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.     

Plasma lipoprotein levels and functional status of thrombocytes in patients with ischemic heart disease during treatment with essential phospholipids

Variations in platelet aggregation activity before and after the control of lipid metabolism with lecithin linoleate (essential preparation, 1800 mg EPL daily) were examined in coronary patients with pronounced hyperlipidemia. A considerable change was noted in the ratios of LP fractions, that is, rising HDLP in the presence of decreasing total plasma lipids, Changes in plasma lipid composition were accompanied with a reduction of platelet aggregation activity that persisted for 3 months following the discontinuation of the drug. Correlation and regression analyses of relationships between platelet aggregation and HDLP levels were carried out.     

Changes in plasma lipid and apoprotein levels in patients with ischemic heart disease after hemosorption]

All the patients who had undergone a course of non-specific hemosorption (HS) for clinical indications showed lower plasma lipid levels and largely lower triglyceride concentrations. The patients with hypercholesterolemia alone simultaneously displayed decreased levels of cholesterol, high density lipoproteins, and apoprotein A-I. Apoprotein B levels reduced in patients having normal lipid values and in those with isolated hypercholesterolemia. The changes in the levels of lipids and apoproteins were different for 2 weeks after hemosorption in relation to the baseline lipid spectrum. The patients with coronary heart disease with hyperlipidemias had positive trends in lipid spectral changes: the parameters of atherogenic classes of lipids tended to decrease, whereas those of antiatherogenic lipid classes tended to show a slight increase. There was a negative direction in the dynamics of the studied parameters in renal patients, in those who had normal baseline lipid values, and in those with isolated hypo-alpha-cholesterolemia, i. e. higher plasma cholesterol and triglyceride, low density lipoprotein cholesterol and apoprotein B levels.     

Use of the antioxidant ubinon in the complex treatment of patients with ischemic heart disease

A new Soviet antioxidant drug, ubinon, has been used in 75 patients with coronary heart disease (CHD) of functional classes I-III, including 12 patients with ventricular extrasystoles. Treatment with placebo in 10 patients produced no improvement and had no effect on their stress tolerance. Ubinon, taken as 90 and 135 mg/day doses, was shown to produce clinical improvement and raise stress tolerance, mostly in first- and second-class cases. In coronary patients with ventricular extrasystoles, ubinon enhanced antiarrhythmic effect of mexitil. The use of ubinon was accompanied by a drop in blood oxidant activity and a rise in antioxidant activity, an increase in blood 6-keto-PGF1 alpha, a fall in TxB2 and a suppression of platelet activity. In addition, coronary patients with ventricular extrasystoles showed reduced cAMP and cGMP content and elevated cAMP/cGMP ratio.     

Possibilities of hemosorption in the compensation of cardiac dysfunction in patients with ischemic heart disease associated with diabetes mellitus

A total of 36 patients with unstable angina and type II diabetes mellitus were studied in the dynamic. All the patients underwent extracorporeal hemocarboperfusion. Marked improvement in the inotropic function of the myocardium was noted with the increase in the rate of relaxation and contraction of the posterior wall of the myocardium. A decrease in the pressure in the lesser circulation and specific peripheral resistance were registered. Using radiometry technique a corresponding decrease in the volume of extravascular fluid in the lungs was observed.     

Effect of essential phospholipids on the lipid spectrum of blood plasma and the aggregative capacity of thrombocytes in patients with ischemic heart disease

A study of the effect of essentiale-forte in myocardial infarction patients demonstrated favorable shifts in plasma lipid spectrum and ADF-induced platelet aggregation.     

Nebivolol in the treatment of ischemic heart disease patients with chronic heart failure

AIM: To assess effectiveness of inclusion of nebivolol in complex therapy of patients with chronic heart failure (CHF) due to ischemic heart disease (IHD). MATERIAL: Patients (n=62, age 47-73 years) with NYHA class II-III CHF and left ventricular (LV) ejection fraction (EF) less than 45% receiving standard therapy +/- nebivolol (5 mg/day). The patients were followed up for 4 months. RESULTS: After 4 months improvement of clinical state, exercise tolerance, parameters of central hemodynamics and LV remodeling, lipid spectrum, rheological properties of blood and platelets haemostasis was more pronounced in a group of nebivolol treated patients. CONCLUSION: Inclusion of nebivolol in complex therapy increases efficacy of treatment of patients with CHF due to IHD.     

Changes in the levels and composition of lipoproteins and apolipoproteins of blood plasma in patients with ischemic heart disease after hemosorption

Prior to and following activated charcoal hemosorption, concentrations of lipids, apolipoproteins AI and B and lipid and protein composition in lipoprotein fractions isolated by ultracentrifugation were determined in the plasma from patients with coronary heart disease. The majority of the patients showed a parallel proportional decrease in plasma atherogenic parameters and all components of very low density lipoproteins and low density lipoproteins, triglycerides in particular. Antiatherogenic parameters, such as high density lipoprotein and apo-AI cholesterol, and all the components in high density lipoprotein subfractions were less reduced. In 19% of the patients, hemosorption failed to affect plasma lipids and apolipoproteins. The findings suggest that, in case of successful hemosorption, apoB-containing lipoproteins are chiefly eliminated as whole complexes from the plasma and that this procedure is most beneficial in hypertriglyceridemia.     

