[Clinical characteristics and diagnosis of stenocardia in persons with normal coronary vessels]. / Klinicheskie osobennosti i diagnostika stenokardii u lits s normal'nymi koronarnymi sosudami.

To date, the clinical pattern and electrocardiographic diagnosis of only one variant of coronary heart disease (CHD) with unchanged coronarogram, Prinzmetal's angina, have been worked out, while the diagnosis of other variants remains undeveloped. Clinical symptoms and possibilities of CHD diagnosis in the presence of intact coronary arteries have been evaluated in 67 coronary patients, the coronarograms being normal in 46 of those. The diagnosis of CHD was verified by means of various instrumental methods, including electrocardiographic tests and myocardial metabolic studies in conditions of frequent atrial stimulations. The results were computerized, using a specifically designed programme. Sets of signs identifying coronary patients with intact coronary arteries at questioning and noninvasive investigation are presented.

[Use of a universal formalized questionnaire in the differential diagnosis of cardiac and noncardiac pain]. / Ispol'zovanie universal'noi formalizovannoi ankety v differentsial'noi diagnostike koronarogennykh i nekoronarogennykh bolei.

A standard questionnaire, capable of describing chest pain sensations, has been offered for patients with coronary disease and neurocirculatory dystonia, and its diagnostic value is assessed. The questionnaire comprises five sections, each corresponding to a certain type of pain. A diagnostic statement is made after each section. The questionnaire can be analysed by a physician on the basis of individual clinical experience, or computer-processed. It possesses high sensitivity and specificity in detecting typical and atypical angina and cardialgia of different types. The questionnaire can identify a category of patients with chest pains, who require instrumental diagnostic investigation to specify their origin.

[Central hemodynamic function of neurocirculatory dystonia patients at rest and during the performance of load tests]. / Sostoianie tsentral'noi gemodinamiki u bol'nykh neirotsirkuliatornoi distoniei v pokoe i pri provedenii testov s nagruzkoi.

Central hemodynamic (CH) parameters were examined in 288 patients with neurocirculatory dystonia (NCD) and 50 normal subjects, using radiocardiography (RCG), echocardiography (EchoCG) and heart catheterization thermodilution (TD). All the tests were carried out at rest and during bicycle ergometry (BEM), the atrial stimulation test (AST) and the intravenous isadrin test (IT). Patients with severe NCD and basically hyperkinetic hemodynamic type responded to stress with an inadequate rise in the minute volume (MV) and a decline of the stroke index (SI). Thermodilution during the AST demonstrated increased MV, lowered end diastolic left-ventricular pressure and insignificantly reduced SI. TD and EchoCG during stress exposure produced similar results.

[Change in central hemodynamics and systolic phase structure as affected by reflexotherapy in patients with neurocirculatory dystonia]. / Izmenenie tsentral'noi gemodinamiki i fazovoi struktury sistoly pod vliianiem refleksoterapii u bol'nykh neirotsirkuliatornoi distoniei.

Myocardial contractility was examined, using echo- and polycardiography, in patients with neurocirculatory dystonia. An increase was demonstrated in the duration of the phase of isometric tension, mechanical systole and cardiac index in the presence of raised peripheral resistance as well as increased energy spending and enhanced left-ventricular contraction. Auriculo-paravertebral method of reflexotherapy was applied, and the changed parameters returned to normal.

[The oxygen supply in patients with neurocirculatory asthenia during exercise]. / Kislorodnoe obespechenie fizicheskoi nagruzki u bol'nykh neirotsirkuliatornoi distoniei.

The working capacity and the oxygen supply during exercise were studied in 83 patients with neurocirculatory dystonia of various severity and 50 healthy subjects on the basis of the spiroergometric findings. The patients with neurocirculatory dystonia showed a decrease in such parameters of the oxygen supply during "maximum" exercise as the maximum consumption of oxygen at the threshold exercise level, the maximum oxygen pulse, the maximum pulmonary ventilation and the index of the oxygen cost per 1 kgm of work. The correlation of the disorders of the oxygen supply during exercise with the severity of the clinical course of the disease elucidated their relationship: a decrease in the maximum oxygen consumption at the threshold exercise level and an increase in the "oxygen cost" of 1 kgm of work were most pronounced in a group of patients with a severe course of the disease.

