[Various approaches to optimizing the hemodynamics of myocardial infarct patients]. / O nekotorykh podkhodakh k optimizatsii gemodinamiki u bol'nykh infarktom miokarda.

Combined investigation of systemic and intracardiac hemodynamic parameters (radiocardiography and Fick's procedure, transvenous catheterization, and right-ventricular and pulmonary arterial blood pressure measurement) was carried out in 428 myocardial infarction patients admitted to hospital within the early hours after the attack; changes in necrotic area were monitored for 7 days (precordial ECG cartography and serial serum CPK assays). Computer-assisted combined data analysis made use of image identification techniques, the images being based on a general approximation algorithm and informative coefficient. The algorithm permitted a classification of patients' condition by left-ventricular insufficiency (a 77.4% reliability) and by the spread of necrotic area (a 72.5% reliability). The prognosis chart, constructed on the basis of comparison between actual hemodynamic values and their standard vectors, brought out optimum regimens for every parameter associated with the least risk of left-ventricular insufficiency and necrotic spread.

[Combined use of nitrates and beta-adrenergic blockaders in patients with acute myocardial infarct]. / Kombinirovannoe primenenie nitratov i beta-adrenergicheskikh blokatorov u bol'nykh ostrym infarktom miokarda.

A combination of isosorbide dinitrate (40-120 mg daily) and propranolol (80-160 mg) was administered to 146 patients during the early hours of myocardial infarction. The therapeutic effect was assessed for 10 days and compared to the effect observed in a control group of 70 patients selected at random. The combination used was shown to relieve the pain syndrome and extrasystolic arrhythmia during the early days of the disease. The occurrence of signs of heart failure was twice as low during the observation period, as compared to the control group. The treatment evoked typical hemodynamic changes: rhythm deceleration (by an average 7%), a fall in systemic arterial blood pressure (by 19%) and in "double product" (by 25%), a moderate reduction of cardiac output (by 15%) coupled with a marked drop in left-ventricular filling pressure (by 25%). The spread of infarcted area in the first days after the attack, as evidenced by serial electrocardiotopograms and the activity of serum CPK and its MB fraction, was recorded in 13.9% of the treated patients and in 44% of the controls (p less than 0.001).

[Graded volume loading in the diagnosis of early heart failure among myocardial infarct patients]. / Dozirovannaia ob"emnaia nagruzka v diagnostike rannei serdechnoi nedostatochnosti u bol'nykh ostrym infarktom miokarda.

The method of graded physical exercise with the plotting of the functional curves and calculating of the functional coefficient (FC) was used in the study. No relationship was detected between the initial level of the cardiac output and the direction of the functional curve. A negative FC was more frequently recorded in patients with Q-index 25.

[Effect of the combined use of nitrates and beta-adrenergic blockaders on hemodynamics in patients with acute myocardial infarction]. / Vliianie kombinirovannogo primeneniia nitratov i beta-adrenergicheskikh blokatorov na gemodinamiku bol'nykh ostrym infarktom miokarda.

The effect of combined treatment with nitrosorbide and obsidan on major hemodynamic parameters was studied in 47 myocardial infarction patients within the first 24 hours of the disease. Intravenous drip injection of 0.15 mg/kg obsidan simultaneously with the administration of 20 mg nitrosorbide reduced heart rate by 12.7%, systemic blood pressure by 23.5%, and diastolic pulmonary arterial pressure by 38.4%. The cardiac index decreased by 22.8%, mainly due to reduced heart rate. The treatment improved myocardial function as evidenced by and increased number of positive post-treatment "functional curves". This method is safe and efficient, provided it is applied under careful hemodynamic control.

[Hemodynamic effects of nitroglycerin in acute myocardial infarct]. / Gemodinamicheskie effekty nitroglitserina u bol'nykh ostrym infarktom miokarda.

The influence of sublingual dose (0.5 mg) of nitroglycerin on the cardiac function and central haemodynamics was studied in 53 patients with acute myocardial infarction in the first hours of illness. The cardiac output was measured by radiocardiography and tetrapolar rheography, filling pressure on the left ventricle by catheterization of the pulmonary artery. It is shown that nitroglycerin leads to decrease of the systemic arterial pressure and filling pressure in the left ventricle. In patients with a hyperkinetic type of circulation there is a decrease of cardiac output caused by predominantly decreased venous return of the blood. In patients with eukinetic and especially with a hypokinetic type of haemodynamics nitroglycerin leads to significant increase of the cardiac output, caused by predominant decrease of after-load. It is concluded that nitroglycerin is indicated in any haemodynamic variant of myocardial infarction (except cases of marked arterial hypotension). It improves the pumping function of the heart and ensures its oxygen supply.

