[Biochemical blood indices of patients with a myocardial infarct complicated by heart rupture]. / Biokhimicheskie pokazateli krovi u bol'nykh infarktom miokarda, oslozhnennym razryvom serdtsa.

Adrenal function, blood kallikrein-kinin status and the levels of serotonin, histamine, electrolytes and enzymes were repeatedly assessed in 97 patients with myocardial infarction and external cardiorrhexis. Certain patterns were identified as common to the pre-rupture period and the time of the rupture proper that can have a pathogenetic, and sometimes also diagnostic and predictive, significance.

[Fibrinolytic therapy and mechanical restoration of patency of the coronary arteries in acute myocardial infarction]. / Fibrinoliticheskaia terapiia i mekhanicheskaia rekanalizatsiia koronarnykh arterii serdtsa pri ostrom infarkte miokarda.

Results of a Moscow--Berlin collaborative study of urgent coronarography in acute myocardial infarction, using intracoronary treatments (fibrinolytic agents and mechanical thrombus destruction), are reported. Urgent coronarography was performed in 58 patients. Coronary flow could be recovered or improved in 27 patients, as evidenced by control coronarographic tests, particularly late follow-up ones. The procedure did not prevent myocardial infarction, but alleviated its course.

[Pathomorphological changes in the myocardium outside of the infarct area in the postresuscitation period (proceedings)]. / Patomorfologicheskie izmeneniia miokarda vne zony infarkta v postreanimatsionnom periode.

The results of clinico-morphological and electron microscopic examinations of the myocardium outside the infarction zone (73 observations) are presented. The dependence of the alterations on the extent of hemodynamic disorders and on the mechanism of the heart activity arrest was taken into account. In 12 cases repeated heart defibrillation (up to 110 seanses) was applied. In progressive cardiac insufficiency, myocardium outside the infarction zone exhibits disseminated vascular lesions with severe rheological disorders of the blood and development of numerous damages of the contractile myocardium. These changes are less marked in "sudden" death with myocardial infarction. The authors believe that heart fibrillation is structurally reflected in fragmentation of the muscle fibers in the mechanism of the development of which an important role is also played by myocardial ischemia. The authors distinguish two types of myocardium fragmentation: diffuse and focal, the functional importance of which is different. Multiple defibrillations of the heart do not cause severe structural changes in the myocardium.

[Change in adrenal glucocorticoid function in myocardial infarct complicated by cardiogenic shock]. / Izmenenie gliukokoritikoidnoi funktsii nadpochechnikov u bol'nykh infarktom miokarda, oslozhnennym kardiogennym shokom.

The article deals with the results of study of bound and free 11-oxycorticosteroids and the reserve binding capacity of transcortin in 65 patients with myocardial infarction complicated by various types of cardiogenic shock. The most significant increase in the level of 11-oxycorticosteroids and decrease in transcortin reserve binding capacity were found in patients with true cardiogenic shock.

[Generalized sarcoidosis with a predominant lesion of the myocardium]. / Generalizovannyi sarkoidoz s preimushchestvennym porazheniem miokarda.

Materials on heart sarcoidosis are presented on the basis of the literature analysis, morphological and electron microscopical examination of an autopsy observation. Heart sarcoidosis is characterized morphologically by granulomatous myocarditis with diffuse infiltration with lymphoid and macrophage cells, and marked destructive changes in muscle fibers. A damaging effect of the infiltrate cells on cardiomyocytes is shown.

[Therapy and prevention of different forms of ventricullar fibrillation in myocardial infarct]. / O terapii i profilaktike razlichnykh form fibrilliatsii zheludochkov u bol'nykh infarktom miokarda

Data on 80 cases of myocardial infarction complicated by different forms of ventricular fibrillation (VF)--primary, secondary and recurrent--are analysed. VF was shown to be accompanied by distinct disorders in respiration, metabolism and haemodynamics. Metabolic disorders are characterized by acid-base and electrolyte balance changes, increased activity of the adrenal glands, and increased release of catecholamines and glucocorticoids into the blood. The latter proves that VF increases the stress reaction of the body caused by acute myocardial infarction. The success of prevention and treatment of VF depends on the early hospitalization of acute myocardial infarction patients in specialized intensive care and resuscitation units where emergency reanimation measures can be taken, controlled therapy rendered, and VF prevented by influencing the altered metabolism and stress state. Special attention is paid to repeated VF for which the authors employ, along with routine therapy, Glucagon that produces an antiarrhythmic and cardiotonic effect.

[External heart rupture in myocardial infarct (clinical picture, prospects for resuscitation)]. / O naruzhnykh razryvakh serdtsa pri infarkte miokarda (nekotorye voprosy kliniki, perspektivy reanimatsii)

An analysis is presented on 53 cases of external ruptures of the heart in cases of transmural myocardial infarction. Most of the patients were above 60 years of age, with a hypertensive syndrome, with intensive, protracted, often recurring cardiac and retrosternal pains. The pains were interpreted as the manifestation of myocardial rupture. Blood tests revealed a high leucocytosis, an elevated level of lactate dehydrogenase and catecholamines excretion, mainly at the expense of noradrenaline, as well as an increased amount of serotonin, histamine, magnesium salts. A sudden onset of a catastrophic deterioration in the form of a cardiogenic shock was interpreted as a partial rupture with a progressively increasing penetrating rupture; clinical death with a preserved electrical activity of the heart--as its complete rupture. Cases of temporary efficieny resuscitation with a survival period in some cases of as long as 3 days are presented. The authors believe it possible to foresee a myocardial rupture, to diagnose it before the electrical activity of the heart ceases, to maintain the life of the patient so as to permit a cardiac surgical team to undertake an operative procedure.