[Cyclooxygenase inhibitors and antiplatelet effect of acetylsalicylic acid. selective approach to nonsteroidal anti-inflammatory drugs in cardiological practice].

Nonsteroidal anti-inflammatory drugs (NSAIDs) represent class of medicines which is wide concerning chemical structure and mechanism of action. In the light of contradictory data on efficacy and safety of NSAID in cardiovascular patients selection of most appropriate NSAID (basing on profile of efficacy and safety) in patients receiving continuous therapy with low dose aspirin appears to be a problem. In this paper we discuss peculiarities of drug interaction between cyclooxygenase inhibitors and acetylsalicylic acid, and principles of selection of adequate NSAI.

[Effect of lornoxicam on inflammatory markers in patients with non-ST-segment elevation acute coronary syndrome].

AIM: To evaluate the clinical efficacy, safety, and effects of the nonsteroidal anti-inflammatory drug lornoxicam on inflammatory markers in non-ST-segment elevation acute coronary syndrome (NSTEACS). SUBJECTS AND METHODS: Eighty-five patients with NSTESCS were enrolled in a prospective randomized study. They were divided into 2 groups: 1) patients received lornoxicam (8 or 12 mg/daily) for 15 days in addition to standard treatment and 2) controls. Cardiovascular outcomes and the levels of C-reactive protein (CRP), IL-6, and IL-10 were determined. RESULTS: The lornoxicam group exhibited a significant reduction in CRP and a decrease in IL-6. There was also a significant increase in IL-10 levels in this group. A 6-month follow-up indicated a significant reduction in the number of cardiovascular events (nonfatal myocardial infarction, unstable angina, coronary death). CONCLUSION: Lornoxicam reduces the risk of poor cardiovascular outcomes in patients with NSTEACS and the levels of inflammatory markers.

[The efficacy of alteplase in pulmonary embolism treatment].

The results of pulmonary embolism treatment with streptase in 76 patients are discussed. All patients had submassive or massive pulmonary embolism. 66 (86%) of patients recovered. Thrombolysis with the use of heparin was performed in 9 patients, death occurred in 5 of them. Of 20 patients treated with "Actilize", death was reported in three cases. Authors consider alteplase to be highly effective in the treatment of massive pulmonary embolism. In case of late diagnostics of pulmonary embolism, especially recurrent, thrombolytic therapy remains to be effective up to 2 weeks after primary embolization.

[The use of intraaortic balloon counterpulsation in patients with acute myocardial infarction]. / Primenenie vnutriaortal'noi ballonnoi kontrpul'satsii u bol'nykh ostrym infarktom miokarda.

Intraaortic balloon counterpulsation was implemented in 11 patients with acute myocardial infarction and 1 patient with unstable angina. All patients had severe multivessel coronary artery disease. In 9 patients counterpulsation was used in conjunction with percutaneous transluminal coronary angioplasty, in 3 - with thrombolytic therapy. During hospitalization 2 patients died of progressing heart failure, while significant improvement of hemodynamic parameters occurred in other patients. Thus intraaortic balloon counterpulsation used in combination with angioplasty and thrombolytic therapy is an easily accessible highly effective method of treatment of cardiogenic shock in patients with acute myocardial infarction

[Long term use of a non-selective beta-blocker with vasodilating properties carvedilol in patients with severe heart failure]. / Dlitel'noe primenenie neselektivnogo beta-adrenoblokatora s vazodilatiruiushchimi svoistvami karvedilola u bol'nykh s tiazheloi khronicheskoi serdechnoi nedostatochnost'iu.

Results of drug treatment of 51 patients (41 men, 10 women) aged 35-86 years (mean age 62 years) included into COPERNICUS trial are presented. All patients had compensated NYHA class IV chronic heart failure and left ventricular ejection fraction less than 25%. For at least 2 months the patients received therapy with diuretics and angiotensin converting enzyme inhibitors (84%) or angiotensin receptor blockers (16%) and then were randomized to either carvedilol or placebo. Average duration of follow-up was 17 months. Carvedilol was well tolerated both during dose titration and during maintenance therapy. Addition of carvedilol to standard therapy of patients with severe heart failure was associated with increase of average ejection fraction from 21.7 to 30.3%. Rates of cardiovascular and sudden deaths, risk of hospitalization among carvedilol treated patients were 25, 33 and 57% less than among patients subjected only to standard therapy.

[Heart failure in acute myocardial infarction: comparing infusions of nifedipine and nitroglycerin]. / Serdechnaia nedostatochnost' v ostroi faze infarkta miokarda: sravnitel'naia otsenka infuzii nifedipina i nitroglitserina.

The impact of intravenous infusion of nifedipine and nitroglycerin on invasive central hemodynamic parameters and microcirculation was compared in 94 patients with acute myocardial infarction complicated by heart failure. The artery dilating effects of nifedipine were associated with baseline peripheral vascular tone, so the comparison was made separately in the groups with and without vasoconstriction. Nifedipine seems to be beneficial in the management of heart failure due to acute myocardial infarction in patients with systemic vasoconstriction. In patients with severe pulmonary congestion and normal left ventricular afterload, the intravenous vasodilators are preferable.

[Effect of acetylsalicylic acid on the indicators of thrombocytic hemostasis in patients with myocardial infarction]. / Vliianie atsetilsalitsilovoi kisloty na pokazateli trombotsitarnogo gemostaza u bol'nykh infarktom miokarda.

