[Radionuclide ventriculography in the diagnosis of a postinfarct aneurysm and the evaluation of its impact on left ventricular function]. / Radionuklidnata ventrikulografiia za diagnostirane na postinfarktna anevrizma i pretsenka na otrazhenieto ì vurkhu levokamernata funktsiia.

This is a report on thirty-four patients subjected to radionuclide ventriculography because of suspected post-infarction aneurysm. To discover eventual kinetic disorders, apart from visual assessment of the wall kinetics, amplitude-phase analysis is also employed. The sensitivity of the method is compared with that of bi-dimensional echocardiography. The assessment of post-infarction left ventricular function by either of the methods is also compared. A correlation is established between left ventricular area involved by kinetic disorders, and reduction of the radionuclide total ejection fraction. The values of the latter, estimated echocardiographically, are consistently elevated.

[Radionuclide ventriculography for the diagnosis of postinfarct aneurysm and the assessment of its impact on left ventricular function]. / Radionuklidnata ventrikulografiia za diagnostirane na postinfarktna anevrizma i pretsenka na otrazhenieto i vurkhu levokamernata funktsiia.

Radionuclide ventriculography was performed in 34 patients suspected of having postinfarction aneurysm. In addition to visual appraisal of wall kinetics, amplitude-phase analysis was used for detecting kinetic disorders. The sensitivity of the method was compared with that of two-dimensional echography, and postinfarction left ventricular function was assessed by the two methods. Correlation was recorded between left ventricular plane affected by kinetic disturbances and the decrease of radionuclide total ejection fraction. Systematically higher were the values determined by echography.

[Hemodynamic indices assessed by impedance cardiography in patients with the subacute stage of myocardial infarct before and during bicycle ergometry]. / Khemodinamichni pokazateli, pretseneni s impedansna kardiografiia, pri bolni sus subakuten stadii na miokarden infarkt predi i pri veloergometriia.

The hemodynamic indices were determined in 51 patients with myocardial infarction, subacute stage, before and after bicycle ergometric loading. The following indices were determined by impedance cardiography: cardiac output, total peripheral resistance, volume velocity of blood ejection, power of cardiac contractions, index of myocardial contractility etc. The results reveal that the patients with subacute stage of myocardial infarction have reduced reserve possibility of blood circulation apparatus. Signs of latent cardiac failure are manifested in case of extensive localization with transmural involvement, because of seven disorders in the contractile function of myocardium. The adaptation to physical loading, in the rest of the patients, is better but still far less than that in healthy subjects.

[Preoperative clinical and hemodynamic assessment of patients for surgical revascularization of the myocardium]. / Predoperativna klinichna i khemodinamichna otsenka na bolni s khirurgichna revaskularizatsiia na miokarda.

A group of 35 patients with ischemic heart disease (IHD) and 6 patients with aquired heart defects, with established significant coronary obstruction were studied. The clinical picture of the patients with IHD is dominated by severe, refractory to treatment angina pectoris with extensive and high-degree stenosing coronary angina pectoris in combination with a relatively preserved left ventricular function. The patients with aquired defects have no anginal complaints. The aortic-coronary by-pass is justified in the light of the modern studies in the world. The necessity of rapid advancement of coronary surgery in Bulgaria is underlined.

[Treatment of light and moderate arterial hypertension with acebutolol]. / Lechenie na lekata i umerenata arterialna khipertoniia s atsebutolol.

The authors follow up the effectiveness and tolerance of monotherapy with acebutolol in 47 patients with light and moderate hypertension, in a dose of 400-1200 mg in the course of three months. Twenty two of the patients have been treatment with the original French drug of the firm "Specia" and the rest 25--with the Bulgarian preparation, produced by Pharmachim according to a licence of the French one. The following parameters were followed up: arterial pressure, pulse rate, ECG, eventual adverse effects on 30, 60, 90 day of the treatment. The indices of cardiac output and total peripheral vascular resistance were calculated in a group of 13 patients. The results obtained reveal that the monotherapy with acebutolol, in light and moderate arterial hypertension, leads to definite, lasting and progressive antihypertensive effect in over 75% of the patients. The preparation has no significant effect on pulse rate and induces no orthostatism. It affected the total peripheral vascular resistance with 26% from the initial with unchanged or lightly increased indices of cardiac output. The Bulgarian drug, produced by Pharmachim, gives no way in effectiveness to the original French preparation.

[Diastolic and systolic functions of the left ventricle determined by M-echocardiography in idiopathic hypertrophic cardiomyopathy]. / Diastolna i sistolna funktsiia na liavata kamera, opredelena s M-ekhokardiografiia pri idiopatichna khipertrofichna kardiomiopatiia.

