[Coronary reserve peculiarities in patients with ischemic heart diseases depending on gender and age aspects].

Results of clinical and functional studies of 183 patients with organic patology of the cardiovascular system are presented in the article. Coronary reserve peculiarities in women were determined depending on their age. The analysis of dynamics of quantity indicators of myocardium ischemia at hospitalization has shown that patients aged till 45 years have sexual dependence of distribution of changes of repolarization phase, patients older age group it is not so determined. During carrying out of loading tests the percent of the reached loading decreased with age increase, considerably conceding in women, quantitative changes of myocardium ischemia increased with age with an insignificant prevalence in men. Positive test was observed with maximum frequency in patients with ischemic heart disease (IHD). The analysis of haemodynamic shifts in patients with organic diseases has shown that similar changes correlated with a stable tendency to decrease in fraction of ejection fraction.

[Coronary reserve features in patients with ischemic heart disease regarding sex and age aspects].

The article presents results of clinical and functional observations of 183 patients. The authors have studied coronary reserve features in women against age and organic pathology of the vascular-heart system. An analysis of dynamics of quantitative parameters of myocardial ischemia during hospitalization showed existence of the relation between male and female in allocation of phase repolarization changes and it is seen till 45 years. This relation is disappearing in more aged patients. Load test showed that the percent of the reached load decreased with increase in age, considerably conceding in women, quantitative changes of myocardium ischemia increased with age and with an insignificant prevalence in men. Positive test was seen with maximal frequency in patients with acute forms of IHD. An analysis of hemodynamics shifts in groups of patients with organic diseases has shown that analogical changes were with a stable orientation to decrease in election fraction.

[The chronobiological conception of the development of acute myocardial infarction].

The subjects, 1048 patients with acute myocardial infarction (AMI), were examined in order to study the chronobiological periodicity of acute coronary catastrophes. The study established that the probability of AMI was the lowest on Sundays and Saturdays, equally higher on Mondays, Wednesdays, and Thursdays, lower on Tuesdays, and the highest on Fridays. Analysis of circannian AMI incidence demonstrates that its probability decreases in September and increases in February, March, May, and June. In August and November, the incidence of different AMI forms differs: transmural forms prevail in August, while large-focal ones prevail in November.

[Enalapril and irbesartan in treatment of patients with arterial hypertension]. / Enalapryl ta irbezartan u likuvanni khvorykh z arterial'noho hipertenziieiu.

In 68 patients with arterial hypertension a hypotensive effect of enalapril and irbesartan was studied together with the influence these drugs have on circadian rhythms of arterial pressure (AP). Both drug preparations have been shown to exert an apparent antihypertensive effect. However irbesartan is tolerated better by patients and it is capable of reducing high variability of AP.

[Effect of angiotensin receptor blockers on hemodynamic aspects during myocardial infarction]. / Vplyv blokatoriv anhiotenzynovykh retseptoriv na hemodynamichni osoblyvosti perebihu hostroho periodu infarktu miokarda.

As many as 65 patients with myocardial infarction were examined for efficacy of blockers of angiotensin receptors with making use of stress-echocardiography having been instituted on admission and two weeks following treatments administration. Irbesartan has been shown to be highly effective because of its positive impact on myocardial contractility.

[Some specific indices for stress tests in patients with ischemic heart disease concurrent with chronic cholecystitis]. / Osoblyvosti pokaznykiv stres-testiv u khvorykh na ishemichnu khvorobu sertsia u poiednanni z khronichnym kholetsystytom.

The myocardial coronary reserve and functional state were studied in patients with ischemic heart disease concurrent with chronic choletistitis against the background of a stress-test (veloergometry). Particular features are discussed of hemodynamic changes in conducting exercise tolerance tests in coronary patients presenting with diseases that lead to a reduction in the myocardial coronary reserve and decrement in performance capability of the heart.

[The effect of the morphofunctional state of the thrombocytes on the activation of destabilization processes in patients with acute forms of ischemic heart disease]. / Vliianie morfofunktsional'nogo sostoianiia trombotsitov na aktivatsiiu protsessov destabilizatsii u bol'nykh s ostrymi formami ishemicheskoi bolezni serdtsa.

With the purpose of assessing the influence that platelet morphofunctional state may have on the degree of destabilization in patients with different forms of unstable angina we examined 198 patients using stress tests, Holter ECG monitoring, studying activation of thrombocytes with the aid of a luminescent-microscopy technique, and performing an analysis of aggregation. Important differences have been revealed in the studied parameters in those patients presenting with freshly detected and progressive stenocardia and with a developing, despite of the treatments administered, myocardial infarction, that might be caused by abnormal shifts in the thrombocyte intact/activated forms ratio.

[The treatment of chronic ischemic heart disease: the potentials for hypolipidemic correction using current drugs]. / Likuvannia khronichnoï ishemichnoï khvoroby serdtsia: mozhlyvosti hipolipidemichnoi korektsiï iz zastosuvanniam suchasnykh likars'kykh zasobiv.

