[Shifts in the heart left ventricle function in patients with pulmonary tuberculosis during adequate chemotherapy].

To investigate the hemodynamics and myocardic contraction of the heart left ventricle, 61 patients with pulmonary tuberculosis (main group) and 26 healthy subjects (control group) were observed. Higher ultimate systolic and diasystolic volumes of the left ventricle and lower levels of the efflux fraction in the patients with active pulmonary tuberculosis were stated. There was shown inverse correlation of the systemic systolic arterial pressure and the left ventricle efflux fraction with ESR, evident of the tuberculosis intoxication. The most pronounced aggravation of the left ventricle function was recorded in the patients with the most severe tuberculosis process. The impairments in the left ventricle in the patients with active pulmonary tuberculosis were of functional nature. Due to intensive therapy of the tuberculosis, the indices of the left ventricle efflux function improved and the systemic arterial pressure came to normal, along with elimination of the tuberculosis intoxication signs.

[Hemodynamic features in persons with posttuberculosis pulmonary changes].

The specific intravascular and central hemodynamic features were studied in 42 patients with pronounced posttuberculous changes in the lung in comparison to a group of healthy individuals without a history of tuberculosis. Along with clinical, functional, and electrocardiographic studies, the authors used echocardiography. End ventricular and atrial systolic and diastolic areas, end left ventricular systolic and diastolic volume, ejection fraction, stroke and cardiac indices were determined. Dilation of the right ventricle and right atrium and their increased specific contractility were ascertained in patients with pronounced posttuberculous changes. At the same time hypertrophy of the right ventricular wall was rarely observed. This gives grounds to regard dilatation of the right ventricle as an earlier sign of evolving chronic cor pulmonale that its hypertrophy. There were no changes in the left ventricle, left atrium, ejection fraction, stroke and cardiac indices, which was explained by the absence of intoxication and toxic infective action in the persons clinically recovered from tuberculosis.

[The prevalence and course of arterial hypertension in patients with pulmonary tuberculosis].

The specific features of essential arterial hypertension (AH) were studied in patients with active pulmonary tuberculosis (PT) and in those with residual changes (RC) after prior PT. The prevalence of AH was defined in patients with PT in relation to age, gender, and clinical form of a tuberculous process. The study indicated that the prevalence of AH among patients with an active tuberculous process was less than in the general population and it amounted to 18.2%. It was more common in males aged less than 60 years and in females aged above 60 years. The prevalence of AH in fibrocavernous tuberculosis was less than that in other forms, which was associated with the impact of intoxication on blood vessels. The patients with RC after prior PT had more frequently AH than those with an active tuberculous process, as well as target organ changes and a severer course of AH.

[The specific features of coronary heart disease in patients with pulmonary tuberculosis].

The prevalence and some specific features of coronary heart disease (CHD) were studied in patients with pulmonary tuberculosis. Its prevalence was determined in relation to age, gender, and the type of a tuberculous process. ECG changes in ST segment and T wave were found in patients with pulmonary tuberculosis without concomitant CHD under intoxication. The diagnosis of CHD was established in 41 of 491 patients, which was 8.4%. CHD was more common in elderly and senile females. The clinical manifestation of CHD was observed in females of older age than in males; under the age of 60 years, the prevalence of CHD is less among the patients with pulmonary tuberculosis and above the age of 60 years, it does not differ from that in the general population. CHD most commonly manifests clinical signs in patients with residual changes after experienced pulmonary tuberculosis and in cirrhotic tuberculosis, i.e. when the tuberculosis process is less active.

[Use of preductal in therapy of hemodynamic complications in patients with tuberculosis].

To treat hemodynamic disorders, preductal was used in combination with antibacterial therapy in 30 patients with disseminated destructive pulmonary tuberculosis for a month. A control group comprising 31 patients was in parallel observed. Clinical, electrocardiographic, and echocardiographic studies were performed to evaluate the efficacy of preductal. The drug was found to promote improvements in left ventricular function and central hemodynamics as a decrease in end-systolic volume and increases in ejection fraction and stroke and minute volumes. Preductal exerted no significant effect on right ventricular dysfunction associated with chronic cor pulmonale.

[Use of alpha-tocopherol acetate in the treatment of hemodynamic disorders in patients with pulmonary tuberculosis].

Examination of 101 patients with pulmonary tuberculosis established the impact of specific intoxication on central hemodynamics in 51 patients. Specific treatment was found to have a certain positive effect on impaired hemodynamics. However, there were no significant changes in patients with severe tuberculosis. Hemodynamics substantially improved when alpha-tocopherol acetate was supplemented to antibacterial therapy.

