Impact of exercise on alimentary hyperlipoproteinemia in patients with ischemic heart disease]

The impact of graded exercises of various intensity and duration on serum lipoprotein values was examined in 20 patients with coronary heart disease (CHD) and 10 healthy individuals after a single dietary fat load (FL). FL resulted in hypertriglyceridemia which was accompanied by elevated apo-AI levels and reduced apo-B/apo-AI ratio in the healthy persons, whereas it was accompanied by lower apo-AI levels and increased apo-B/apo-AI ratio in the patients. The short-term maximum exercise in the presence of FL caused negative shifts in the lipid transport system both in the healthy persons and the patients, by elevating the level of apo-B-containing lipoproteins. Yet, the healthy individuals showed a further increase in apo-AI concentrations. The long-term exercise in the training mode corrected changes in lipid values, which had been induced by FL in the two groups of the examinees. There was a decrease in the levels of triglycerides, low density lipoprotein, cholesterol and an increase in the level of high density lipoprotein cholesterol.     

Trimetazidine in correction of chronic heart failure in patients with ischemic heart disease

Twenty patients with NYHA class II-IV heart failure and ejection fraction below 40% received standard therapy (control period) or standard therapy plus open trimetazidine (20 mg t.i.d.) for 3 months in a cross-over design. Therapy with trimetazidine was associated with attenuation of clinical signs of heart failure (average NYHA class 2.90-/+0.10, 2.27-/+0.20 and 2.88-/+0.13, p<0.05, at baseline, after trimetazidine and control period, respectively), improvement of results of 6-minute walk test (average distance 321-/+19, 375-/+20 m, p<0.02, and 303-/+17 m at baseline, after trimetazidine and control period, respectively), increase of left ventricular ejection fraction (from 34.1-/+2.0 to 38.1-/+1.8%, p<0.05) and improvement of quality of life. Thus in patients with heart failure addition of trimetazidine to standard therapy for 3 months produced positive effect on clinical and hemodynamic status, exercise tolerance and quality of life.     

Blood viscosity in ischemic heart disease with different types of hyperlipoproteinemia]

Fifty patients with chronic forms of ischaemic heart disease were examined, their blood viscosity being determined with the aid of a rotational viscosimeter, and their hematocrit and fibrinogen levels being measured. Some increase in blood viscosity was found in patients with ischaemic heart disease with a tension shift of 0.7 and 0.5 dyn/cm2. In analysing the interrelationship between the blood viscosity figures and the risk factors inherent in ischaemic heart disease it was found that smoking results in an increasing blood viscosity with low tension shifts. The highest blood viscosity with low tension shifts. The highest blood viscosity values were found in patients with IIb and IV types of hyperlipoproteinemia. A direct correlation was established between the level of triglycerides and blood viscosity with a tension shift of 0.7 dyn/cm2.     

瓣膜性心脏病伴缺血性心脏病的外科治疗

目的 :总结瓣膜性心脏病伴缺血性心脏病手术治疗的早期效果和经验 ,以期提高疗效。方法 :11例患者中 ,行主动脉瓣置换术 4例 ,二尖瓣置换术 2例 ,二尖瓣和主动脉瓣双瓣置换术 1例 ,主动脉带瓣管道置换 2例 ,二尖瓣成形术 1例和三尖瓣成形术 1例 ;搭 1支桥 4例 ,搭 2支桥 1例 ,3支桥 3例 ,4支桥 3例 ,平均 (2 .5±1.3)支。结果 :11例无手术早期死亡 ,痊愈出院 ;随访 2～ 16 (平均 6 .3)个月 ,心绞痛症状消失 ,心功能明显改善。结论 :对年龄 >5 0岁瓣膜病患者或具有冠心病高危因素患者 ,应行冠状动脉造影检查 ;彻底纠正心脏病变 ,加强心肌保护 ;妥善处理术后并发症 ,手术疗效满意     

Circulation time of 125I-labeled fibrinogen in patients with ischemic heart disease with different types of hyperlipoproteinemia]

In 31 patients with ischaemic heart disease and different types of hyperlipoproteinemia the Takeda method was used for determining the duration of 125I-labelled fibrinogen circulation. The half-life period of labelled fibrinogen was found to be twice shorter in the patients than in the normal individuals. Two types of curves of plasma radioactivity reduction were distinguished in patients with ischaemic heart disease. The briefest circulataion period of the labelled fibrinogen was found in patients with type II hyperlioproteinemia. In patients with ischaemic heart disease and normal blood lipids content the period of circulation of the labelled fibrinogen comprised 2.07 +/- 0.27 days and was higher than in those with hyperlipoproteinemia.     

Pharmacologic correction of microcirculatory disorders and hemosorption in the treatment of patients with ischemic heart disease

Patterns of red blood cell hemostasis and microcirculation changes are analysed in 115 chronic coronary patients in the course of purposeful medication and at extracorporeal carbohemoperfusion. Differences in the mechanisms of action of trental, phosphaden and essentiale are identified by means of television capillaroscopy, termography, scanning electron microscopy; the mechanism of the antianginal effect of extracorporeal carbohemoperfusion is specified. A considerable disaggregating effect associated with trental and phosphaden, as well as an essentiale-associated improvement in red blood cell morphology and membrane permeability were demonstrated. Extracorporeal carbohemoperfusion is followed by an improvement of red blood cell hemostasis and microcirculation characteristics and a decrease in plasma lipoproteins.     

