[Prehospital thrombolytic therapy with tenecteplase in patients with ST-elevation myocardial infarction].

We carried out prehospital thrombolytic therapy (TLT) with tenecteplase in 24 patients with ST-elevation myocardial infarction (MI) at the background of standard concomitant therapy with unfractionated heparin, aspirin, and clopidogrel and analyzed clinical course of MI, ECG dynamics, systolic left ventricular function according to echocardiography. In 20 patients coronary angiography was performed after TLT. Mean symptom - needle time was 113 min. In 14 patients (58%) TLT was carried out within 2 hours after appearance of symptoms. In 19 patients the course of disease was uncomplicated. Electrocardiographic criteria of effective reperfusion were registered in 14 patients (58%), angiographic criteria - in 13 patients (65% of subjected to angiography). Percutaneous intervention was performed in 18 patients (75%). Systolic left ventricular dysfunction was revealed in 5 patients (21%), aborted MI - in 4 patients. Significant correlation was found between aborted MI (r=0,38, p=0,034) and uncomplicated MI (r=0,40, p=0,027) and performance of TLT during first 2 hours. There were no hemorrhagic complications. Results of the study evidence for high efficacy of prehospital thrombolysis with tenecteplase and real possibility of its use under conditions of existing system of organization of urgent cardiological aid.

[The long-term physical training of patients with functional class-III stenocardia who have had a myocardial infarct]. / Dlitel'nye fizicheskie trenirovki bol'nykh, perenesshikh infarkt miokarda, so stenokardiei III funktsional'nogo klassa.

Twenty-six patients who suffered myocardial infarction associated with FC III angina pectoris were examined for the effect of physical training on the health status. 25 patients made up the control group. Physical training lasted II months and included remedial exercise, bicycle ergometry training, and graded walking. The central hemodynamics at rest and during exercise was assessed by tetrapolar chest rheography. All reactions in the hemodynamics were analyzed in respect to the status at rest. Ultrasound sectorial scanning was used to study left ventricular contractile function at rest. The patients undergoing training manifested a decrease of angina pectoris manifestations, a considerable rise of work fitness, improvement of the hemodynamic response towards physical exercise, corresponding to 75% of the initial threshold level. In the control group patients, the clinical status, work fitness and the hemodynamic response towards exercise did not undergo any substantial changes. Neither main nor control group demonstrated any appreciable changes on the part of left ventricular contractile function.

[Use of physical training in the rehabilitation of patients with post-infarct heart failure]. / Ispol'zovanie fizicheskikh trenirovok dlia reabilitatsii bol'nykh s postinfarktonoi serdechnoi nedostatochnost'iu.

The effect of exercise was examined in 15 postmyocardial-infarction patients showing clinical signs of heart failure; 17 patients were taken as controls. The drills continued for 11 months and included exercise therapy, bicycle ergometry and rationed walks. In addition to a considerable increase in physical working capacity, the patients doing exercise showed more favorable hemodynamic response to stress that featured a greater stroke index, a smaller heart rate increment and a more significant fall in specific peripheral resistance. In the control patients, hemodynamic response to stress grew worse, while physical working capacity remained basically unchanged.

[Effectiveness of the physical training of post-myocardial infarction patients with differing exertion tolerances]. / Ob effektivnosti fizicheskikh trenirovok perenesshikh infarkt miokarda bol'nykh s razlichnoi tolerantnost'iu k nagruzke.

A total of 159 men after myocardial infarction were examined. Of them 73 were engaged in physical training for 11 mos. Its efficacy was analysed after the results of bicycle ergometry taking account of initial exercise tolerance. A positive effect of physical training was noted both in the patients with high and low exercise tolerance. Raised physical working capacity was observed in parallel with the improved indices of the left ventricular contractility in accordance with the results of two-dimensional echocardiography. The authors also observed a favorable effect of physical training on lipoprotein metabolism, in particular a decrease in the value of the apo B/apo AI ratio was noted that might suggest a decrease in the inflow of cholesterol to the vascular wall and an enhanced outflow from it.

[Clinical and instrumental characteristics of idiopathic hypertrophic cardiomyopathy and dynamics of echocardiographic indices as affected by beta-adrenergic blockaders]. / Kliniko-instrumental'naia kharakteristika idiopaticheskikh gipertroficheskikh kardiomiopatii i dinamika ékhokardiograficheskikh pokazatelei pod vliianiem beta-adrenergicheskikh blokatorov.

Clinical investigation of 31 patients with idiopathic hypertrophic subaortal stenosis (IHSS) and idiopathic hypertrophic nonobstructive cardiomyopathy (IHNCMP) comprised electro- and phonocardiography, roentgenologic examination and echocardiography. The disease was latent in 3 patients, and ischemic heart disease or rheumatic heart lesion had been diagnosed prior to echocardiography in 26. Asymmetrical hypertrophy and hypokinesia of the upper third of the ventricular septum, narrowed left-ventricular cavity and septum-wise systolic movement of the anterior mitral cusp were findings common to all IHSS patients. The ventricular septum/left-ventricular posterior wall thickness ratio was elevated (1.42 +/- 0.06). In IHNCMP patients, this ratio was within normal range. The results of an acute pharmacologic test with 10 mg intravenous obsidan given to 10 IHSS patients suggested that the obstruction of left-ventricular outflow pathway was somewhat reduced. Prolonged (2 months to 3 years) obsidan treatment was given to 25 patients and was associated with positive effect in terms of improved subjective manifestations of the disease. However, echocardiographic patterns only showed moderate improvement in 9 of the 13 patients who had completed 1-3 years' treatment course.