[Emission tomography in the diagnosis of ischemic heart disease]. / Emissionnaia tomografiia v diagnostike ishemicheskoi bolezni serdtsa.

Myocardial perfusion scintigraphy was made at rest and during bicycle ergometer exercise to diagnose coronary heart disease (CHD), to define the site and extent of left ventricular aneurysms, and to determine the compensatory potentialities of coronary circulation, to evaluate the efficiency of drug therapy. This was performed on a two-detector emission tomograph by using 99mTc. The data obtained were processed by two protocols: 1) tomographic heart specimens and 2) large protruding eye. In patients with a questionable diagnosis, the method evidenced stenotic coronary arteries in 60% of cases and exclude coronary abnormality. In CHD patients, exercise testing could reveal the extent of resting perfusion defects and new defects, i.e. define the reserve potentialities of coronary circulation, which is of great prognostic value. The site and extent of lesions were specified in extensive myocardial cicatricial lesions and left ventricular aneurysms.

[Effectiveness of propranolol in an acute test and a course of treatment in patients with stenocardia]. / Effektivnost' propranolola v ostroi probe i pri kursovom lechenii u bol'nykh stenokardiei.

A comparative study of antianginal propranolol efficacy in an acute test and 7 days after regular therapy in patients with a stable form of angina of effort has shown that the duration of beta-blockade and antianginal action of the drug increases during course therapy at individual doses in a 3-4-fold regimen of administration. Sharp reduction of a degree of the antianginal effect of propranolol was noted almost in 42% of the patients on regular therapy which could be accounted for by an increase in beta-blocker negative inotropic action. In the group of patients in whom propranolol antianginal efficacy was on a decrease during course therapy, not a single clinical or hemodynamic sign was defined permitting the prediction of a reduced effect of propranolol during course therapy.

[Effect of beta-adrenoreceptor blockade on gas exchange in patients with angina pectoris during physical load]. / Vliianie blokady beta-adrenoretseptorov na gazoobmen u bol'nykh so stenokardiei pri fizicheskoi nagruzke.

Changes in ventilation, gas exchange and hemodynamic parameters were examined in 16 anginal patients, exposed to stepwise stress in the presence of beta-block. Physical stress of 30-60-90 W was associated with less pronounced hemodynamic response, as compared to a control bicycle-ergometric test, in anginal patients. Propranolol reduced ventilation, oxygen consumption and carbon dioxide expiration during a 30-60 W exercise. When stress was increased to 90 W following beta-block, oxygen consumption decreased further, while the increment of ventilation and the respiratory coefficient was more marked, as compared to the controls. The pattern of ventilation and gas exchange variation was dependent on the magnitude of stress and related to hemodynamic shifts due to the beta-block.

[Anaerobic threshold: its non-invasive evaluation and relation to exertion tolerance in patients with stenocardia]. / Anaérobnyi porog: neinvazivnoe opredelenie i sviaz' s tolerantnost'iu k nagruzke u bol'nykh so stenokardiei.

The study of changes in gas exchange, lactate and acid-base balance in 36 trained patients with angina pectoris on effort, functional class II and III during spiroergometry has demonstrated that: 1. Ventilation equivalent by oxygen is the most informative and reproducible gas exchange variable during identification of the anaerobic threshold. 2. Anaerobic threshold in patients with low exercise tolerance is reached earlier and at lower oxygen consumption (0.92 +/- 0.02 l/min) than in patients with average exercise tolerance (1.5 +/- 0.06 l/min). 3. In all the cases anaerobic metabolism activation was accompanied by the development of signs of subendocardial myocardial ischemia, which indicates that the basic cause of anaerobic threshold reduction in trained patients was deteriorated cardiac pump function during the onset of myocardial ischemia.

[Methodological aspects of using the exercise test during clinico-pharmacological trials of anti-angina preparations]. / Metodicheskie aspekty primeneniia proby s fizicheskoi nagruzkoi pri kliniko-farmakologicheskom izuchenii antianginal'nykh preparatov.

Studies of physical stress tolerance in 37 patients with angina of effort subjected to repeated bicycle ergometry demonstrated a systematic increment in physical stress tolerance that included an adaptation stage (first 2 or 3 exercise sessions) and a slow-training stage that followed. The adaptation stage was characterized by a significant increase in the duration of the effort and the output. The training stage was represented by a moderate tolerance increment that never exceeded the range of accidental tolerance variation from one exercise period to another. It is suggested that the results of exercise tests conducted before adaptation is achieved cannot be used as control values in pharmacologic studies of anti-anginal effects, while the practicability of taking into consideration the training factor should be examined in each individual case.

[Duration of the hemodynamic effect of various doses of delayed-action nitroglycerin preparations]. / Prodolzhitel'nost' gemodinamicheskogo éffekta preparatov nitroglitserina prolongirovannogo deistviia v razlichnykh dozakh.

