[Post-infarction stenocardia (clinical and prognostic significance)]. / Postinfarktnaia stenokardiia (klinicheskoe i prognosticheskoe znachenie).

The impact of postinfarction angina pectoris on the course of myocardial infarction (MI) was studied in the hospital setting in 359 patients who had sustained large MI, 247 of them being followed for a year after their discharge. In the group of patients with postinfarction angina pectoris, the course of the disease was found to be more severe in hospital and during a year-follow-up after MI. They more frequently developed acute and chronic heart failure, rhythm and conduction disturbances, recurrent MI. A statistic relationship was not established between the development of postinfarction angina and late fatality. Postinfarction angina was demonstrated to increase a risk for an unfavorable course of a postinfarction period. No significant difference was found in the prognostic significance of the time angina occurred following MI.

[The role of a spasm of the coronary arteries in the pathogenesis of acute myocardial infarct and in the development of sudden coronary death]. / Rol' spazma venechnykh arterii serdtsa v patogeneze ostrogo infarkta miokarda i v razvitii vnezapnoi koronarnoi smerti.

Based on the clinical experience and clinicoanatomic correlations, the authors suggest the role of hemorrhage and rupture of atherosclerotic patches in the pathogenesis of sudden coronary death. Proceeding from long-term follow-up studies of patients suffering from CHD, the necessity is substantiated of the regular use of beta-adrenoblockers which significantly reduce the rate of sudden death both in the acute and chronic phases of CHD, particularly in patients with a history of myocardial infarction. Taking into consideration the multifactorial nature of the pathogenesis of acute occlusion of coronary arteries, it is suggested that in addition to the preventive administration of beta-adrenoblockers, thrombolytic agents in combination with antiaggregation remedies and calcium antagonists should be prescribed, especially in cases of arterial pressure rises.

[Experience in long-term use of allapinin in polyclinical practice]. / Opyt dlitel'nogo primeneniia allapinina v poliklinicheskoi praktike.

The authors summed up the practical experience gained in long-term maintenance treatment with allapinine, a new Soviet antiarrhythmic agent, given to 65 patients with various cardiac arrhythmias in the outpatient setting. The long-term allapinine use yielded good results: its efficacy was proved to be approximately equal (63% and 60%) in patients with ventricular or supraventricular extrasystoles, respectively, but it was 77% in those with paroxysmal atrial fibrillation. There were no decreases in antiarrhythmic activity of allapinine during its long-term therapy. The agent produced no significant effects on heart rate, blood pressure, and myocardial contractility. Its side effects were recorded in 17 (26.2%) patients, however, withdrawal of the agent was required only in 6 cases.

[Characteristics of the course of ischemic heart disease and diabetes mellitus occurring jointly]. / Osobennosti techeniia ishemicheskoi bolezni serdtsa i sakharnogo diabeta pri ikh sochetanii

Findings of research into the specific course of ischaemic heart disease (IHD) concurrent with diabetes mellitus are analysed. Diabetic patients were found to have a more severe course of IHD after myocardial infarction, which was more often complicated with arrhythmias, cardiac failure, and unstable angina. The incidence of painless IHD after myocardial infarction was found to be twice higher in diabetics. A consistent relationship between the severity of diabetes and an increase in painless IHD incidence was noted. Diabetes was found to aggravate the IHD course irrespective of the patient's age. A correlation was observed between the severity of IHD and insulinaemia. Certain functional-diagnosis methodologies are shown to be most informative in the differential diagnosis of IHD and diabetic cardiomyopathy. The high efficacy of a complex therapy including beta-blockers and angioprotectors in concurrent IHD and diabetes is demonstrated.

[Characteristics of the course of posterior diaphragmatic myocardial infarction in patients with depression of the ST segment in precordial ECG leads]. / Osobennosti techeniia zadnediafragmal'nogo infarkta miokarda u bol'nykh so znizheniem segmenta ST v prekordial'nykh otvedeniiakh EKG.

The course of acute posterior diaphragmatic myocardial infarction (MI) was evaluated in 82 in-patients, with 47 of those followed up after the discharge. The patients were divided into 2 groups: those without and with ST depression in precordial ECG leads (groups 1 and 2, respectively). MI took a more severe course in the second group. Heart failure and high-grade ventricular extrasystoles were significantly more common both in and after hospital in such patients. Atrioventricular blocks, cardiogenic shock and recurrences during hospital stay prevailed in the second group. After the discharge, they showed a higher mortality rate and significantly more frequent exacerbations of coronary disease, including all cases of repeated macrofocal MI. This suggests that patients with posterior-diaphragmatic MI and ST depression in precordial ECG leads have a poorer immediate and long-term prognosis and can be designated a high-risk group.