[Bacterial factors and decompensation of cor pulmonale in patients with pulmonary tuberculosis]. / Bakterial'nye faktory i dokompensatsiia legochnogo serdtsa u bol'nykh tuberkulezom legkikh.

Sputum from 88 patients with different forms of pulmonary tuberculosis complicated by chronic cor pulmonale (CCP) was tested for Mycobacterium tuberculosis (MBT) and nonspecific flora. The high occurrence of multidrug resistance of MBT and nonspecific causative agents are found in patients with signs of heart failure in the presence of decompensatory CCP in 20% of cases, the frequency of concomitant chronic bronchitis was 86%.

[Respiratory and renal functions and blood electrolytic composition in patients with pulmonary tuberculosis in the treatment of heart failure]. / Sostoianie funktsii dykhaniia, pochek i élektrolitnogo sostava krovi u bol'nykh tuberkulezom legkikh pri lechenii serdechnoi nedostatochnosti.

The authors studied respiratory and renal functions and blood electrolytic composition in 94 patients with pulmonary tuberculosis in the treatment of heart failure with angiotensin-converting enzyme inhibitors (ACEI) and an angiotensin II blocker (AIIB). At the same time they examined a control group of 24 patients untreated with ACEI and AIIB. All the patients received combined antituberculous therapy. Cardiac glycosides and diuctics were given in some cases. During 1-2 months, the patients from the experimental group additionally took captopril, 12.5-25.0 mg, twice a day or prestarium, 2.0-4.0 mg, once a day, or cossar, 50 mg, once a day. After the treatment, ACEI and AIIB were found to have no effect on blood gas and electrolyte composition, and respiratory and renal functions. With captopril and ramipril there was a higher patency of minor bronchi in the experimental groups than in the controls.

[Activity of the renin-angiotensin-aldosterone system and its impact on the effectiveness of treatment of chronic heart failure in patients with pulmonary tuberculosis]. / Aktivnost' renin-angiotenzin-al'dosteronovoi sistemy i ee vliianie ma éffektivnost' lecheniia khronicheskoi serdechnoi nedostatochnosti u bol'nykh tuberkulezom legkikh.

The renin-angiotension-aldosterone system (RAAS) was studied in 93 patients with pulmonary tuberculosis complicated by chronic heart failure (CHF). Radioimmunoassay was used to determine plasma renin activity (PRA) and serum angiotensin I and aldesterone levels. There was higher RAAS activity, as shown by elevated PRA. RAAS activity decreased during CHF treatment with angiotension-converting enzyme inhibitors (captopril, ramipril, prestarium) and an angiotensin II-receptor blocker (cosaar), which is indicative of the efficiency of CHF treatment.

[Effects of angiotensin-converting enzyme inhibitors and cosaar on quality of life of patients with pulmonary tuberculosis and chronic heart failure]. / Vliianie ingibitorov angiotenzinprevrashchaiushchego fermenta i kozaara na kachestvo zhizni bol'nykh tuberkulezom legkikh s khronicheskoi serdechnoi nedostatochnost'iu.

Two and thirty four patients with pulmonary tuberculosis complicated with chronic heart failure (CHF) were examined to study life quality (LQ) and its changes due to hemodynamic correction. LQ was assessed by the Minnesota Life Heart Failure Quality questionnaire filled in by patients before and after treatment of CHF with angiotensin-converting enzyme inhibitors (captopril, ramipril, prestarium) and an angiotensin II-receptor blocker (cosaar) given for 1.5-2 months during chemotherapy for tuberculosis. In patients with pulmonary tuberculosis complicated by CHF, LQ was found to be related to the degree of hemodynamic disorders and to significantly improves with complex treatment of a tuberculous process and with correction of hemodynamic disorders.

[Ramipril treatment of heart failure in disseminated forms of pulmonary tuberculosis]. / Lechenie serdechnoi nedostatochnosti pri rasprostranennykh formakh tuberkuleza legkikh s ispol'zovaniem ramiprila.

A total of 108 patients with heart failure-complicated disseminated pulmonary tuberculosis were followed up. Fifty eight patients received combined therapy including the angiotensin-converting enzyme inhibitor ramipril in a daily dose of 0.25-0.50 mg for 1.5-2 months. Fifty ramipril-untreated patients comprised a control group. Examinations revealed the benefits of the agent in decompensatory chronic cor pulmonale as improved right ventricular systolic and diastolic functions and health in the patients.