[Use of obzidan in the acute period of myocardial infarct]. / Primenenie obzidana v ostrom periode infarkta miokarda.

Forty-four patients with acute myocardial infarction were given 0.15 mg/kg propranolol (obsidan) by intravenous drip, after which 80--160 mg of the drug were given daily by mouth for 4--5 days. The extent of the ischemic damage and the dynamics of the infarction zone were judged according to the results of electrocardiotopogram recorded from 35 leads and serial tests for creatine phosphokinase activity in blood serum. The hemodynamic shifts occurring under the effect of the treatment were determined in the same patients. The results were compared with those in a control group (37 patients) identical in clinical and hemodynamic signs. It is established that obsidan given by the schedule proposed reduces significantly the electrocardiographic signs of ischemic damage to the myocardium (according to the ST segment) and the spread of the zone of necrosis in the first days of the follow-up. This is attended by deceleration of the cardiac rhythm and a decrease in systemic arterial pressure and cardiac output. The hemodynamic shifts occur within the ranges of admissible fluctuations and do not cause circulatory insufficiency as a rule.

[Assessment of the dimensions and dynamics of the necrosis zone in acute myocardial infarct]. / Otsenka razmerov i dinamiki zony nekroza u bol'nykh ostrym infarktom miokarda.

In 165 patients with myocardial infarction admitted to the clinic within the first 24 hours of the disease, the size of the zone of affection and its dynamics in the immediate 4--5 days were appraised. Three methods were used for this purpose: cartographic analysis of the ECG in 35 precordial leads; vectorcardiography and serial determination of creatine phosphokinase activity (CPK) in blood plasma with calculation of the size of the necrosis in units of weight (grams). It is shown that ECG-cartography and serial determination of serum CPK activity are valuable methods in quantitative appraisal of the size of the necrotic focus in patients with myocardial infarction. Study of the ECG-cardiogram and vectorcardiogram in dynamics and analysis of CPK activity curves enables one to appraise the spreading of the zone of the necrosis in the first days of the infarction. According to the results of these methods, in most patients (68 to 82%) with macrofocal myocardial infarction the zone of the necrosis spreads in length and in depths in the first days of the disease.

[Hemodynamic variants of acute myocardial infarct]. / Gemodinamicheskie varianty ostrogo infarkta miokarda.

In 165 patients with myocardial infarction admitted to the clinic within the first 24 hours of the disease the size of the zone of the lesion and its dynamics were appraised in the immediate 4-5 days. Cartographic ECG analysis and study of the vectorcardiogram in dynamics and analysis of the creatine phosphokinase activity curves make it possible to appraise the dynamics of the necrotic zone in the first days of myocardial infarction. It was found that in most patients with macrofocal myocardial infarction the zone of the necrosis increases both in length and in depth in the first days of the disease.

[Experience with combined use of neurolepsy and vasodilator substances in the treatment of patients with acute myocardial infarct]. / Opyt sovmestnogo ispol'zovaniia dlitel'noi neirolepsii i vazodilatatornykh sredstv pri lechenii bol'nykh ostrym infarktom miokarda

On the basis of an examination of 412 patients with myocardial infarction the efficacy of a long-term employment (for 3--4 days) of a neuroleptic Droperidol and a vasodilator Curantyl was examined. Optimum dosages of the drug and its administration techniques were worked out with due account of the data of clinical and physiological observations and blood concentrations of Curantyl. The incidence of the pain syndrome, of extrasystolic arrhythmias, of cardiogenic shock and sudden ventricular fibrillation was shown to decrease under the effect of the treatment. Without affecting the haemodynamics of the general circulation, the employed combination of drugs improved the pulmonary circulation and produced a beneficial inotropic effect upon the right ventricular myocardium, thus causing a distinct improvement of microcirculation, normalizing the ratio of diameters of the arterioles and venules, increasing the level of the tissue blood flow, and significantly reducing the intravascular aggregation of the formed elements of the blood. A long-term combined employment of the drugs for a few early days of the disease clearly favoured a positive haemodynamics in an important part of the patients, as demonstrated by the data of electro- and vectorcardiography.

[Evaluation of clinical study methods in the diagnosis of cardiac insufficiency in myocardial infarct]. / Otsenka klinicheskikh metodov issledovaniia v diagnostike serdechnoi nedostatochnosti pri infarkte miokarda

On the basis of an examination of 500 patients with myocardial infarction the authors undertook a critical analysis of the informativeness of some clinical methods of evaluation of the cardiac muscle contractility employed in this pathology. The authors concluded that attempts at assessing the contractility of the left ventricle on the basis of the temporal intervals of the mechanical systole alone may give misleading results in myocardial infarction patients. The dp/dtmax parameter cannot serve as an independent measure of the inotropic function since its changes largely depend on the conditions of the ventricular load.