The data obtained by the authors suggest that lipanor may correct those lipid metabolic disturbances that are most pronounced in each individual case. Moreover, the above drug is capable of lowering substantially the level of total blood cholesterol and atherogenic fractions of lipoproteins as early as at day 14 after its intake. Being associated with minimum adverse effects, and intended to be taken on a once-daily schedule, the drug will, we believe, come in wide use.

[The characteristics of the realization of myocardial ischemia as dependent on stress test results in women with myocardial lesions of various origins]. / Osoblyvosti realizatsiï ishemiï miokarda zalezhno vid rezul'tativ stres-testiv u zhinok z urazhenniam miokarda riznoho henezu.

Overall, 72 female subjects presenting with chest pain and/or ST changes in ECG were studied. Average age of the examinees was 44.6 years, all the above women being less than 67 years old. Certain differences were found in those subjects presenting with non-Q-wave myocardial infarction, unstable angina, function disorders of the cardiovascular system, as per transesophageal electrocardiostimulation. Stress-tests results were studied for an objective appraisal to be done of the myocardium function state.

[Circadian rhythms and the risk of the development of a myocardial infarct]. / Tsyrkadni rytmy ta ryzyk rozvytku infarktu miokarda.

As many as 70 patients were examined under conditions of a cardio resuscitation unit to gain insight into relatedness of time of development of acute of myocardial infarction (AMI) to its forms and particular clinical picture. The highest risk of AMI development was recordable within the time interval of 6-12 hours with the existing dependence for morning probability of microfocal AMI, daytime probability of microfocal and transmural AMI, with significant reduction thereof within the interval of 18-24 hours. Lesser probability of AMI development within 18-24 hours was closely related to reduction of levels of aspartate aminotransferases, lactatdegidrogenases, and creatinphosphokinases in AMI patients within this time interval.

[Right ventricular function and the hemodynamic status of patients with unstable stenocardia]. / Funktsiia pravoho shlunochka i stan hemodynamiky u khvorykh z nestabil'noiu stenokardiieiu.

With the purpose of studying the condition of haemodynamics and function of the right ventricle in 28 patients with unstable stenocardia paired transesophageal electrocardiostimulation and bicycle ergometry [correction of veloergometry] were done with recording of echocardiographic indicators at the height of stress-tests. Important changes were identified in the right ventricular ejection fraction peculiar to changes of end-diastolic and end-systolic volumes in conditions of simulating myocardial infarction.

[Structural and functional disorders of the left ventricle as a predictor of the subsequent course of the disease in patients with unstable angina]. / Narusheniia struktury i funktsii levogo zheludochka kak prediktor dal'neishego techeniia zabolevaniia u bol'nykh s nestabil'noi stenokardiei.

Significance of total ejection fraction was assessed in the long-term follow-up of 270 patients with unstable angina pectoris in the course of bidimensional echocardiography and 99mTc radioisotope ventriculography of the myocardium in order that we might be able to forecast the remote outcomes of this particular disease. Ejection fraction was shown to be an independent predictor of informative value for the end point of the disease.

[The clinico-functional status of patients with unstable stenocardia (based on Holter electrocardiographic monitoring data)]. / Kliniko-funktsional'nyi stan khvorykh na nestabil'nu stenokardiiu (za danymy kholterivs'koho elektrokardiohrafichnoho monitorynhu).

As many as 50 patients presenting with unstable angina were examined for clinicofunctional status, using bicycle ergometry [correction of veloergometry], transesophageal electrocardiostimulation and 24-hour Holter ECG monitoring during 1-yr follow-up. The results of exercise tests at enrollment into the study suggested a dramatic decrement in the patients' exercise tolerance, as to Holter, with the painless myocardial ischemia tending to be more common among them than the painful one. A follow-up study a year later showed the course of the illness to be most variable among those cases presenting with unstable angina. A correction of their management being warranted, the latter was then tailored to the individual on the basis of findings from a comprehensive evaluation of each of them at the original admission to a hospital.

[The structure of the ventricular arrhythmias in patients in the first 24 hours of a myocardial infarct]. / Struktura zheludochkovykh aritmii u bol'nykh v pervye sutki infakta miokarda.

Therapeutic interventions policy and efficiency rely on whether one succeeds in identifying accurately and in timely fashion the nature of ventricular arrhythmia which is frequently a primary manifestation of acute coronary disaster. With the view to studying cardiac arrhythmias in 85 patients with acute large size myocardial infarction admitted within 12 hours of the condition development. 24 h Holter monitoring was instituted. The results obtained showed only 27% of patients at relatively low risk development of life-threatening arrhythmias. In all the others, high grades ventricular extrasystoles are recorded, including episodes of ventricular tachycardia in 50% of the patients. High incidence rate of the complex rhythm disturbances development during first 12 hours of monitoring suggest a need for an adequate supplementary antiarrhythmic treatment to be administered within this time period, subsequent to which anti-ischemic therapy is thought to be capable of exerting sufficient antiarrhythmic effect.