[Course of ischemic heart disease in patients who have sustained a stroke]. / Techenie ishemicheskoi bolezni serdtsa u bol'nykh, perenesshikh mozgovoi insul't.

The state of the cardiovascular system was studied over time in 171 patients with a history of acute impairment of the brain circulation; 135 of them were suffering from coronary heart disease (CHD) (the study group) and 35 patients were free of CHD (the control group). The majority of the study group patients showed little if any clinical manifestations of CHD in the acute period of cerebral stroke. Five (3.7%) patients displayed small focal myocardial infarction on the ECG, two showed focal dystrophy of the myocardium, 71 (52.2%) patients had compromised coronary circulation and 47.5% of the patients had various disorders of rhythm and conductivity. The impairment of the coronary circulation in the acute period of cerebral stroke was shown to correlate with a subsequent course of CHD.

[Prognosis of complex ventricular arrhythmias at different periods in myocardial infarct]. / Prognozirovanie slozhnykh zheludochkovykh aritmii v razlichnye periody infarkta miokarda.

The incidence and pattern of ventricular arrhythmias in acute, subacute, late hospital and posthospital periods of myocardial infarction were investigated, using Holter monitoring, in 121 patients with large-focal and transmural myocardial infarction. A high incidence of complex ventricular arrhythmias was noted after the transfer from intensive care unit (38.8%). The relationship of complex ventricular arrhythmias to ventricular arrhythmias at previous stages was reviewed. Factors contributing to arrhythmias at different stages of myocardial infarction were analysed; the informative value of clinical signs and electric myocardial instability parameters was assessed. Signs having the greatest predictive power were identified, and risk indices for the development of arrhythmias during the subacute and late hospital stages of myocardial infarction were established using linear discriminant analysis, to enable identification of patients at risk of developing ventricular arrhythmias.

[Functional classification of ischemic heart disease]. / Funktsional'naia klassifikatsiia bol'nykh ishemicheskoi bolezni serdtsa.

A modified variant of the functional classification of patients with ischemic heart disease standard for all stages of rehabilitation is suggested. It is based on the rate with which the program of treatment is fulfilled and on the determination of the clinico-functional parameters and the physiological reaction of the patient during rehabilitation. The classification was tested on 98 patients with macrofocal myocardial infarction (average age 53.5 years) who underwent a successive rehabilitation program at the inpatient, sanatoria, out-patient stages with a subsequent two-year follow-up as out-patients after they had resumed working. The classification proved sufficiently informative in regard to the prognostication of the restoration of working capacity and the character of the course taken by ischemic heart disease.

[Microfocal myocardial infarct as a variant of exacerbation of ischemic heart disease]. / Melkoochagovyi infarkt miokarda kak variant obostreniia ishemicheskoi bolezni serdtsa.

The results of long-term (3- to 4-year) follow-up of 180 patients with microfocal myocardial infarction are analysed. The difference in the course and prognosis of primary and recurrent microfocal myocardial infarction is determined. It is shown that microfocal myocardial infarction as a form of exacerbation of ischemic heart disease is characterized by a complex of syndromes differing from the typical picture of marcrofocal myocardial infarction. As compared to macrofocal myocardial infarction, the course of the disease after microfocal myocardial infarction is characterized by more frequent exacerbations of coronary insufficiency and a greater tendency toward the development of recurrent myocardial infarction. In some cases, microfocal myocardial infarction heralds the development of macrofocal myocardial infarction with a severe course and high mortality rate, which provides the grounds for the conclusion that patients with microfocal myocardial infarction have a lower coronary reserve.

[Prognosis of work capacity in the system of rehabilitation of patients with myocardial infarct]. / Prognozirovanie trudosposobnosti v sisteme reabilitatsii bol'nykh infarktom miokarda

The possibilities of prognosing with regard to the capacity for work within the 1st year of resuming working were studied in the system of rehabilitation of myocardial infarction patients. The prognostic value of several items was determined that characterize the state of the patient prior to his myocardial infarction, the course of the acute phase, and the state in the postinfarction period prior to resuming working. The informativeness of several sets of items was determined along with the relative informativeness of a certain single item, with that of a group of other items known. It was demonstrated that in determining the capacity for work the leading items should be conside