[The proarrhythmogenic activity of non-anti-arrhythmia drugs. Is treatment with antihistamines and cisapride safe?]. / Proaritmogenna aktivnost na neantiaritmichni medikamenti. Bezopasno li e lechenieto s antikhistamini i s tsizaprid?

The non-antiarrhythmic drugs, which possess antiarrhythmic properties could induce dangerous, potentially fatal arrhythmias--extrasystoles, ventricular tachycardia, sudden cardiac arrest. The arrhythmogenic properties are due to block of the potassium channels of the cells and are realized by prolongation of the QT interval on ECG. Accelerating mechanisms are the bradycardia and the hypokalemia. Such drugs are the H1 blockers--astemisol (hismanal) and terfenadine, the prokinetic cisaprid (prepulsid, propulsid, coordinax) and the macrolides. These preparations should be carefully prescribed and not combined with each other, as well as, with antiarrhythmics and blockers of the cytochrome oxidase system (antifungal antibiotics, metronidazole, cyprofloxacin, antidepressants). During their use the patients have to be followed up for changes in QT, bradycardia, arrhythmia, hypokalemia.

[The anesthesiological risk and treatment characteristics of patients with ischemic heart disease prepared preoperatively with beta-receptor blockers, calcium antagonists and nitro preparations]. / Anesteziologichen risk i osobenosti v lechenieto na patsienti s iskhemichna bolest na surtseto, podgotveni predoperativno s beta-retseptorni blokeri, kaltsievi antagonisti i nitropreparati.

The anesthesiologic risk in ischemic heart disease (IHD) patients undergoing noncardiac surgery is determined by the duration of myocardial infarction sustained in the past, and the degree (severity) of stenocardia manifestations. Such risk is estimated as minimal within six months after myocardial infarction in the presence of stenocardia stabilization. In this contingent of patients the anti-ischemic therapy is proceeded with in both pre- and postoperative period. The role of beta-adrenergic blocking agents (propranolol, acebutolol, esmolol, sotalol) and calcium antagonists (nifedipine, diltiazem) in the prophylaxis against intraoperative myocardial ischemia, rhythm disorders and pathologic arterial pressure rise is definitely proved.

[Critical assessment of the criteria proposed for the ECG diagnosis of atrial loading]. / Kritichna pretsenka na kriteriite, predlagani za EKG diagnoza na predsurdno obremeniavane.

Some criteria, proposed for the diagnosis of auricle loading have been evaluated during the study of 210 healthy subjects--87 patients with left auricle loading (LAL) and 71 patients with right auricle loading (RAL). The total duration of P wave differentiates a smaller LAL than the duration of PII. The ratio of P duration to PP segment in V1 has a poor specificity. The phenomena interatrial conduction disorder with left auricular retrograde activation has a low sensitivity on EGC for LAL, and with the orthogonal EGC--low sensitivity and specificity. The ratio of duration to amplitude of PII has a restricted value. LAL and RAL differ significantly but they are very bad results in the stages of left auricular dilation. The various ways of evaluation of the electric axis (digital or in degrees) have their place in the multidirectional pathological deviations--LAL and RAL.

[Preoperative clinical and hemodynamic characteristics of patients with mitral valve defects subjected to valve prosthesis]. / Predoperativna klinichna i khemodinamichna kharakteristika na bolni s mitralen klapen porok, podlozheni na klapno protezirane.

Sixty one patients were studied that were subjected to mitral valvular prosthesis--28 patients with pure or prevailing mitral stenosis, 12 with pure or prevailing mitral insufficiency and 21 patients with degree competitive stenosis and insufficiency. The patients, to have mitral valvular prosthesis, undergo the operation, most often, in the presence of pronounced pulmonary capillary and arterial hypertension and preserved right-ventricular and left-ventricular function. The pulmonary hypertension is with the highest values in the patients with mitral stenosis leading. In the patients with leading stenosis, passes of compromised right-ventricular function could be established. The cases with disturbed left-ventricular function are from the groups with prevailing mitral insufficiency or competitive stenosis and insufficiency. The time for mitral valvular prosthesis should be selected so as not to allow the manifestation of bilateral cardiac insufficiency as well as the formation of essential pulmonary disorders.