The diastolic function and the correlation between pump and diastolic function of left ventricle were studied in 35 patients with idiopathic hypertrophic cardiomyopathy with subaortic stenosis via a M-echocardiographic investigation by Echoview 80 C in the routine method. The following indices were used: A. For the diastolic function: 1. Telediastolic dimension (TDD) and volume (TDV) of left ventricular cavity. 2. Dimension (DPhFF) and volume (VPhFF) of the left ventricular cavity at the end of the phase of fast filling; 3. Velocity of fast filling of the left ventricle (ml/sec) - (formula; see text) 4. Fraction of fast filling of left ventricle (%) - (formula; see text) 5. Velocity of backward motion of the anterior mitral cusp at the beginning of diastole (E - F segment); 6. Velocity of early diastolic motion of the posterior wall of left ventricle (PWLV); 7. Ratio between early diastolic (D) and systolic (S) interval of PWLV: D/S; 8. Telediastolic interval (A - C) of mitral valve; 9. Index of fast emptying of left ventricle; 10. Amplitude E - E' of mitral echogram; II. Area (cm2) between two mitral cusps in diastole. B. For the systolic (pump) function: 1. Stroke and minute volume (SV, MV) of left ventricle according to the cubic formula and Teicholz formula; 2. Telesystolic dimension (TSD) and volume (TSV) of left ventricular cavity; 3. Fraction of shortening (FS) of left ventricle (%); 4. Mean velocity of shortening of the circumferential fibres (mVcf) of left ventricle (circumf./S); 5. Ejection fraction (EF) of left ventricle (%). 6. Distance between left ventricular endocardium of interventricular septum and point E of mitral valve; 7. Fraction of systolic thickening of IVS and PWLV; 8. Velocity of systolic thickening of IVS and PWLV; 9. Amplitude of systolic motion of IVS and PWLV.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical and hemodynamic characteristics of the decompensation syndrome in patients with congestive cardiomyopathy]. / Klinichna i khemodinamichna kharakteristika na dekompensatsionniia sindrom pri bolni s kongestivna kardiomiopatiia.

Thirty seven patients were clinically and hemodynamically studied under hospital conditions. The stage of cardiomegaly, the stasis in the pulmonary and systemic circulations were followed up as well as the presence of manifestations of pulse deficit, incidence of gallop rhythm manifestation. It was established that in the patients with II-A stage of decompensation of circulation, a decreased cardiac output was found, enhanced peripheral resistance and normovolemia. In the patients with II-B stage of circulation decompensation, further decrease of stroke and minute volume was found as well as moderately slowed down blood flow in the pulmonary and systemic circulation and normal peripheral vascular resistance. Conclusions were drawn, on the base of the data obtained, about the optimal treatment depending on the circulation decompensation stage.

[Treatment of chronic congestive failure with vasodilators (acute trial with prazosin and erythrityl tetranitrate)]. / Lechenie na khronichnata zastoina nedostatuchnost s vazodilatatori (ostur opit s prazozin i eritritiltetranitrat).

An acute clinical experiment was carried out with 34 patients with chronic refractory cardiac insufficiency with stasis and idiopathic dilating (stasis) cardiomyopathy so as to follow up the hemodynamic effect of the vasodilators prazosin and erythrityl tetranitrate. The values of the central and peripheral vascular hemodynamics were followed up before and one hour after the peroral intake of 2 mg prazosin and half an hour after the peroral intake of 40 mg erythrityl tetranitrate. The results indicate that a statistically significant decrease of the arterial pressure and the total peripheral vascular resistance developed after prazosin intake. The systolic arterial pressure was decreased from 121,80 +/- 3,52 to 102,40 +/- 3,71 (p less than 0,001) and the diastolic--from 80,20 +/- 2,41 to 68,20 +/- 2,56 (p less than 0,01). The values of the total peripheral vascular resistance were decreased from 2629,65 +/- 174 to 1865,53 +/- 153 (p less than 0,001). The indices of the pump function--Stl and SI were increased (Stl from 22,74 +/- 1,85 to 30,37 +/- 2,14 with p less than 0,025 and Sl--from 1,90 +/- 0,08 to 2,64 +/- 0,19; p less than 0,02). The indices of the pressure in the left ventricular filling had no statistically significant change. After the administration of erythrityl tetranitrate, a statistically significant improvement of the indices of the cardiac output was also observed as well as of the total peripheral vascular resistance. The systolic index grew from 1,74 +/- 0,20 to 2,70 +/- 0,16 (p less than 0,01); stroke index--from 18,35 +/- 2,82 to 32,99 +/- 2,88 (p less than 0,01), and the total peripheral vascular resistance was decreased from 2897,0 +/- 186,0 to 1556,0 +/- 154,0 (p less than 0,001). Prazosin and erythrityl tetranitrate led to a considerable decrease of the counter load of the heart and improvement of the pump function of left ventricle in an acute experiment in case of chronic cardiac insufficiency with stasis.

