[Study of atrio-ventricular conductivity in patients with ischemic heart disease by recording electric potentials of the bundle of His]. / Izuchenie atrio-ventrikuliarnoi provodimosti u bol'nykh ischemicheskoi bolezn'iu serdtsa putem registratsii elektropotentsialov puchka Gisa

Data concerning the recording of the depolarizing complex of the atrioventricular bundle during cardiac catheterization in patients with the ischaemic heart disease are presented. The elements of the His's bundle electrogram and the intervals characterizing the atrioventricular conductivity are analysed. In 12 patients, among the total 16 examined ones, selective coronary angiography revealed certain changes in the proximal portions of the coronary arteries. In the presence of distinct changes in the coronaries with a subtotal or total stenosis of the major coronary arteries the changes in the atrioventricular conductivity may be lacking. In 2 of the 12 patients conductivity disorders were revealed in the His-Purkinje section. The recording of the His's bundle electrogram permitted to precise the localization of the ectopic rhythms in some cases.

[Disorders of heart rhythm during bicycle ergometry in ischemic heart disease]. / Narusheniia ritma serdtsa pri veloérgometrii u bol'nykh ishemicheskoi bolezn'iu serdtsa.

During a test on a bicycle ergometer disorders of cardiac rhythm were revealed in 41 (20.5%) out of 240 patients with ischemic heart disease who underwent coronary arteriography. It is concluded that disorders of cardiac rhythm are mostly encountered in patients with ischemic heart disease attended by stenosing changes of the coronary arteries and disorders of left ventricular contractile function as demonstrated by ventriculography. In a few cases ventricular extrasystole may be the only sign of myocardial ischemia in patients with ischemic heart disease.

[Comparison of the data of the veloergometric test and coronarography in ischemic heart disease]. / Sopostavlenie dannykh veloergometricheskoi proby i koronarografii u bol'nykh ishemicheskoi bolezn'iu serdtsa.

The results of the bicycle ergometry test were compared with the findings of coronarography in 254 patients with ischemic heart disease or suspicion of it. The high diagnostic significance of the test was demonstrated; stenosis of the heart coronary arteries was found in 73% of patients producing a positive test. The occurrence of an attack of angina pectoris with simultaneous "ischemia" reduction of the ST segment by 1 mm and more is a significant sing of a positive test. The severity of changes in the coronary arteries grows when these signs are combined with poor tolerance of physical load. With the higher degree of stenosis and an increase in the number of involved arteries load tolerance decreases, while the percentage of positive results of the load test increases.

[Significance of subcutaneous nodules in the leg for the diagnosis of connective tissue pathology in patients with cardiovascular diseases]. / Znachenie podkozhnykh uzelkov na goleni v raspoznavanii soedinitel'notkannoi patologii u bol'nykh s serdechno-sosudistymi zabolevaniiami.

Subcutaneous nodules on the leg were found in 40 (16%) of 250 male cardiologic in-patients, aged 17-65; they correlated, with a significant frequency with increased skin distensibility, overextension of the fingers and breast-bone deformation, mitral valve prolapse and atrial fibrillation. This feature can be used in the diagnosis of inherited generalized connective-tissue dysplasia.

[Diagnostic value of changes in Q wave amplitude in left thoracic leads during physical loading]. / Diagnosticheskaia tsennost' izmenenii amplitudy zubtsa Q v levykh grudnykh otvedenii pri fizicheskoi nagruzke.

The informative value of stress-induced changes in Q wave amplitude and ST segment for the diagnosis of coronary heart disease was compared in records from left chest leads. Bicycle ergometry was conducted in 74 patients with coronary angiographically documented stenosis (more than 70% of the lumen) of one or more coronary arteries, and 28 subjects showing no apparent coronary arterial changes. The lack of increment in Q wave amplitude was shown to be a fairly sensitive sign of myocardial ischemia. Yet, its specificity is relatively low, much inferior to that of ST changes. The predictive value of changes in ST segment is significantly higher, as compared to that of changes in Q wave amplitude during exercise. Simultaneous assessment of ST and Q wave changes in response to stress failed to improve the predictive accuracy, as compared to the interpretation of ST changes alone.