[The intracardiac laser irradiation of the blood in correcting left ventricular dysfunction in progressive stenocardia]. / Vnutriserdechnoe lazernoe obluchenie krovi v korrektsii levozheludochkovoi disfunktsii pri progressiruiushchei stenokardii.

The authors studied the effect of intracardiac irradiation of blood with a low intensity Helium-Neon laser on the pumping function of left ventricle in 73 patients with progressive angina pectoris. 47 patients underwent a course of laser hemotherapy while being given medicamentous therapy, the remaining 26 received nitrates, calcium antagonists and analgesics. Employment of laser light irradiation was associated with more satisfactory clinical effect than that in patients who had not had the procedure. It has also been established that intracardiac laser light irradiation of blood makes for the improvement of the characteristics of the intracardiac haemodynamics by diminishing the volumes and augmenting the left ventricular (LV) ejection fraction. Beneficial effect of laser hemotherapy on the intracardiac haemodynamics characteristics results from the stabilizing influence the method exerts on LV regional contractility and appear to be associated with its anti-ischemic effect.

[The prediction of the probability of the development of a myocardial infarct in patients with unstable angina]. / Prognozirovanie veroiatnosti razvitiia infarkta miokarda u bol'nykh s nestabil'noi stenokardiei.

Coronary reserve and functional state of myocardium were studied in 27 patients with unstable angina and myocardial infarction which had developed in spite of the treatment. Non-invasive study included stress-tests (transesophageal electrocardiostimulation, bicycle ergometry [correction of veloergometry)], echocardiography and Holter's monitoring. Possibility of early forming of risk group with consequent optimization of the treatment was shown.

[The complex assessment of myocardial electrical instability in exacerbated ischemic heart disease]. / Kompleksnaia otsenka élektricheskoi nestabil'nosti miokarda pri obostrenii ishemicheskoi bolezni serdtsa.

Risk of sudden coronary death in patients with unstable stenocardia is studied insufficiently. 39 patients with unstable stenocardia underwent Holter's monitoring, loading tests and invasive programmed ventricular stimulation coming lately into increasingly wide use for assessment of myocardial electric stability. Programmed stimulation allowed to single out two groups of patients: with ventricular tachycardia (56.4%) and without it (43.6%). Results obtained by aforementioned methods showed no correlation which is explained by the authors as being due to different pathogenetical mechanisms initiating ventricular arrhythmias. Thus, for example, rhythm disorders emerged not infrequently in the periods of ischemia during Holter's monitoring while myocardial ischemia was not observed in all cases of programmed ventricular stimulation. That is why complex approach needs to be pursued for assessment of electric stability of myocardium in patients with advancing stenocardia.

[The effect of ultraviolet-irradiated blood on the factors determining an unfavorable prognosis in patients with progressive stenocardia]. / Vliianie obluchennoi ul'trafioletovymi luchami krovi na faktory, opredeliaiushchie neblagopriiatnyi prognoz u bol'nykh s progressiruiushchei stenokardiei.

Effect of autohemotransfusions of ultraviolet-irradiated blood (UVIB) on ventricular arrhythmias and electric stability of myocardium were studied in 85 patients with advancing stenocardia. Bicycle ergometry [correction of Veloergometry], Holter's monitoring and invasive programmed cardiostimulation were used. Results of examination carried out before and after the treatment suggest anti-ischemic effect of PVIB and beneficial influence electrophysiological properties of myocardium which manifested in reduced periods of ventricular tachycardia and onsets of twin extrasystoles.

[The clinical morphofunctional determinants of restabilization in the course of acute forms of ischemic heart disease: approaches to the procedure for managing patients with unstable stenocardia]. / Klinicheskie i morfofunktsional'nye determinanty restabilizatsii techeniia ostrykh form ishemicheskoi bolezni serdtsa: podkhody k taktike vedeniia bol'nykh s nestabil'noi stenokardiei.

There has been no concept of the ways of stabilizing the status in patients with unstable angina and preventing further coronary heart disease progression. The application of stress tests suggests that consequent use of transesophageal cardiac pacing and bicycle exercise makes it possible to work out an appropriate regime of graded exercise, to objectivize the patients' status to noninvasively evaluate the coronary reserve, to indirectly define the number of diseased vessels and their topology, and to evaluate the efficiency of therapy. To supplement stress echocardiography to examination techniques is of interest in studying left ventricular performance and segmental contractility. Based on their own studies, by using long-term monitoring of the status in terms of clinical features, dynamics of coronary reserve and myocardial function, changes in the blood lipid spectrum, immune link, the morphofunctional properties of platelets, neurohumoral factors, the authors propose a classification of unstable angina. The detected clinical and morphofunctional determinants of restabilization allow one to optimize a long-term management of patients with unstable angina, to identify groups at various risk and to improve the patients lifestyle in adequate drug correction.