[Hypertrophic cardiomyopathy: variants of the clinical picture]. / Gipertroficheskaia kardiomiopatiia: varianty klinicheskoi kartiny.

The authors describe a variety of the clinical manifestations of hypertrophic cardiomyopathy (HTCM) and identify the most frequent variants of its clinical picture, namely pseudocoronary, pseudorheumatic, dystonic. A number of symptoms and their combinations indicative of the presence of the HTCM are also described. The key role of echocardiography in the diagnosis of this disease was demonstrated. The syndrome of giant negative T waves was observed in 35% of the patients with the HTCM; this syndrome was shown to correlate with the predominance of hypertrophy in the apical area. A correlation was established between the echocardiographic signs of impairment of the diastolic pliability of the left ventricle and the presence of circulatory failure. The authors discuss the role of myocardial ischemia in the genesis of pains and ECG changes in patients with the HTCM as well as the significance of research into the myocardial metabolism in the diagnosis of myocardial ischemia in this category of patients.

[Characteristics of anginal pains in chronic ischemic heart disease]. / Osobennosti anginoznykh bolei pri khronicheskoi ishemicheskoi bolezni serdtsa.

A special questionnaire chart was used to analyse the "structure" of the cardiac pain syndrome in 77 patients with ischaemic heart disease and atypical pains: protracted attacks were recorded in 53 (out of them 13 had Prinzmetall angina pectoris), 11 had attacks with a vegetative crisis background. In 6 patients localization of pains was atypical, in 15 the pains bore the character of cardialgia. To avoid diagnostic errors the physician must analyze thoroughly subjective feelings of the patient with pains in the heart.

[Clinical symptoms and the diagnosis of the hyperkinetic cardiac syndrome]. / Klinicheskaia simptomatika i diagnostika giperkineticheskogo kardial'nogo sindroma.

The authors examined 40 patients with the hyperkinetic syndrome (HS) who underwent thorough clinical and instrumental examination including ECG, PCG, bicycle ergometry, hyperventilation and orthostatic tests, and determination of the central hemodynamic indices by echocardiography and the rate heart indices in dopplercardiography. The great diagnostic possibilities of doppler-cardiography are demonstrated. The diagnostic criteria of HS are suggested and general recommendations for treatment are given.

[Syndrome of premature ventricular repolarization]. / Sindrom prezhdevremennoi repoliarizatsii zheludochkov.

ECG abnormalities are described in 71 persons with the syndrome of premature repolarization of the ventricles. The syndrome of premature ventricular repolarization is considered a benign, most probably congenital, change of the electro-physiological state of the heart which due to its morphological peculiarities, however, leads to hyperdiagnosis of ischemic heart disease. In the discussion of the pathogenesis of this syndrome, the main attention is focused on the increased effect of the vagus nerve and the possible existence of anomalous additional pathways of atrioventricular conduction.

[Characteristics of the sound symptomatology of the heart in functional cardiopathy]. / Osobennosti zvukovoi simptomatiki serdtsa pri funktsional'noi kardiopatii.

Sixty persons with functional cardiopathy who had a systolic murmur were examined. The purpose of the study was the demonstration of the criteria for the positive diagnosis of a functional systolic murmur in this pathologic condition since hyperdiagnosis of valvular heart disease among these patients is a frequent occurrence. The auscultatory and phonocardiographic characteristics of the functional systolic murmur are described, a conclusion on the absence of any connection between this murmur and the valvular apparatus of the heart is drawn, an opinion on the mechanism of its formation is presented, and the data on the effect of beta-blocking agents on the systolic murmur (single dose and a course of treatment) are discussed.