[Course and outcome of ischemic heart disease in patients with angiographically confirmed coronary arteriosclerosis]. / Techenie i iskhod ishemicheskoi bolezni serdtsa u bol'nykh s angiograficheski podtverzhdennym koronarnym aterosklerozom

The clinical course and prognosis were studied in 116 patients with clinical signs of ischaemic heart disease when they were hospitalized in an institution in which selective coronary angiography was practiced along with the routine clinical examinations. Control examinations were conducted 2 years later. The dynamics of the clinical manifestations and the results of the disease were evaluated according to the following categories: improvement, stabilization, progressive course, death. All the examined patients were divided into 2 groups: 74 patients with atherosclerotic coronary heart disease proved at angiography, and 72 patients without angiographic signs of coronary pathology. The course of the disease was found to depend on the presence and severity of the atherosclerotic process in the coronary arteries. Essential hypertension aggravated the course and prognosis of the disease. The distinctness of the clinical manifestations of coronary insufficiency, the ischaemic changes in the ECG repolarization complex, the duration of the disease history, and the age of the patients tended to predispose the outcome of the atherosclerotic lesion of the heart. In the group of patients with clinical signs of ischaemic heart disease, but without angiographic changes in the coronaries the result was more favourable, than in those with coronary atherosclerosis. This group, however, included some patients with prognostically unfavourable myocarcial lesions of non-atherosclerotic genesis.

[Myocardial function and the use of propranolol in ischemic heart disease]. / Funktsional'noe sostoianie miokarda i primenenie propranolola pri ishemicheskoi bolezni serdtsa.

Clinical-functional analysis of the efficacy of propranolol was conducted in 32 patients with ischemic heart disease and stable angina pectoris (with angiographically verified stenosing coronary atherosclerosis) depending on the initial myocardial contractility. A marked antianginal effect of propranolol in a dose of up to 160 mg daily was demonstrated irrespective of the initial myocardial contractile function. Treatment with propranolol was not attended with signs of cardiac insufficiency or aggravation of its subclinical symptoms. The results of the study provide convincing data that optimum doses of blocking agents of beta-adrenergic receptors of the myocardium causing a negative inotropic effect even in patients with diminished myocardial function may be used more widely.

[Stress-Doppler echocardiography in the diagnosis of ischemic heart disease in an ambulatory setting]. / Primenenie stress-Doppler-ekhokardiografii dlia diagnostiki ishemicheskoi bolezni serdtsa v ambulatornykh usloviiakh.

Coronary arteriography, bicycle ergometry and transesophageal atrial pacing (TAP) in combination with Doppler echocardiography (stress-Doppler echocardiography) were used to evaluate cardialgias in 30 outpatients. Stress-Doppler echocardiography showed a high (94%) sensitivity and a high (86%) specificity to detect coronary heart disease (CHD). There was a high correlation (r = 0.79, p less than 0.001) between the wall motion values obtained by echocardiography during TAP and coronary rating. The left ventricular (LV) diastolic filling (DF) was studied by pulsed wave Doppler echocardiography in the postpacing period. The Doppler-derived parameters of LV DF obtained in that period appeared to be moderately sensitive (75%) and specific (64%) in detecting CHD. In post-pacing ischemia, the "pseudonormalized" LV filling pattern was observed in 5 of 6 patients (sensitivity 80%) having three-vessel disease and major left (or equivalent) coronary stenosis.

[Interrelation of the state of perfusion and the coronary vascular bed in patients with chronic ischemic heart disease]. / Vzaimosviaz' sostoianiia perfuzii i koronarnogo sosudistogo rusla u bol'nykh khronicheskoi ishemicheskoi bolezn'iu serdtsa.

Coronary angiographic and scintigraphic (using 201Tl) studies in 139 patients with verified diagnosis of chronic coronary heart disease demonstrated high sensitivity (85.6%) of myocardial perfusion scintigraphy with respect to detecting disorders of myocardial blood supply due to the stenosis of major coronary arteries and microcirculation disorders. False negative scintigraphic results in the screening for perfusion defects are commonly due to the shortcomings of semiquantitative assessment of the scintigrams.

[Study of left ventricular blood filling during post-pacing ischemia: comparison of Doppler echocardiography and heart catheterization]. / Izuchenie krovenapolneniia levogo zheludochka vo vremia poststimuliatsionnoi ishemii: sopostavlenie dannykh doppler-ékhokardiografii i kateterizatsii serdtsa.

Left ventricular blood filling was performed in 72 patients by using pulsed Doppler echocardiography at rest and in postpacing ischemia. In 10 patients, non-invasive examination findings were compared with the values of a left ventricular pressure curve which had been obtained in frequent atrial pacing. No changes in transmitral blood flow were found in patients without coronary heart disease, whereas 2 types of abnormal transmitral blood flow were detected in those with coronary heart disease in the postpacing period. The patients with Type I abnormal transmitral blood flow exhibited prolonged isovolumetric relaxation and slightly elevated left ventricular end-diastolic pressure in the postpacing period when catheterization was conducted. Those with Type I ("pseudonormal") transmitral blood flow displayed more prolonged relaxation and significantly (greater than 20 mm Hg) elevated end-diastolic pressure. The pattern of changes in transmitral blood flow was not pathognomonic to any definite myocardial abnormality, but reflected the hemodynamics.