[Dissecting aortic aneurysm]. / Disekirashta anevrizma na aortata.

Twenty cases with aortic dissecting aneurysm (ADA) are presented, at an average age of 52.5 (from 14 to 75), 15 of them males and 5--females. Nineteen had acute form of the disease and 1--chronic. Etiology, clinical picture, diagnostic approach and treatment were analyzed. Pain as leading symptom was present in all patients with various intensity and predominantly antero-thoracal localization. Seventeen of the patients (70%) were in shock at admittance. Pulse asymmetry was established in 8 (40%) and in 4, out of 12 cases (33%) with ADA, complicated by cardiac tamponade, a freshly appeared diastolic murmur was present. Enlarged aortic shadow at X-ray investigation had 14 (70%) of the patients with a dynamics of the enlargement in 5 patients. The disease has been clinically diagnosed in 19 (95) of the patients. Five out of 20 patients underwent operation, two of them followed for two years after the surgical treatment. Only one patient out of the non-operated 15 patients, survived. The modes of therapeutic behaviour are discussed on the base of the authors' experience and literature data.

[Effect of arterial hypertension on the atrial portion of the electrocardiogram]. / Efekt na arterialnata khipertoniia vurkhu predsurdnata chast na elektrokardiogramata.

Pathologic signs of left atrial load are found very often in arterial hypertension. The diagnostic combinations are very slightly expressed, more often in the orthogonal ECG. Pathologic criteria found most often are: pathologic end-strength of the P wave in lead V1 (in 42% of the patients) and increased amplitude of PX (in 39% of the patients). The pathologic changes of the P wave increase with the development of left ventricular hypertrophy and heart failure. The values of the end-strength of the P wave in lead V1 when they are negative more than - 0.03 mm.s should be considered pathologic in contrast to mitral valvular disease.

[Effect of nonpathological factors on the atrial segment of an orthogonal ECG in healthy persons]. / Vliianie na nepatologichni faktori vurkhu predsurdnata chast na ortogonalnata EKG u zdravi.

The effect of deep breathing and shifting of the electrodes along the horizontal line was followed up in four orthogonal ECG systems. The duration of P wave did not change during deep breathing. The amplitude of P wave increased in the traditional ECG, simulating right atrial loading in the traditional ECG. The amplitude of Px decreased in OECG but it cannot lead to diagnostic difficulties. With the shifting of the electrodes (within the involuntary errors) OECG systems of McFee--Parungao and SVEK III are not liable to shifting of the electrodes and that of Frank shows an increase of the amplitude of the negative part of P z as in right-atrial loading.

[Combined acute myocardial infarct and pulmonary thromboembolism with fatal outcome]. / Suchetanie na ostur miokarden infarkt i belodroben tromboembolizum,zavurshilo letalno.

A retrospective clinical and pathologicoanatomic analysis was made of 37 patients with the combination of acute myocardial infarction (AMI) and pulmonary thromboembolism (PTE), that had a lethal end. The following facts were established: The combination of AMI with PTE is established in 7.89% in AMI. All patients have several preconditioning factors for PTE, advanced age including. PTE advances usually in extensive anterior and anterior-posterior myocardial infarction, complicated with cardiac insufficiency. In rare cases, a reverse succession is likely--massive PTE with a following, most frequently posterior-inferior AMI. The percentage of the undistinguished PTE in case of AMI is high--46%. The diagnosis of PTE in AMI is made, with a high probability, in acutely advancing respiratory distress, tachycardia (tachyarrhythmia, pulmonary hypertension, loading of right ventricle, arterial hypotension, phlebothrombosis in the absence of data for extension of the myocardial infarction. ECG, roentgenography, laboratory investigations do not essentially improve the possibilities of making the diagnosis of PTE in AMI.