[Comparison of intracoronary and intravenous methods of thrombolytic streptokinase therapy of patients with myocardial infarct]. / Sravnenie vnutrikoronarnogo i vnutrivennogo metodov tromboliticheskoiterapii streptokinazoi bol'nykh ostrym infarktom miokarda.

Intracoronary streptokinase (250.000 units over 60-90 min) was administered within 7.8 +/- 0.4 hrs after the onset of myocardial infarction symptoms to 85 patients, and intravenous streptokinase (500.000 units over 5-10 min) was given within 4.8 +/- 0.4 hrs to 46 myocardial infarction patients. Coronary angiography was conducted 1 to 3 hours after intravenous streptokinase administration. Coronary arterial reperfusion was achieved in 62% of patients in the former group, and in 66% in the latter one. Reperfusion was seen in 84% of patients in the first 3 hours after the onset of infarction, and in 60-66% at later dates. Hypofibrinogenemia did not become critical and persisted for one more day in cases of intravenous streptokinase infusions, as compared to the intracoronary route. Intravenous administration of 500.000 units streptokinase at the rate of 100.000-50.000 U/min is an effective and safe method for the treatment of myocardial infarction, and its prospective application in health practices appears quite promising.

[Effect of intracoronary streptokinase infusion and verapamil treatment on the size of the affected area in myocardial infarct patients]. / Vliianie vnutrikoronarnoi infuzii streptokinazy i lecheniia verapamilom na razmer zony porazheniia u bol'nykh infarktom miokarda.

The effect of intracoronary streptokinase administration (31 patients), verapamil treatment (23 patients) and conventional therapy (27 patients) on the size of the affected area was examined in patients with acute myocardial infarction (MI). Streptokinase was administered in a dose of 250,000-500,000 IU within the first 3 to 20 hours of myocardial infarction, and verapamil, 360 to 400 mg, daily within the first 5 to 12 hours of the attack. The occluded coronary artery was recanalized in response to streptokinase administration in 21 patients. Serial measurements of CPK activity and serum myoglobin levels, and electrocardiographic precordial cartograms demonstrated a reduction in MI size following streptokinase administration. Verapamil had no basic effect on the final size of myocardial lesion, although it improved somewhat the clinical course of the disease.

[Effect of various drugs on peripheral hemodynamics in left-ventricular insufficiency in patients with chronic ischemic heart disease]. / Sostoianie perifericheskoi gemodinamiki i vliianie na nee nekotorykh lekarstv pri levozheludochkovoi nedostatochnosti u bol'nykh khronicheskoi ishemicheskoi bolezn'iu serdtsa.

It is established that in the majority of patients at the height of left ventricular insufficiency (LVI) low cardiac output is not recorded, it is within the normal limits and at times even higher than normal. In isolated LVI present only with pulmonary hypertension, despite the absence of insufficiency of the right heart considerable disorders of peripheral haemodynamics are present in the shape of decreased volume of tissue blood flow, venous capacity and extensibility of the peripheral veins. The degree of this decrease is proportional to the severity of LVI and upset of the pulmonary circulation. The more persistent and considerable effect correcting decreased capacity and extensibility of the peripheral veins and enhancing the perfusion of tissues with isolated LVI is exerted by furosemide, nitroglycerine is somewhat less effective. Strophanthin exerts such effect in roughly 50% of cases, and obsidan is unreliable in its effect.

[Changes in contractile function of the left ventricle under the effect of thrombolytic reperfusion of the coronary arteries in acute myocardial infarct]. / Izmenenie sokratitel'noi funktsii levogo zheludochka pod vliianiem tromboliticheskoi reperfuzii koronarnykh arterii pri ostrom infarkte miokarda.

A total of 73 patients with myocardial infarction (MI) were included into a prospective study involving intravenous and/or intracoronary streptokinase administration. The total ejection fraction (EF) and the extent of left ventricular dys- and akinetic areas were measured by contrast ventriculography in the first 3-9 hours and 4 weeks after the onset of MI symptoms. Coronary reperfusion performed in the first 3 hours after the onset of symptoms in patients with anterior MI (n = 8) and following 3-9 hours (mean 6.6 +/- 0.89 hours) in patients with inferior MI (n = 17) significantly (p less than 0.05) reduced the extent of dys- and akinetic areas from 20.5 +/- 4.16 to 6.0 +/- 3.99 and 10.0 +/- 1.56 to 5.0 +/- 1.74%, respectively) following 4 weeks. EF significantly (p less than 0.01) increased in the former and tended to show an increase from 51.0 +/- 2.44 to 64.0 +/- 2.26% (p less than 0.1) in the latter. In patients with anterior MI (n = 19) there was a tendency to a decrease in the extent of dys- and akinetic areas from 26.0 +/- 2.85 to 17.0 +/- 3.9 (p less than 0.1) following 3-9 hours. No substantial changes were observed in the values of left ventricular dys- and akinesis and EF in patients with anterior (n = 13) and inferior (n = 16) MI without coronary reperfusion.

[Limitation of the extent of a myocardial infarct by lysing the thrombus using intracoronary streptokinase]. / Ogranichenie razmera infarkta miokarda u bol'nykh putem lizisa tromba vnutrikoronarnym vvedeniem streptokinazy.

A total of 66 patients with acute myocardial infarction (MI) were examined: 39 of them received treatment with intracoronary administration of streptokinase within the first 3-20 h from the beginning of anginal pains, the other 27 patients (controls) were treated using routine methods. Occlusion of the coronary artery (CA) was found in 31 of 39 patients of the intervention group, stenosis over 75% was found in 8 patients. CA recanalization was achieved in 21 of 31 patients with CA occlusion. CA stenosis of various degree remained at the site of former occlusion in all the patients after recanalization. Repeated coronarography in 28 days showed reocclusion of the coronary artery at the site of stenosis in 20% of the cases. Blood flow restoration in the CA was often accompanied by the appearance of ventricular arrhythmias. Data on precordial ECG mapping (35 leads) showed the development of lesser size MI in the patients with the restored blood flow in the CA as compared to the group on routine therapy.