differences in circulatory response to the orthostatic test. During exercise, female subjects showed lower systolic arterial pressure, cardiac and stroke indices, and greater diastolic arterial pressure, heart rate and peripheral resistance to blood flow, irrespective of their age. Parameters of physical efficiency are higher in males as compared to females. Exercise tolerance decreases with age in subjects of both sexes, the decrease, however, being more pronounced in males.

[Orthostatic changes in renal function in diabetic patients with normal arterial pressure and with hypertension]. / Ortostaticheskie izmeneniia funktsii pochek u bol'nykh sakharnym diabetom s normal'nym arterial'nym davleniem i gipertoniei.

Glomerular filtration (GF) and renal flow (RF) were measured in 65 patients with compensated diabetes, 38 of them hypertensive. Renal function was normal in normotensive patients with normal urinary findings, when tested in resting supine position. RF and GF were moderately decreased in cases of transitory proteinuria, whereas the decrease was more pronounced in permanent proteinuria. In patients with arterial hypertension, RF and GF were lower, as compared to matched cases with normal blood pressure. Diabetic patients showed a greater RF and GF decrease in orthostatic position, as compared to normal controls. Hypertensive and nephropathic patients showed a still greater orthostatic decrease. In some patients with normal urinary results and normal renal function, the orthostatic RF and GF decrease exceeded the average group one, a fact suggestive of some latent renal changes.

[ECG study of diabetes mellitus patients at rest, in an orthostatic posture and under physical load]. / Izuchenie EKG u bol'nykh sakharnym diabetom v pokoe, ortostaticheskom polozhenii i pri fizicheskoi nagruzke.

ECG changes at rest were noted in half of 87 patients with diabetes mellitus. Negative ECG changes in orthostatics were observed in 2/3 of the patients. The rate of the changes depends upon the heart rate increase, reflecting higher sympathetico-adrenal activity. The results of potassium salt application point to metabolic disorders in the myocardium of patients with diabetes mellitus. The orthostatic test performed during the course of treatment with potassium salt may serve as an index of efficiency and stability of the therapy conducted. ECG changes under physical exercise were observed in 14 of 54 patients, only in 4 of them the changes were tupical of coronary heart disease. Comparison of exercise tolerance, orthostatic and potassium salt tests which reveal cardiac damage of different nature, suggests that myocardial changes in patients with diabetes mellitus are mostly conditioned by the development of metabolic changes.