[Long-term ECG recording and cardiac rhythm disorders in patients with different conditions of the coronary arteries (according to the angiographic data)]. / Dlitel'naia registratsiia EKG i narusheniia ritma serdtsa u bol'nykh s razlichnym sostoianiem koronarnykh arterii (po dannym angiografii).

The results of long-term continuous ECG recording during 24 hours in 50 patients are presented. A comparison of these data with the results of a clinical examination and selective coronary angiography has revealed that patients with chronic ischaemic heart disease and distinct atherosclerotic changes in the coronary arteries have rhythm disorders twice as often as those free from ischaemic heart disease. The employment of the method of long-term continuous ECG recording during normal patients' activity will permit to evaluate the effect of different factors on the development of cardiac rhythm disorders.

[Myocardial contraction in ischemic heart disease]. / Sokratitel'naia funktsiia miokarda u bol'nykh ishemicheskoi bolezn'iu serdtsa.

The indices of contractility of the left ventricular myocardium were studied by means of ventriculography and catheterization in 84 patients with ischemic heart disease according to the extent of damage to the coronary arteries and the course of the disease. Changes in the coronary arteries were encountered twice as frequently among patients with postinfarction cardiosclerosis as among patients with angina pectoris and no history of infarction. The main cause of disorders of myocardial contractility in patients with ischemic heart disease is post-infarction cardiosclerosis (56% of cases). Signs of impaired functional capacity of the left ventricle appeared in segmental asynergy involving 20 to 25% of its circumference. Changes in the indices of contractility were revealed in 13% of patients with angina pectoris.

[Newly developed stenocardia: electrocardiographic and angiographic comparisons and the possibility of conducting intraluminal dilatation of coronary arteries]. / Vpervye voznikshaia stenokardiia: elektrokardiograficheskie i angiograficheskie sopostavleniia, vozmozhnost' vypolneniia vnutriprosvetnoi dilatatsii koronarnykh arterii.

Fifty coronary patients were examined within the first 3 months after the onset of anginal attacks. All patients were subjected to coronaroangiographic investigation, bicycle ergometry, and 45 patients, to ECG-monitoring. Resting ECG patterns were assessed. One coronary vessel, the anterior interventricular branch of the left coronary artery in most (73%) cases, was affected in 66% of the patients. The stenoses suitable for intraluminal balloon dilatation were found in 58% of the patients with one vessel affected. In a considerable proportion (24%) of the patients, 2 or 3 arteries were affected. Combined electrocardiographic investigation demonstrated lesions of the anterior interventricular branch of the left coronary artery. The early results obtained with the intraluminal balloon dilatation of coronary arteries (16 attempts in 13 patients) showed good clinical effect to accompany anatomically-successful procedures (8 patients).

[Experience with intraluminal balloon dilatation of constricted coronary arteries in ischemic heart disease]. / Opyt primeneniia vnutriprosvetnoi ballonnoi dilatatsii stenozirovannykh koronarnykh arterii pri ishemicheskoi bolezni serdtsa.

Twenty-seven attempts at coronary arterial intraluminal balloon dilatation (CAIBD) were made in 24 patients; 16 of those were successful. The procedure could only be accomplished in patients with affected anterior interventricular branch. Thrombotic occlusion of the dilated segment was recorded in 3 patients, and 2 of those developed intramural myocardial infarction. While the procedure is not yet fully set up, it is indicated to patients with an isolated lesion of the anterior interventricular artery that does not exceed 90%, no apparent signs of coronary spasm and no effect of conventional antianginal therapy.

[Echocardiographic study of the coronary vessels]. / Ob ékhokardiograficheskom issledovanii koronarnykh arterii.

The coronary arteries were studied in normal subjects and in patients with coronary heart disease, using two-dimensional echocardiography. The authors succeeded in obtaining the image of the major trunk of the left and of the opening of the right coronary artery and in ascertaining various forms of coronary artery lesions. In twenty cases the findings of echocardiography and coronary angiography were compared.