In 113 patients with coronary disease finger rheoplethysmography was used to study the duration of the hemodynamic effect of nitroglycerin drugs of prolonged action (NDPA) as compared to placebo. Nitrong and sustac in doses of 2.5 and 2.6 mg, respectively, were effective 1 1/2 and 2 h, on the average; in doses of 6.5 and 6.4 mg--4 1/2 and 3 1/2 h, and in doses of 13 and 12.8 mg--5 1/2 and 4 1/2 h, respectively. The duration of the effect of NDPA and nitroglycerin (0.5 mg) given sublingually varied greatly in some patients from entire absence of any effect to rather prolonged action. The duration of NDPA and nitroglycerin (0.5 mg) action closely correlated, which enables prognosing the hemodynamic effect of NDPA.

[Calcium antagonists in stress angina pectoris (pharmacodynamic study)]. / Antagonisty kal'tsiia pri stenokardii napriazheniia (farmakodinamicheskoe issledovanie).

In 10 patients with stress stenocardia pharmacodynamics of Isoptin was studied with the aid of identical physical loads on the treadmill repeated with an hour's interval for 5-6 hours. A clearcut antianginal effect was recorded which consisted in the reduction of ST segment depression and of the pain syndrome for 5 hours after administration of 3 tablets over 5 hours and for 6 hrs 20 min after administration of 5 tablets of both drugs. The degree of effect increased considerably after the dose of isoptin was enhanced and was not changed after the dose of corinfar was enhanced. Difference in the haemodynamic effect of the drugs was found in their effect on the cardiac rate. Corinfar increased the cardiac rate, isoptin decreased it.

[Sustak pharmacodynamics in effort stenocardia]. / Farmakodinamika sustaka u bol'nykh so stenokardiei napriazheniia.

Sustak pharmacodynamics was studied in 32 patients with stable angina pectoris of effort during acute tests with dosaged physical exercises repeated a tone-hour intervals. The results were compared with those in placebo. It is shown that the duration and pronounced character of the antianginal sustak effect varies widely in different patients. The maximum effect of the drug in a dose of 6.4 mg was encountered one hour after medication and was characterized by reduced depression of the ST segment by 54% during physical exercise and alleviation of the pain syndrome. The drug caused a statistically significant reduction of arterial pressure, an increase in the pulse rate at rest and a decrease of this value during exercise. The antianginal effect of sustak was particularly manifest in patients with low tolerance of physical exertion and in patients in whom the attack of angina pectoris was attended by marked dyspnea.

[Pharmacodynamics of nitroglycerin for sublingual medication in ischemic heart disease]. / Farmakodinamika nitroglitserina dlia sublingval'nogo priema u bol'nykh ishemicheskoi bolezn'iu serdtsa.

The hemodynamic effect of sublingual nitroglycerin (0.5 mg) was studied in 113 patients with ischemic heart disease by means of tetrapolar finger rheoplethysmography and impedance-cardiography. A decrease in systemic arterial pressure, stroke and minute cardiac indices and ejection period, and increase in the rate of cardiac rhythm were found. In 8% of cases there was a negative reaction to nitroglycerin manifested by a marked drop in arterial pressure and increase in the rate of cardiac contractions. In 40% of patients a negative "after--effect" was recorded following cessation of the direct effect of nitroglycerin. The most informative index of the effect of nitroglycerin was its peripheral activity. According to the duration of the hemodynamic effect of a standard nitroglycerin dose, three groups of patients are distinguished.

[Comparative pharmacodynamics study of korinfar and isoptin in ischemic heart disease]. / Sravnitel'noe farmakodinamicheskoe izuchenie korinfara i izoptina u bol'nykh ishemicheskoi bolezn'iu serdtsa.

The effect of Korinfar (30 and 50 mg) and isoptin (120 and 200 mg) on exercise tolerance was studied in 11 patients with angina pectoris of effort using the double blind crossover method. Both doses of Korinfar and 120 mg of isoptin increased cardiac output by 70--80% and 200 mg of isoptin--by 136%. Korinfar had a pronounced growth hypotensive effect and induced tachycardia, which is an increased dose hindered growth of exercise tolerance. The negative chronotropic effect of isoptin increased its efficacy. As a result of calcium antagonists action a stable threshold double product was established, and its was higher, than the control one.

[Pharmacodynamic study of nitroglycerin preparations by methods of tetrapolar rheoplethysmography of the finger and impedance cardiography in ischemic heart disease]. / Izuchenie farmakodinamiki preparatov nitroglitserina metodami tetrapoliarnoi reopletizmografii pal'tsa i impedans-kardiografii u bol'nykh ishemicheskoi bolezn'iu serdtsa.

A method of tetrapolar impedance plethysmography of the finger (TIPF) is suggested for the evaluation of the peripheral hemodynamic effect of drugs containing nitroglycerin. The method is based on the changes in the beta wave amplitude in TIPF as compared to the initial level. The central hemodynamics was studied by means of impedance cardiography (by the cardiac index) simultaneously with TIPF. The results are presented of the comparative pharmacodynamics of 6.4 mg sustac and 6.5 mg nitrong. The hemodynamic effect of sustac was higher that that of nitrong but its duration was 1--1 1/2 h shorter. Extreme variants have been demonstrated of the individual sensitivity of patients to the long-acting nitroglycerin agents.