[Silent Myocardial Ischemia as a Result of Cardiac Autonomic Neuropathy].

AIM: to verify the effect of vegetative nervous system on the silent myocardial ischemia. MATERIALS AND METHODS: We included in this study 56 patients with functional class II-III effort angina (22 men and 34 women, age 45-49 years) with silent myocardial ischemia (SMI). Examination included 24hour blood pressure and ECG monitoring. RESULTS: We revealed the interrelation between elevation of parameters of heart rhythm variability reflecting activity of parasympathetic nervous system and ST segment depression depth during episodes of SMI. Also, а significant interrelationship was found between SMI duration and degree of nocturnal diastolic blood pressure decrease which reflected parasympathetic nervous system activity. CONCLUSION: Silent myocardial ischemia more often occurred at the background of elevated activation of the parasympathetic nervous system.

[Clinical and functional assessment of electric heart instability in patients with painless myocardial ischemia].

Markers of electric myocardial instability were studied in 82 patients during painless episodes of coronary heart disease (CHD). Clinical examination was supplemented by 12-lead ECG, 24-hour ECG monitoring, functional tests, echocardiography, signal-averaged ECG, recording of LVP, analysis of cardiac rhythm variability, and assessment of ventricular repolarization time. It is concluded that a combination of 24-hr ECG monitoring and functional tests (veloergometer) is indispensable for diagnostics of CHD and the evaluation of the patient"s condition. Daily dynamics of myocardial ischemia and the number of its painless episodes are shown to correlate with the results of signal-averaged ECG, Q-T dispersion and LF/HF ratio. Patients with painless CHD show enhanced frequency of myocardial infarction with the Q-wave, high-grade ventricular extrasystole, and LVP coupled to disordered autonomous vegetative control of the sinus rhythm.

[The clinical and functional evaluation of cardiac electrical instability in patients with silent myocardial ischemia].

AIM: To study markers of myocardial electrical instability in patients with coronary heart disease (CHD) during silent myocardial ischemic episodes. SUBJECTS AND METHODS: Eighty-two patients with stable CHD (mean age 62.6 +/- 5.4 years) were examined. In addition to standard physical examination, a complex of their study comprised 12-lead electrocardiography (ECG), Holter ECG monitoring, exercise testing, echocardiography, average signal (AS) ECG recording with identification of late ventricular potentials (LVP), analysis of cardiac rhythm variability (CRV), and estimation of QT interval duration. RESULTS: The study revealed that a combination of Holter ECG monitoring and exercise testing (bicycle ergometry) was required to diagnose silent CHD and to evaluate functional condition severity. Diurnal myocardial ischemia and the number of silent ischemic episodes were found to associate with AS-ECG readings, QT interval dispersion, and LF/HF ratio. In patients with silent CHD, the incidence of Q-wave myocardial infarction and the frequency of high-grade ventricular premature beats were higher, late ventricular potentials were more frequently found, and autonomic vegetative control of sinus rhythm proved to be more significantly impaired. CONCLUSION: No pain signal in patients with CHD leads to underestimation of the seriousness of the situation and, accordingly, to inadequate measures for its elimination therefore early diagnosis and correction of silent myocardial ischemia are prognostically important in preventing life-threatening acute manifestations of CHD and arrhythmic complications.

[The clinical and hemodynamic efficacy of telmisartan and enalapril in the treatment of arterial hypertension in patients with type 2 diabetes mellitus].

AIM: To study the effects of enalapril and telmisartan on hemodynamic parameters and diastolic function (DF) of the left ventricle (LV) in patients with type 2 diabetes mellitus (DM) concurrent with arterial hypertension (AH). SUBJECTS AND METHODS: The study included 64 patients (mean age 54.3 +/- 5.2 years) with type 2 DM. For the treatment of AH, Group 1 (n = 31) received enalapril and Group 2 (n = 33) took telmisartan (micardis). Their examination comprised 24-hour blood pressure (BP) monitoring, Holter ECG monitoring, and echocardiography. The fasting and postprandial levels of blood glucose and glycosylated hemoglobin were measured to evaluate the compensation for carbohydrate metabolism. RESULTS: In patients with type 2 DM and elevated BP, LV diastolic dysfunction was detectable in the absence of reduced contractility. LF DF, isovolumetric relaxation time, and the ratio of the peak blood flow velocity during early diastolic filling to that during atrial systole were found to correlate with HbA(1c), diastolic hypertension time index, and the diurnal duration of asymptomatic ST-segment depression. During enalapril therapy, the goal level of BP was achieved in systolic BP (SBP) in 77% of the patients and diastolic BP (DBP) in 64.5%, which was accompanied by reductions in the number of nondippers and night-pickers in 45.4% of cases with no changes in HbA(1c) and LV DF. CONCLUSION: In addition to effective SBP and DBP control with the normalization of their diurnal profiles in 87.5% of the patients with abnormal circadian rhythm, the 24-week course of telmisartan therapy ensures improvements in carbohydrate metabolism and LVDF.