Antidepressant therapy in patients with ischemic heart disease

Depressive disorders are common in patients with ischemic heart disease and have serious consequences in terms of the risk of further cardiac events and cardiac mortality. Among survivors of acute myocardial infarction, up to one fifth meet diagnostic criteria for major depression, and the presence of major depression carries a >5-fold increased risk for cardiac mortality within 6 months. This article reviews clinical trial data on the cardiac safety profiles of antidepressant agents with the aim of discussing clinical considerations in selecting the most appropriate treatment of comorbid depression in patients with ischemic heart disease. Tricyclic antidepressants are effective against depression but are associated with cardiovascular side effects including orthostatic hypotension, slowed cardiac conduction, antiarrhythmic activity, and increased heart rate. Selective serotonin reuptake inhibitors, by contrast, have benign cardiovascular profiles and are well tolerated in patients with cardiac disease. The safety of dual-acting serotonin and noradrenaline reuptake inhibitors has not been well studied. Intervention with a selective serotonin reuptake inhibitors has the potential to provide the depressed patient with ischemic heart disease relief from their depressive symptoms and may offer a potential improvement in their cardiovascular risk profile.     

Blood lipophages in patients with ischemic heart disease

Ninety three individuals were examined and divided into 3 groups: (1) patients with coronary heart disease in the presence of angiographically documented coronary atherosclerosis; (2) those with non-specific aortoarteritis; and (3) subjects without signs of cardiovascular disease. Blood levels of lipid-saturated mononuclear cells were measured by flow cytofluorimetry. The patients (42 (90%) patients of 46) of the first group were found to have higher blood lipophages than those of the other groups, no correlation being established between the plasma content of total cholesterol, high density lipoprotein cholesterol and triglycerides.     

Surgical treatment of patients with ischemic heart disease associated with the lesions of the brachiocephalic arteries

Experience with the detection and surgical treatment of combined lesions of brachiocephalic arteries in coronary patients is reported. Noninvasive screening of 500 coronary patients detected brachiocephalic arterial lesions with transitory ischemic attacks or without cerebral ischemic symptoms in 82 patients. Simultaneous reconstructions are recommended for severe lesions of the main cerebral vessels and coronary arteries, and two-step operations, with cerebral flow recovery as the priority, for cases of mild clinical anginal manifestations. Forty-one operations were performed, 18 of them being simultaneous. One (2.4%) patient died. Cerebral and coronary symptoms were largely improved in discharged patients.     

Noninvasive assessment of patients with ischemic heart disease

The diagnosis of acute myocardial infarction can be strengthened in selected patients by the use of pyrophosphate scanning. Such scans may provide useful information about the relative size of myocardial infarction. Radionuclide angiography and two-dimensional echocardiography are useful for determining the extent of myocardial dysfunction following infarction. Two-dimensional echocardiography is especially suitable for use in the acute care setting and can provide excellent anatomic images to help diagnose the mechanical complications of infarction, such as mural thrombus formation and ventricular septal rupture. Therefore, many investigators believe that two-dimensional echocardiography is indicated for evaluating every myocardial infarction patient.The predischarge assessment of the postinfarction patient is critical for planning a rational rehabilitation program. Uncomplicated patients should have low level treadmill exercise tests to detect unsuspected problems which indicate a poor prognosis, such as angina pectoris. Continuous ambulatory electrocardiogram recordings are useful for excluding prognostically important, but asymptomatic, dysrhythmias. Two-dimensional echocardiography and radionuclide angiography also are helpful for assessing the extent of myocardial dysfunction and defining left ventricular aneurysms and mural thrombi.     

Physical training of patients with ischemic heart disease

In a coronary club, physical trainings (30-60 lessons) by using bicycle ergometry were performed in 242 patients with various types of coronary heart disease, two thirds having a history of myocardial infarction. In 58% of the patients, the interval between the onset of myocardial infarction and the initiation of the trainings ranged 1 to 3 months. The trainings were found to be beneficial in 99.4% of the patients who had sustained myocardial infarction. After 30 training lessons, the threshold exercise capacity showed a 36.3% increase. Beneficial trainings depended on the number of trainings and, to a lesser degree, on patients' age. The trainings were followed by favorable changes in plasma lipid levels and hemorheology.     

Immunogenetic characteristics of patients with ischemic heart disease

The distribution of the principal erythrocyte and HLA-antigens was investigated in 202 males aged 20-50 years with a history of myocardial infarction and various courses of coronary heart disease. The occurrence of one or the other group of antigens differed both as compared with a group of healthy subjects (619 subjects) and in relation to the anamnestic and clinical characteristics of the disease course. The findings helped to draw a conclusion as to the presence of associative links between a number of the studied antigens (A (II), MN, HLA-B7, HLA-B14, HLA-B15, HLA-CW4) and the risk of the development of, at least, some forms of coronary heart disease.