Effect of vasodilator agents on the effectiveness of the complex treatment of patients with ischemic heart disease and congestive heart failure

A total of 153 coronary patients with congestive heart failure, stage IIA and IIB, were investigated. Thirty patients underwent a three-week course of treatment with cardiac glycosides, plus diuretics and potassium preparations where necessary. In addition to conventional treatment, 123 patients were treated with vasodilating agents (2% nitroglycerin ointment, nitrosorbide or molsidomin) with the doses adjusted individually on the basis of acute drug testing. Those patients with congestive heart failure who received combined treatment with cardiac glycosides and vasodilators demonstrated a more obvious improvement of clinical parameters and instrumental findings as compared to the patients, treated with cardiac glycosides alone.     

Characteristics of nicardipine treatment of patients with ischemic heart disease

The new calcium antagonist nicardipine (barizine) was tested for effects on platelet function and transient myocardial ischemia in 23 patients with coronary heart disease. Prior to the therapy, lower platelet function was more frequently encountered in patients with more severe angina pectoris and more prolonged myocardial ischemia. The efficacy of nicardipine was demonstrated to be related to the clinical course of coronary heart disease and the baseline platelet function. It is advisable to prescribe the drug to patients with Functional Class II stable angina and higher platelet functional activity.     

Prevention and treatment of ischemic heart disease in patients with diabetes mellitus

The incidence of cardiovascular diseases among diabetic patients is so high that diabetes mellitus is currently defined as a cardiovascular disease equivalent. Furthermore, diabetic patients who develop acute coronary syndromes have a poorer short-term and long-term prognosis, so primary and secondary preventive measures are critically important in this population subgroup.There is substantial evidence that pharmacological therapy for primary and secondary cardiovascular prevention is more effective in diabetic patients than in non-diabetics. This article reviews the evidence of the efficacy of pharmacological prevention therapies in diabetic patients in favor of an aggressive pharmacological preventive strategy. Every diabetic patient without known cardiovascular disease should be treated with angiotensin-converting enzyme inhibitors and statins. High-risk patients should also receive low-dose aspirin.Compared with non-diabetics, diabetic patients who develop acute coronary events benefit more from the addition of intensive antithrombotic therapy to aspirin treatment. Diabetic patients presenting with non-ST segment elevation syndromes have better outcomes when treated with clopidogrel or glycoprotein IIb/IIIa inhibitors, and diabetics presenting with ST-segment elevation or left bundle-branch block have a greater survival benefit when given thrombolytic therapy compared with non-diabetic patients.Unless formal contraindications are present, diabetic patients with ischemic heart disease, particularly those with previous myocardial infarction, should always be treated with aspirin, betablockers, angiotensin converting enzyme inhibitors, and statins, regardless of lipid levels, left ventricular systolic function or the presence of congestive heart failure.     

Use of prazosin and capoten in the treatment of heart failure in patients with ischemic heart disease

Eighty eight patients with ischemic heart disease were studied. There was a significant increase in pulmonary blood flow time (Tp), pulmonary blood volume (BVp). mean pulmonary pressure (MPP), and total pulmonary resistance (TPR). as regarded as initial signs of heart failure, in group 1 that comprised 35 patients out of 65 after a graded isometric loading test. After prazosin therapy, these patients showed a significant decrease in blood pressure, only moderate reduction in MPP and TPR, and a rise of the cardiac index (CI). There was a significant decrease in Tp, BVp, MPP, TPR during the loading test following the therapy. From group 2, 23 patients were treated with capoten. The monotherapy was beneficial in 9 patients, capoten was discontinued in 1 case; 13 patients received a combined therapy with glycosides and saluretics. In all the cases, a positive clinical and hemodynamic effect (lower blood pressure, total peripheral resistance, BVp, higher CI with virtually unchanged heart rate) was achieved.     

Hemosorption in the complex treatment of arteriosclerotic dyscirculatory encephalopathy associated with chronic ischemic heart disease

Hemosorption was included in combined treatment of 110 patients with atherosclerotic dyscirculatory encephalopathy combined with coronary heart disease. The effect was assessed on the basis of clinical improvement, psychological tests, blood lipid assays, compressed spectral EEG analysis and ultrasonic flowmetry of the carotid arteries. The effectiveness of hemosorption was demonstrated at all stages of the disease, with the regression of general cerebral and focal neurologic symptoms preceding clinical remission of coronary heart disease. Hemosorption was shown to have good effects on blood lipids, cerebral circulation and EEG spectrograms.