The factors determining the efficacy of the rehabilitative treatment of patients who have had a myocardial infarct]

Factors responsible for the efficacy of rehabilitative treatment of patients with a history of myocardial infarction were defined on the basis of the 2-year follow-up of 235 patients who suffered myocardial infarction, bicycle ergometry data, studies into intracardiac hemodynamics, oxygen supply in exercise tests, and criteria for the significance of the tetrachoric indicator with regard to the confidence limits. In patients who suffered uncomplicated myocardial infarction, prediction of the decreased work fitness in the long-term period is determined by the presence of angina pectoris and arterial hypertension. It has been established that whether will be lowered in future can be judged from the changes seen in the magnitude of the liminal power and the end diastolic volume of the left ventricle during the first 6 months following myocardial infarction.     

Fibrinogen and fibrin degradation products in the blood of acute myocardial infarct patients at the hospital rehabilitation stage

An enzyme immunoassay was used for a study of the time course of the content of fibrinogen degradation products (FDP) and free hemoglobin (fHg) in the blood of patients with acute myocardial infarction (AMI) during uncomplicated hospital rehabilitation. A considerable increase in the levels of FDP in the blood serum and fHg in the blood plasma of the AMI patients were noted. These levels were particularly high on the 6-12th day of rehabilitation with further fluctuations on the 22-24th day from the beginning of disease resulting from an increase of the patients' motor activity during rehabilitation which might cause the depletion of endothelial reserves of fibrinolysis activators and an increase in thrombinemia, however changes in the content of FDP and fHg in the blood were more likely associated with DIC-syndrome inherent fluctuations in the system of hemostasis. The content of FDP and fHg in the blood of AMI patients was recommended to be used as a marker of DIC-syndrome and assessment of corrective therapy.     

The information value of diagnosing myocardial infarct by blood density at the prehospital stage]

Basing on the clinical evidence, a comparative study was made of a diagnostic significance of ECG, biochemical findings and blood density in myocardial infarction. Unlike the former two criteria, changes in blood density allowed the clinicians to detect irreversible lesions in the myocardium. The method has advantages in prehospital diagnosis of the infarction as its efficacy at the very onset of the disease is superior to that of ECG. In view of blood density diagnosis of myocardial infarction convenience for practical use, reproducibility, ability to provide information when routine modalities fail to determine the ischemic myocardial lesion, it can be introduced as an adjuvant diagnostic means for cardiologic and common emergency teams.     

The initial results of the sanatorium rehabilitation of patients having had an acute myocardial infarct in a mid-alpine climate

Short-term results of rehabilitation of 1046 CHD patients at a cardiological sanatorium in mountains at average altitude (1600 m above the sea level) were studied. Large focal myocardial infarction (MI) was found in 738 of them, small focal MI in 249, and acute focal myocardial dystrophy of ischemic genesis in 59. Of 1046 patients considerable improvement of the status after rehabilitation therapy at the sanatorium was noted in 27.6%, improvement in 64.5%, no changes in 6.1%, deterioration in 1.7%; one patient died. This type of therapy in a mountainous climate at average altitude yielded good immediate results in most of the patients (92.06%) with MI and could be recommended for rehabilitation of CHD patients at the 2nd stage of treatment at a sanatorium.     

Experience with the use of streptokinase in acute myocardial infarct at the prehospital stage]

The authors analyze the experience gained with the systemic thrombolytic therapy (STLT) at the prehospital stage of the treatment of acute myocardial infarction by specialized emergency cardiological teams. The screening of patients to be given STLT was performed via the remote diagnostic center. STLT was provided to 43 patients who were given intravenous injections of 500,000 PU streptokinase (Avalizin, GDR) for 15-30 minutes. The control group included 16 patients given standard therapy. After STLT 62.8% of the patients demonstrated moderate arterial hypotension, which could readily be corrected. Myocardial reperfusion after STLT manifested by rapid removal of the painful syndrome, characteristic dynamics of ECT, and by the appearance of specific reperfusion disorders of rhythm and conduction. The accelerated idioventricular rhythm, ventricular premature heart beat and A-V rhythm of the junction were recorded most frequently. The indicated rhythm disorders were removed readily enough. It is recommended that STLT may be carried out at the prehospital stage of AMI treatment by the cardiological emergency teams, which is likely to appreciably enhance the efficacy of the given therapy form.     

The treatment of acute myocardial infarct with perlinganit

As many as 43 patients with myocardial infarction were under observation. There were 30 men and 13 women aged 36 to 82 years. Of these, 26 patients had large-focal and 17 transmural myocardial infarction. Perlinganit was injected in the form of 0.1% solution by means of a drug-dosing apparatus (DDA-1). The drug infusion lasted 51.1 +/- 4.8 h on the average, the mean infusion rate was 74.5 +/- 3.4 micrograms/min. After 24 hours it was required that in 32 patients the mean infusion rate be increased 1.5-fold. The hemodynamics was assessed with the aid of tetrapolar chest rheography. Well-defined clinical and hemodynamic effects were revealed. In some patients, the clinical signs of left ventricular insufficiency could be eliminated. Contractile function of the left ventricle returns to normal within the first hours of disease. During perlinganit treatment, the antianginal and antiarrhythmic effects were recorded. The data obtained point to the fact that the use of perlinganit for the treatment of acute myocardial infarction is advisable.     

First-year results of a community peripheral vascular screening program at an academic community hospital.

Disease associated with the vascular system, including peripheral arterial disease, poses a serious health problem with incidence growing annually. Recognizing this, several health care organizations across the United States have developed programs for public education and community awareness, and for screening individuals at risk for vascular disease. Lehigh Valley Hospital developed and implemented a screening program that evaluated more than 160 individuals during a 12-month period. Results suggest that screening should be limited to patients at high risk; however, the intrinsic value of patient education and patient peace of mind is worth proceeding with the screening effort because patients reported a positive experience.     

两种康复程序在急性心肌梗死患者介入术后心脏康复中的应用效果观察

目的探讨10 d康复程序在急性心肌梗死（acute myocardial infarction,AMI）患者介入术后心脏康复中的应用效果。方法将80例AMI行介入手术后无并发症的患者随机分为观察组与对照组,每组各40例,对照组按照临床路径实施两周的心脏康复训练,观察组在对照组基础上优化路径实施10 d心脏康复训练。比较两组患者出院时左室射血分数（left ventricular ejection fraction,LVEF）、生活自理能力、心功能分级、并发症发生率、住院时间和住院费用情况。结果出院时观察组患者LVEF、生活自理能力、心功能分级明显优于对照组,两组比较,均P＜0.05,差异具有统计学意义;两组患者并发症发生率比较,均P＞0.05,差异无统计学意义;观察组患者住院时间明显短于对照组,住院费用明显少于对照组,两组比较,均P＜0.01,差异具有统计学意义。结论10 d心脏康复程序有利于患者心脏的康复,而且缩短住院时间和减少住院费用,值得临床推广应用。