[Intracardiac hemodynamic characteristics in high-degree mitral stenosis and an assessment of the indications for its surgical treatment]. / Osobenosti na intrakardialnata khemodinamika pri visokostepenna mitralna stenoza o otsenka na pokazaniiata za neinoto operativno lechenie.

The data from the right cardiac catheterization, echocardiography M-type and radiocardiography were juxtaposed in 54 patients with "pure" or predominating severe mitral stenosis (MS)(mitral valvular opening under 1 cm2)--confirmed at operation, in the determination of their functional and hemodynamic characteristics. The patients were grouped into three groups depending on the degree of pulmonary--capillary pressure increase (PC)--greater than 2.666, greater than 3.999 and 4.132 kPa(greater than 20, greater than 30 and less than 31 mmHg). The first group covering 28 per cent of the patients with a mean PC--2,399 +/- 0.257 kPa = (18 +/- 1.93 mmHg) are of particular interest. A light to moderate increase of pulmonary arterial pressure, elevated TPVR, absence of right ventricular insufficiency with reduced M. V SI resp. were established in them. It was assessed as a group with hypovolemia and proper preoperation preparation but requiring attention as regards the eventual hypotension, intra- or post operation. The third group covers 22 per cent of the patients and is characterized with increased TPVR, high hypertension in pulmonary artery, elevated telediastolic pressure in right ventricle and normal or lightly increased MO, assessed as a group with an inadequate diuretic therapy pre-operatively. The second group is with typical hemodynamic characteristics of severe MS and includes 50 per cent of the patients. The analysis forces the conclusion, that for an adequate evaluation of hemodynamics and MS severity, the PC pressure is necessary to be always discussed in connection with blood volume and flow, as well as with the other hemodynamic indices, in order to avoid the omissions as regards MS operability.

[Comparative evaluation of impedance cardiographic and dye dilution methods in determining hemodynamic indices]. / Sravnitelna otsenka na metodite na impedanskardiografiia i bagrilna dilutsiia pri opredeliane na niakoi khemodinamichni pokazateli.

The norms of cardiac output and general peripheral resistance in 81 healthy subjects were determined by impedance-cardiography. The same hemodynamic indices were also studied in 150 patients with ischemic heart disease, idiopathic myocardiopathies, hypertonic disease and acquired valvular diseases in a state of compensation or cardiac insufficiency. The methods of impedance-cardiography and dye dilution were used. A high correlation dependence was found between the results, obtained by the two methods. Discrepancies in the individual results were observed only in the cases with mitral and aortic insufficiency combined mitral and mitral-aortic valvular defects. The author recommends the impedance-cardiography as a reliable method for a wide application in the clinical practice.

[Peroral use of a lidocaine preparation]. / Peroralno prilozhenie na preparata lidokain.

The authors studied the therapeutic effect of lidocainee peroral forms in case of rhythm disorders, accompanying with various cardiac diseases. The results obtained revealed that in 76 per cent of the cases with ventricular extrasystoles, the treatment result was very good, with complete disappearing of extrasystoles. Good effect was found in 18 per cent, with the recording of some rare, single extrasystoles towards the end of the treatment, and the treatment had no effect on 6 per cent of the patients. The drug proved to be effective in the cases with supraventricular extrasystoles. Lasting result was attained in 89.36 per cent of the patients treated. Due to the favourable therapeutic effect and good tolerance the authors recommended lidocain peroral form for wide application in the treatment of rhythm disorders.

[Clinical dynamic ECG observations of the physical load tolerance of myocardial infarct patients]. / Dinamichni EKG nabliudeniia za tolerantnostta kum fizichesko natorvane pri bolni s infarkt na miokarda v klinichna obstanovka.

Dynamic ECG observations are reported after a full day interval motor programme, applied with four motor regimes on patients with myocardial infarction under clinical conditions. The motor programme was used for the treatment of 241 patients, distributed into 2 groups. Observation on the effect of peak physical loading at the end of each motor regime was also reported. The authors concluded that the tolerance to physical loading was adequate, being confirmed by the absence of significant ECG dynamics even with the peak loadings, performed at the end of all motor regimes.

[Retrospective assessment of the preinfarction period]. / Retrospektivna tsenka na predinfarktniia period.

The prodromal symptoms were retrospectively assessed in 100 patients with acute infarction of myocardium. The authors found preinfarction state in 48 per cent of the patients. In 95 per cent of the cases pain paroxysm was the basic manifestation. In 60,42 per cent it was accompanied by rhythm disturbances and to a lesser degree by some other symptoms: sense of lack of air, unusual fatigability, conductivity disturbances, vegetative manifestations, etc. In 43,75 per cent of the patients, electrocardiograms were recorded and in 80,95 per cent a lowered, bi-phase or negative T-wave was found and in 47,62 per cent--S--T depression.

