Treatment of coronary insufficiency in diabetics. Part 3: chronic coronary insufficiency

The drug treatment of chronic coronary insufficiency in diabetic patients is now well defined. Platelet antiaggregants, especially aspirin, must be prescribed in the long-term or even indefinitely. Other drugs (beta-blockers, calcium channel blockers, nitrates, etc.) can be used in the same way as in the absence of diabetes. Angioplasty gives immediate favourable results in diabetics, very similar to those obtained in the absence of diabetes. In contrast, the longer term prognosis is less favourable, as the mortability, myocardial infarction, restenosis and bypass graft rates are significantly higher. First-line stenting lowers the restenosis rate to a level comparable to that observed in non-diabetics. However, instrumental revascularization is less complete than surgical revascularization and the number of redilatations and/or secondary bypass grafts remains high. The indications, mortality and early complications of coronary surgery are now identical to those observed in the absence of diabetes. Its long-term results are significantly more favourable than those of medical treatment or even angioplasty, although this issue is still controversial. The improved prognosis observed in operated diabetic coronary patients is due to the more frequent use of arterial bypass grafts. The maintenance of blood glucose control and correction of the frequently associated cardiovascular risk factors (obesity, sedentary lifestyle, smoking, HT, dyslipidaemia) increase the efficacy of treatment of coronary insufficiency in diabetic patients. This goal can only be achieved by permanent, unfailing collaboration between cardiologists and diabetologists.     

Spectrum analysis of heart sounds in chronic coronary insufficiency

Major heart tone amplitude-frequency characteristics were studied in relation to central hemodynamics and physical stress tolerance in 147 chronic coronary patients. A method of spectrogram assessment is proposed that includes the measurement of spectrum width, resonance frequency and the Q-factor. Amplitude-frequency studies demonstrated limited left-ventricular vibration capacity with reduced myocardial contractility and increased myocardial weight. The results of bicycle ergometry were correlated with heart tone spectrum data. A relationship was demonstrated between changes in major parameters of tone 1 and the double product, threshold capacity for exercise and the output.     

Treatment of chronic coronary insufficiency with Irrigor]

The results of treatment of 103 patients suffering from ischemic heart disease with irrigor for 7--25 days are discussed. The drug was given in a daily dose of 30 to 150 mg in tablets, intramuscularly, and intravenously. Ergometry, study of the values of central hemodynamics and lipid metabolism, and recording of the rheoencephalo-, rheovaso-, and electroencephalogram were conducted before and after the treatment. The efficacy of irrigor was appraised in treatment applied in courses, in a single intravenous infusion, and under conditions of the double blind method. A relatively stable clinical effect was noted on the 9th--12th day. A good effect was produced in 49.3% of patients. The efficacy of irrigor was the highest in patients with grade I and II chronic coronary insufficiency, with no history of circulatory insufficiency or myocardial infarction, and in intramuscular and intravenous administration. Treatment with irrigor improved the indices of central hemodynamics and cerebral and peripheral blood flow. No side effects of the treatment were noted. The study showed irrigor to be an effective agent in the treatment of ischemic heart disease.     

Cordaron and nonachlasine in treatment of chronic coronary insufficiency]

In a double blind study of the clinical effect of Cordaron conducted in 55 patients with chronic ischaemic heart disease a positive effect was obtained in 80.4% of the cases, an effect of placebo-in 24.3%. Cordaron was especially effective in patients with localized stenoses of the coronary arteries. Nonachlasine (an activator of the cardiac beta-adrenergic receptors) proved effective in 10 of 13 patients with chronic ischaemic heart disease.     

Contractile activity of the myocardium in chronic coronary insufficiency]

Cardio- and hemodynamics was investigated in 69 patients with chronic coronary insufficiency without manifestations of cardiac decompensation and with symptoms of congestive incompetence of the heart by using radiocardiography and analyzing systolic phases of the left ventricle. Furthermore, fractional composition of myocardial proteins and the ATP-ase myosin activity were studied in 31 persons, who during their life-time suffered from ischemic heart disease. In patients presenting no symptoms of cardiac insufficiency significant changes in cardio- and hemodynamics along with a reduced content of the actomyosin complex proteins and their disturbed ATP-ase activity were uncovered. These changes proved more intensive in the face of manifestations indicating cardiac decompensation. Thus, a complex investigation of cardio- and hemodynamics enabled it to disclose initial disorders in the contractile activity of the myocardium in patients with chronic coronary insufficiency, when such disturbances are associated both with deranged utilization and with defective accumulation of energy in the myocardium.     

Use of gutimine for treatment of chronic coronary insufficiency]

The therapeutic effect of an antihypoxic drug--Gutimine--was studied in 30 patients with chronic coronary insufficiency. The effect of gutimine on the adaptation for physical exercises connected with motor hypoxy in 5 normal individuals was used as control. The treatment with Gutimine resulted in a clear subjective improvement (less frequent and less intense anginal attacks) in 2/3 of the patients with chronic coronary insufficiency. Objective signs of improvement (positive ECG shifts, phases of the left ventricular systole and hemodynamics; increased tolerance of physical exercises) after Gutimine therapy were noted only in 4 patients who had a comparatively mild course of their disease and less distinct sclerotic changes in the myocardium. When Gutimine was used in normals, significant improvement of their capacity for work was noted, as well as an improvement of their cardiovascular functions and gas exchange parameters during "extreme" exercises. The positive effect of Gutimine was more distinct after 1-2 weeks of its administration. Side effects were absent.