[Role of the vasospastic factor in stenocardia in ischemic heart disease]. / Rol' vazospasticheskogo faktora pri stenokardii u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Selective coronarography and pharmacological test with intravenous administration of ergometrin have been carried out in 100 patients. The test permits one to demonstrate the vasospastic form of angina pectoris, which is encountered in patients with different degrees of lesions of the coronary arteries and different tolerance to exercise. Lack of coincidence in localization of ischaemic zones in the myocardium in tests with exercise and intravenous injection of ergometrin according to myocardium scintigraphy with 201Tl points to the possibility of existence of two forms of angina pectoris in the same patient, differing not only in the pathogenetic mechanisms but also in the localization of the ischaemic changes supervening in the myocardium. According to the data of echocardiography during the anginal attack with rise of the ST segment there is a more pronounced dilatation of the left ventricle cavity and decrease of the myocardial contractility than in the anginal attack with depression of the ST segment. In patients with spontaneous angina pectoris and rise of the ST segment corinfar exerted marked antianginal effect. Inderal was ineffective. In patients with angina pectoris and depression of the ST segment there was no difference between the two drugs.

[Clinical and angiographic comparisons in stable stenocardia]. / Klinicheskie i angiograficheskie sopostavleniia pri stabil'noi stenokardii.

Comparative data of clinical, instrumental and coronarographic studies in 185 patients with ischaemic heart disease and stable angina pectoris are presented. It is concluded that in the evaluation of the severity of ischaemic heart disease along with the clinical data it behooves to give due consideration to the additional signs of chronic ischaemia of the myocardium: changes in repolarization on ECG at rest and after exercise, local disorders of the function of the left ventricle, disorders of lactic acid metabolism and cardiac rhythm.

[Diagnostic importance of the ergometrine test in ischemic heart disease]. / Diagnosticheskoe znachenie proby s érgometrinom u bol'nykh ishemicheskoi bolezn'iu serdtsa.

The ergometrine test was performed in 102 patients with ischemic heart disease (IHD) and cardialgias of various genesis. The diagnosis was verified in all patients by the bicycle exercise test and coronary arteriography. The variant of angina pectoris was diagnosed when there were precordial pains and the ST-segment elevation after intravenous ergometrine injection. The appearance of angina pectoris and ischemic ST-segment depression was observed in patients with angina of effort and at rest. This type of reaction in the ergometrine test indicates obstructive coronary heart disease. The appearance of precordial pain without ECG changes is probably the sign of latent coronary insufficiency. The ergometrine testing is proposed for the differential diagnosis of different forms of angina pectoris.

[Criteria of myocardial ischemia in bicycle ergometry of patients with stenosing arteriosclerosis of the cardiac coronary arteries depending on the initial ECG at rest]. / Kriterii ishemii miokarda pri veloérgometrii u bol'nykh stenoziruiushchim aterosklerozom venechnykh arterii serdtsa v zavisimosti ot iskhodnoi EKG v pokoe.

The sensitivity of various criteria of the physical exercise test in revealing myocardial ischemia was studied in 2 groups of patients with ischemic heart disease: 1st group of 64 patients with normal ECG at rest, 2nd group of 96 patients with cicatricial changes in the myocardium. Selective coronography demonstrated atherosclerotic narrowing (stenosis of more than 70%) of one or more coronary arteries of the heart in all patients. During physical exercise an attack of angina pectoris without "ischemic" changes on the ECG occurred in 36.1% of patients of the 1st group and in 22.4% of patients of the 2nd group. The frequency of other clinical signs of cessation of the exercise (dyspnoea, change of arterial pressure, extrasystole and others) was three and a half times higher in patients with cicatricial changes in the myocardium. It is concluded that the frequency with which signs of myocardial ischemia are revealed during physical exercise depends not only on the pronounced character of the pathological coronary condition and the development of collateral circulation but also by the sensitivity of the separate ECG leads and the presence and localization of cicatricial changes in the myocardium.

[Comparative evaluation of bicycle ergometry and coronary radiography results in stenocardia as a function of the ECG ST segment reaction during physical loading]. / Sravnitel'naia otsenka rezul'tatov veloérgometrii i koronarografii u bol'nykh stenokardiei v zavisimosti ot reaktsii segmenta ST na EKG vo vremia fizicheskoi nagruzki.

The authors undertook a comparative study of the results of bicycle ergometry and angiocardiography in two clinically homogeneous groups of patients with angina pectoris: without ischemic displacement (group I, 83 patients) and with displacement (group II, 85 patients) of the S--T segment on the ECG during an anginal attack induced by physical exercise. It is shown that the considerable diminution of functional reserves of coronary circulation in all patients revealed in bicycle ergometry was combined with marked coronary atherosclerosis. Affection of two or three arteries was encountered in 96.4% of patients in group I and in 88.2% of patients in group II. In group I patients the attacks of angina pectoris develop with lower values of double production, while the intercoronary collaterals on the coronarograms are more pronounced. The authors substantiate the reliability of a typical anginal attack induced by physical exertion as a criterion of positive bicycle ergometry test irrespective of the concomitant reaction of the S--T segment on the ECG.