[Development of chronic cor pulmonale in restrictive and obstructive pulmonary dysfunctions]. / Razvitie khronicheskogo lëgochnogo serdtsa pri restriktivnom i obstruktivnom tipakh narusheniia funktsii lëgkikh.

A total of 2840 patients with pulmonary tuberculosis and bronchial asthma were studied. Antigens are shown to induce a systemic vascular response with elevated systolic pressure in the pulmonary artery, peripheral venous spasms. There is activation of the sympathoadrenal system and desensitization of beta-adrenoreceptors with lower levels of cyclic adenosine monophosphate (CAMP). There is a direct correlation between the CAMP levels and the cardiac output, between those and the pulmonary systolic pressure (PSP). This determines hyperkinetic hemodynamics in tuberculosis with the volume- and pressure-loaded heart. Paresis of pulmonary circulation, as well as hypokinetic hemodynamics occur as a result of an allergic immunological reaction in severe fibrocavernous processes in the area of tuberculosis. There is a direct correlation between the circulating immune complexes and CAMP. In bronchial asthma microcirculation is impaired due to antigenic exposures and elevated intrathoracic pressure. Pulmonary capillary reduction in restrictive processes results in higher levels of CAMP and right-to-left shunt, leading to hypoxemia. In obstructive pulmonary diseases, hypoxemia is caused by hypoventilation and impaired ventilation-perfusion ratios.

[Significance of cyclic nucleotides in pathogenesis of cor pulmonale in tuberculosis of respiratory organs and the use of beta adrenoblockers]. / Znachenie tsiklicheskikh nukleotidov v patogeneze legochnogo serdtsa pri tuberkuleze organov dykhaniia i primenenii beta-adrenoblokatorov.

Blood levels of cyclic nucleotides and their actions on central hemodynamics were studied in 129 patients with pulmonary tuberculosis. A direct correlation was established between heart rate, pulmonary artery systolic pressure and concentrations of cyclic adenosine monophosphate. Basing on this finding, the authors propose introduction of beta-adrenoblockers in hyperkinetic circulation tuberculous patients to prevent cor pulmonale. Administration of anapriline in tuberculous patients with compensated cor pulmonale and symptoms of sympathoadrenal hyperfunction improves the patients' condition, promotes a decrease in cardiac output, cardiac index, systolic pressure in the pulmonary artery. No side effects of the drug were reported.

[Classification of respiratory insufficiency in pulmonary tuberculosis]. / Klassifikatsiia dykhatel'noi nedostatochnosti pri tuberkuleze legkikh.

605 patients with different forms of pulmonary tuberculosis were examined. Blood gases and acid-base condition (ABC) were studied. In 22.2 per cent of the patients, hypoxemia was lacking with normal ABC and no respiratory failure (RF); in 36.6 per cent, hypoxemia was not accompanied by ABC changes and hence was caused by circulatory disturbances; in 15.6 per cent, it was combined with respiratory alcoholism; and in 6.8 per cent, with respiratory acidosis. The rest of the cases found to have metabolic disturbances of the ABC. Thus, hypoxemia is observed both with chronic forms of tuberculosis and with infiltrative/focal one, i.e. it follows a subacute course. In case of pulmonary tuberculosis, it is recommended to isolate subacute RF with PaO2 of 68.3 +/- 0.56 mm Hg, chronic RF of the 1-st phase with PaO2 of 71.8 +/- 0.7 mm Hg and chronic RF of the 2-nd phase with PaO2 of 64.2 +/- 0.88 mm Hg and accompanied by chronic cor pulmonale. In this case it seems necessary to find the basic mechanism of RF which is important for the treatment purposes.

[The use of apressin in patients with pulmonary tuberculosis and functional disorders of the external respiration and hemodynamics]. / Ispol'zovanie apressina u bol'nykh tuberkulezom legkikh s narusheniem funktsii vneshnego dykhaniia i gemodinamiki.

Effects of apressin, a peripheral vasodilator, on external respiration function and central hemodynamics was studied in 51 patients with pulmonary tuberculosis. The study showed that a single administration of 20 mg apressin in pulmonary tuberculosis patients failed to bring about any changes in both external respiration function and blood gases, only causing a minor shift in the buffer bases. Systolic pressure in the pulmonary artery remained unchanged after a single 20 mg dose of apressin was given. A statistically significant decrease in total pulmonary vascular resistance and an increase of the central hemodynamic values in pulmonary tuberculosis patients with hypokinetic type of circulation are recorded.