[Hospital and prehospital mortality from acute myocardial infarct during 1982-1984]. / Bolnichen i dobolnichen letalitet ot ostur miokarden infarkt za perioda 1982-1984 g.

The hospital and pre-hospital lethality is discussed for the period 1982-1984 according to the materials of the Clinic of cardiology and the necropsy protocols of the chairs of forensic medicine and pathological anatomy. The role of the risk factors, age and sex for hospital lethality during all three years is given consideration. Hospital lethality was reduced during the last (1984), the relative share of the deceased of cardiogenic shock was decreased. Almost identically high level of pre-hospital lethality persisted during all three years, bringing up the problem of the effectiveness of the primary prophylaxis of ischemic heart disease and improved work at the level of regional and workshop physicians and emergency medical aid.

[Effect of korvatone on hemodynamics in the acute stage of myocardial infarct]. / Vliianie na korvatona vurkhu khemodinamikata v ostriia stadii na surdechniia infarkt.

The pressure in pulmonary and brachial arteries, cardiac output and the period of isovolumetric contraction of left ventricle were measured prior to and by 15, 30 and 60 min post 4 mg corvaton sublingual administration in 20 patients with acute cardiac infarction by the third day after the disease onset (12--with normal diastolic pressure in pulmonary artery--under 1.87 kPa (14 mm Hg)--group I and 8--with elevated pressure--group II). The mean pressure in brachial artery was established to decrease more pronouncedly in group I (from 12.24 +/- 1.79 kPa (91.8 +/- 13.4 mm Hg to 10.45 +/- 1.61 kPa/78.4 +/- 12.1 mm Hg)--p less than 0.002) than in group II (from 11.96 +/- 1.49 kPa (89.11.2 mm Hg) to 11.22 +/- 1.32 kPa (84.2 +/- 9.9 mm Hg)--p less than 0.10). Heart rate was slightly accelerated in group I (from 83.6 +/- 6.21. min1 to 89.8 +/- 20.8.min-1--p less than 0.05) and in group II--an initial tendency to slow down (from 80.7 +/- 20.0.min-1 to 76.7 +/- 20.7.min61 beats, every 15 min, p less than 0.025). The pressure in pulmonary artery was slightly decreased in group I (average pressure--from 1.93 +/- 0.28 kPa (14.5 +/- 2.1 mm Hg) to 1.64 +/- 0.37 kPa (12.3 +/- 2.8 mm Hg, p less than 0.01), the decrease in group II was more manifested [average--from 3.96 +/- 0.61 kPa (29.7 +/- 4.6 mm Hg) to 3.29 +/- 0.77 kPa (24.7 +/- 5.8 mm Hg)--p less than 0.002 and diastolic--from 2.80 +/- 0.53 kPa (21.0 +/- 4.0 mm Hg) to 2.45 +/- 0.69 kPa (18.4 +/- 5.2 mm Hg)--p less than 0.01]. Those changes were accompanied by manifested reduction of cardiac index (from 3.02 +/- 1.06 to 2.47 +/- 0.61 1/min/m2, p less than 0.025), stroke index (from 36.2 +/- 10.4 to 29.1 +/- 6.9 cm3/m2, p less than 0.01) and stroke working index (from 42.1 +/- 14.7 to 29.2 +/- 9.0 g.m/m2, p less than 0.001) in group I, whereas in group II those indices under went no substantial changes (cardiac index--from 1.96 +/- 0.62 to 1.89 +/- 0.53 l/min/m3, stroke index--from 27.6 +/- 9.7 to 27.6 +/- 9.8 cm3/m2 and stroke working index--from 25.3 +/- 10.8 to 24.1 +/- 9.6 g.m/m2, p less than 00,1). The systemic vascular resitence and delta P/delta T of the left ventricle did not change in both groups (p less than 0,01). The changes in the hemodynamics developed gradually and were best manifested by the 60 min, but 50 per cent of the maximum effect was realized as early as the 15th min. Corvaton, was concluded, by the authors, to be useful in the treatment of the originated stasis cardiac insufficiency in those patients.

[Echocardiographic diagnosis of congestive cardiomyopathy associated with mitral regurgitation]. / Ekhokardiografska diagnostika na kongestivna kardiomiopatiia, suchetana s mitralna regurgitatsiia.

Echocardiographic findings are comparatively analyzed in 25 patients with congestive cardiopathy, combined with mitral regurgitation, a control group of healthy and 10 patients with volume loaded left ventricle with rheumatic "pure" mitral insufficiency. Some discrepancies were established in the usual echocardiographic characteristics of congestive cardiomyopathy in the patients with CCMP, combined with significant mitral insufficiency: normal, even increased amplitude of movement of the interventricular septum in the absence of systolic increase of the septal thickness. The differentiation between the rheumatic mitral insufficiency and mitral insufficiency in case of congestive myocardiopathy is difficult, due to the considerable differences in the functional Echo-C characteristics of left ventricle and morphological characteristic features in mitral echogram.

[Bicuspid aortic valve. Echocardiographic diagnostic potentials]. / Bikuspidna aortna klapa. Ekhokariografski diagnostichni vuzmozhnosti.

The echocardiographic potentialities in the diagnosis of bicuspid aortic valve are discussed. In the group of 32 patients examined with a clinic and murmurs suspected for that disease, the index of excentricity in five patients, was found to be respectively 1.6, 1.4, 1.6, 1.8, 1.5, accepted as a reliable index for the diagnosis of aortic bicuspidia. Excentricity index is equal to 1/2 of the aortic diameter, divided to the minimal distance from the diastolic echo of the closed aortic valve to the closer aortic wall. The control group consisted of 44 patients with tricuspid aortic valve, 17 of them being with aortic defect (isolated stenosis or combined aortic defect) and the rest 28 -- without valvular heart disease. Excentricity index for the control group was low -- 1.0--1.33 (average value 1.28). Conclusions are drawn that the echocardiographic method, from the group of the bloodless methods, is with the best diagnostic potentialities in the bicuspid valve and should be looked for in patients with expulsion murmur and click of aortic origin.