[Vasodilator treatment of chronic heart failure: a chronic double-blind trial with prazosin and erythrityl tetranitrate]. / Lechenie na khronichnata surdechna nedostatuchnsot s vazodilatoatori--khronichen dvoino sliap opit s prazozin i eritritiltetranitrat.

A chronic double-blind experiment was carried out with 32 patients with severe chronic stasis cardiac insufficiency, with concomitant idiopathic congestive cardiomyopathy and ischemic heart disease, in assessing the effect of vasodilators prazosin or erythrityl tetranitrate upon the decompensation symptomatics and hemodynamic indices. The clinical indices of cardiac insufficiency with hemodynamic signs of pre-loading, myocardial contractility and postloading of left ventricle were followed up. Besides vasodilators the patients were administered the ordinary maintenance therapy with digoxin and diuretics. The experiment was a double blind one, controlled by placebo-periods and covered a 6 months follow-up period. The combined venous-arteriolar vasodilator prazosin was reduced pre and post-loading, it increased the cardiac output, without essential changes in functional capacity of the patients with chronic cardiac insufficiency. Erythrityl tetranitrate, however, has no substantial effect on the clinical and hemodynamic indices of statis cardiac insufficiency even in higher doses. That suggests the necessity of the chronic cardiac insufficiency treatment to be carried out with vasodilators with venous and arteriolar effect.

[Comparative evaluation of the radiocardiographic and the dye dilution methods of determining cardiac output and circulating blood volume]. / Sravnitelna otsenka na radiokardiografskiia i bagrilno-dilutsionniia metod pri opredeliane na surdechniia debit i obema tsirkulirashta kruv.

The authors compared the radiocardiographic and dye-dilution methods for hemodynamics determination. Cardiac capacity and volume of circulating blood were determined in 42 patients with atherosclerotic myocardiosclerosis and acquired valvular defects. A very high correlation dependence was established between the two methods. The correlation coefficient for minute volume is r = 0.93, for cardiac index it is r = 0.91 and for beat volume--r = 0.95 (P less than 0.001). A high correlation coefficient was established for the volume of the circulating blood--r = 0.86 (P less than 0.001). The authors admit that both methods are equally accurate and completely interchangable.

[Sick sinus node syndrome and the transitory collapse of the R wave in myocardial infarct]. / Sindrom na bolniia sinusov vuzel i prekhoden proval na zubetsa R pri infarkt na miokarda.

The authors observed 40 patients (7.79%) with the morbid sinus node syndrome among the treated 526 patients with acute myocardial infarction at the department of intensive care during the period 1973--1976. Thirty one were males and nine--females. The syndrome was manifested, in all patients followed up, during the first 14 days after the onsed of the coronary incidence. One case was with a lethal end. Ten patients (1.90%) were observed with the syndrome "transitory collapse of R-deflection" in the separate precordial leads. Half of them had a combination of both syndromes. The collapse of R-deflection was manifested between the 3rd and 14th day in all cases. The character and incidence of rhythm-conductivity disturbances accompanying both syndromes are discussed.

[Changes in the hemodynamic indices in the subacute stage of myocardial infarct before and after bicyle ergometry]. / Promeni v khemodinamichnite pokazateli v podostriia stadii na miokardniia infarkt predi i sled veloergometriia.

The basic hemodynamic indices: cardiac volume, volume of circulating plasma and blood, total peripheral vascular resistance and velolity of blood flow were studied in 60 patients with myocardial infarction, subacute stage in progress, prior to and post veloergometric loading. A decreased tolerance to physical loading was established: cardiac index--insignificantly increased, beat volume-decreased, volume of circulating plasma and blood--tendency to increase. The results show a dependence on the clinical development of the disease--the signs of a latent insufficiency being manifested in the cases with extensive localization of the infarction, transmural affection and with a formed aneurisma after a dosed loading.

[Changes in myocardial contractile function and in the hemodynamic indices in patients with myocardial infarct before and after beta-blockader treatment]. / Izmeneniia v sukratitelnata funktsiia na miokarda i khemodinamichnite pokazateli pri bolni s miokarden infarkt predi i sled lechenie s beta-blokeri.

The changes in the basic hemdynamic indices and in the phase structure of the cardiac cycle in patients with acute infarction prior to and post treatment with beta-blockers (Obsidan and Trasicor) were studied. Manifested changes in the hemodynamics were established, namly: pulse rate and cardiac flow decrease, the total peripheral resistance grows; veloqcilty of blood flow is slowed down. The preparations used have a negative effect upon the phase structure of left ventricle as well. The authors underline that beta-blockers administration in acute myocardial infarction should be evaluated very carefully and in the presence of clinical signs for cardiac insufficiency, it should be carried out on the background of cardiotonic treatment.