The examination of 50 patients with acute myocardial infarction indicated that enhanced platelet functional activity was a prognostically unfavourable sign and associated with a higher risk for myocardial infarction complications. The application of aspirin, 250 mg daily, in patients with high platelet functional activity in the acute period of the disease failed to produce a beneficial antiaggregatory effect.

[Use of intravenous nifedipine in the treatment of cardiac insufficiency in the acute period of myocardial infarction]. / Primenenie vnutrivennoi formy nifedipina v terapii serdechnoi nedostatochnosti u bol'nykh v ostrom perriode infarkta miokarda.

The efficacy of intravenous nifedipine was examined in 42 patients with acute myocardial infarction complicated by congestive heart failure. In patients with a higher systemic arteriolar tone, its normalization caused an increase in cardiac output and tissue oxygen supply with a concomitant decrease in pressures in the lesser circulation and the right heart. In contrast, a cardiodepressive effect of the agent was shown in more than a half of the patients with para-normal values of peripheral vascular resistance. The latter is one of the determinants in selecting patients with acute heart failure to be treated with nifedipine.

[Disorders of hemodynamics and pulmonary gas exchange in the acute period of myocardial infarct]. / Narusheniia gemodinamiki i gazoobmena v legkikh v ostrom periode infarkta miokarda.

In 40 patients with massive myocardial infarction, the central hemodynamics was examined by probing the right-sided chambers of the heart and the pulmonary artery. The cardiac output was measured by thermodilution. The gas exchange (respiratory minute volume, capnography, gas analysis of arterial and mixed venous blood) was explored. Arterial hypoxemia was found to be associated with increased intrapulmonary blood shunting in patients with acute myocardial infarction complicated by congestive heart failure. Deterioration of arterial hypoxemia was promoted by a combination of increased overall pulmonary shunting and decreased residual venous oxygenation. Abnormalities in the ventilation-perfusion relations are of great importance.

[The role of abnormally located chordae in the origin of accidental heart murmurs in children]. / Znachenie anomai'no raspolozhennykh khord v proiskhozhdenii aktsidental'nykh shumov serdtsa u detei.

A study of 55 children with accidental systolic and diastolic heart murmurs demonstrated that abnormal chorda position (ACP), detected at echocardiography in various heart cavities, was the principal contributing factor. The relationship between the intensity and other parameters of systolic murmurs and abnormal chorda topography is discussed. Abnormal position of the chordae was not associated with any deviations from basic morphometric characteristics of the heart and should therefore be regarded as a normal variant.

[Use of automation potential in intensive care units of a multi-profile hospital]. / Ispol'zovanie vozmozhnostei avtomatizatsii v otdeleniiakh intensivnogo lecheniia mnogoprofil'nogo statsionara.

An example of an automated information system of a large general hospital has shown that using a sufficiently informative clinical data base (with a minimal set of parameters) on patients in intensive care departments, it is possible to provide information inquiries of diagnostic units and hospital administration without distracting staff-members on duty to report on the patients' state. The use of an automated bed turnover management system made it possible to reduce the time of patients' admission to hospital, to improve the planning of hospitalization and hospital transfers, to raise the efficacy of bed turnover, and to reduce unproductive labor of the hospital staff.

[Clinical observation of the repeated use of isolated ultrafiltration in treating chronic circulatory insufficiency]. / Klinicheskoe nabliudenie povtornogo primeneniia izolirovannoi ul'trafiltratsii v lechenii khronicheskoi nedostatochnosti krovoobrashcheniia.

Repeated courses of isolated ultrafiltration performed 4 times within 19 mos. in patients with chronic heart failure against a background of drug therapy resulted in remissions. The authors assessed positively the clinical effect of each course of procedures supported by the results of echocardiographic investigations. No significant changes in laboratory findings were noted.

[Comparative clinico-instrumental characteristics of different morphological variants of hypertrophic cardiomyopathy]. / Sravnitel'naia kliniko-instrumental'naia kharakteristika razlichnykh morfologicheskikh variantov gipertroficheskoi kardiomiopatii.

Six morphologic variants of hypertrophic cardiomyopathy (HCMP) have been identified on the basis of the echocardiographically-documented extent and localization of left-ventricular hypertrophy in 34 patients with HCMP. More than half of the patients had no complaints. The more characteristic echocardiographic features of the disease included a considerable thickening of one or more departments within the left ventricle, the size of its cavity being diminished. In most cases, HCMP was associated with considerably enlarged R waves on the electrocardiograms from 35 precordial leads that were usually combined with ST segment depression and T wave inversion. The latter two features often provided grounds for a hyperdiagnosis of coronary heart disease (CHD). What distinguishes HCMP from CHD is the discrepancy between marked and persistent pathologic electrocardiographic changes and a relatively uneventful clinical picture of the disease. The comparison of echocardiographic and ECG charting data allows a more detailed assessment of the kind of left-ventricular hypertrophy in HCMP patients, and can be used in the differential diagnosis of HCMP vs. CHD.

[Diagnosis of infectious endocarditis and the assessment of the effectiveness of its treatment]. / Diagnostika infektsionmogo éndokardita i otsenka éffektivnosti ego lecheniia.

The results of investigation and treatment of 58 patients with infectious endocarditis are presented. Changed clinical pattern of the disease, its increasing incidence among older people and the emergence of its "immunologic" variety with signs of myocarditis, vasculitis and, less commonly, glomerulonephritis have been noted over recent years. The disease has become polyetiologic. Methods of treatment for infectious endocarditis are discussed with reference to the etiology and clinical pattern of the disease. Indications for surgical treatment are outlined.