[Peculiarities of pregnancy management after multiple stenting of coronary arteries].

This paper describes the strategy for pregnancy and labour management in women with the history of myocardial infarction after multiple stenting of coronary arteries using stents with cytostatic coating. The authors discuss a broad range of diseases underlying coronary lesions in young pregnant women receiving antiaggregation therapy. Neither multiple stenting nor intake of aspirin and ticlopid provoked teratogenic effect.

[A newly diagnosed intraventricular septal defect in a pregnant woman presenting with pulmonary hypertension].

This clinical description of pregnancy follow-up and labour management in women with severe pulmonary hypertension caused by an interventricular septum defect is intended to familiarize practicing physicians with the methods for maintaining pregnancy and ensuring spontaneous delivery despite the said pathology. Indispensable conditions for the attainment of these goals include thorough clinical and laboratory control, comprehensive analysis of possible complications, efficacious epidural anesthesia, and correct choice of medicines.

[Pregnancy management and spontaneous labor in heart diseases: present-day solution to the dilemma].

AIM: to study cardiac rhythm variability (CRV), to optimize pregnancy management tactics and to choose a delivery procedure. SUBJECTS AND METHODS: Ninety-six 19-to-37 year-old (mean age 28.3 +/- 9.4 years) women at 35-39 weeks gestational age were examined. All the women were diagnosed as having congenital or acquired (rheumatic) heart disease. Their hemodynamics and CRV were analyzed according to the type of hemodynamic overload, for which purpose three patient groups were formed: 1) volume overload; 2) pressure overload; and 3) combined overload. A control group comprised 40 healthy pregnant women. Before and 2-3 days after delivery, all the women underwent 24-hour Holter cardiac rhythm monitoring with the estimation of the temporary and spectral parameters of CRV. RESULTS: In antepartum heart diseases accompanied by volume overload, there was a tendency for total CRV (SDNN 95.4 +/- 15.8 msec versus 125.5 +/- 17.8 msec in the controls) to decrease and for sympathetic activity to significantly increase (SDANN 65.7 +/- 13.7 and 109.9 +/- 14.7 msec, respectively; p < 0.05). When pressure overload (a moderate gradient) developed, the temporary parameters of total CRV, sympathetic and parasympathetic activities did not differ from those in the control group. Heart diseases attended by pressure overload and a high gradient were characterized by a significant reduction in total CRV (100.5 +/- 24.6 msec; p < 0.05) as compared with those in patients having a moderate pressure gradient, with a declining trend for total spectrum power, Group 3 patients showed a reduction in all the indices reflecting the temporary and spectral characteristics, suggesting a considerable rise in sympathetic activity and a decrease in total autonomic spectrum power. CONCLUSION: Based on SRV studies, indications for prolonged pregnancy and spontaneous or, in some cases, surgical delivery can be assessed in pregnant women with heart diseases.

[Kawasaki disease in an adult European].

A case of Kawasaki disease is reported with manifestations of autoimmune vasculitis and predominant affection of coronary arteries. The relevant literature review describes major symptoms of this pathology and risk factors of its atypical forms. It is emphasized that rare occurrence of Kawasaki disease among non-mongoloid subjects should not make the general practitioner les suspicious of this condition.

[Optimization of antihypertensive therapy in pregnant women using 24-hour arterial pressure monitoring].

The purpose of the investigation was to study peculiarities in the parameters of 24-hour arterial pressure monitoring (APM) in pregnant women with various extragenital and obstetric pathologies to define indications to administration and optimization of hypotensive therapy. The results of 24-hour APM of 558 pregnant women with a suspected arterial hypertension (AH) of different origins were matched with peculiarities of pregnancy and its outcome (gestosis, an abortion due to AH complications, serious obstetric complications such as intrauterine fetal death or detachment of placenta). The control group consisted of 41 women without cardiovascular diseases or any complications during pregnancy. The analysis of the results made it possible to offer a classification of 24-hour curves of systolic and diastolic arterial pressure and heart rate based on relations between these parameters. This classification is convenient for clinical application and makes it possible not only to define indications to hypotensive therapy, but also to recommend certain pharmacological group of hypotensive preparations in each particular case. Prognostication of the development of severe gestosis or serious obstetric complications.

[Heart disease and pregnancy: grounds for confidence in the safe outcome].

Indications for prolongation of pregnancy and spontaneous delivery in women with congenital and acquired heart disease are proposed based on original observations and literature data. Special attention is given to risk factors of an undesirable outcome of pregnancy for mothers with high functional class cardiac insufficiency, high blood pressure gradient, and severe pulmonary hypertension with mitral valve and aortic stenosis.

[Supraventricular paroxysmal tachycardias during pregnancy: the therapeutic tactics and prognosis].

The paper contains recommendations on treatment of supraventricular paroxysmal tachycardias (SVPT) during pregnancy. The recommendations are based on contemporary literature data and authors" own data. SVPT in postural syndrome are shown to be benign and to demand no continuous antiarrhythmic therapy, while tachycardiac attacks are terminated by vagal tests and adenosine application. Relapsing and steady forms of SVPT with a high heart rate are accompanied by subjective symptoms and require preventive antiarrhythmic therapy, which should be conducted considering risk/benefit ratio. According to the authors, sotalol is the most effective and safe pharmaceutical.

[The ECG-phenomenon of ST segment elevation: the reasons for it and its clinical significance].

The authors adduce a detailed analysis of the reasons for ST segment elevation, which is found in patients with various pathologic conditions and in some normal individuals, basing this analysis on their own experience and literature data. The authors pay special attention to differential ECG-diagnostics of ST elevation, which plays the most significant part in practice.

[Principles of rehabilitation in major occupational diseases].

The article deals with personal experience and literature data, basing recommendations on rehabilitation of patients with occupational diseases. Rehabilitation measures include better work conditions, job placement of individuals in whom the disease was not caused by etiology factor, rehabilitation through medical and nonmedical measures.

[Significance of the system of atrial natriuretic peptides in heart failure and hypertension]. / Znachenie sistemy predserdnykh natriureticheskikh peptidov pri serdechnoi nedostatochnosti i arterial'noi gipertenzii.

This literature review presents current information on mechanisms of realization and action of natriuretic peptides in heart failure and hypertension. Significant role in degradation of natriuretic peptides belongs to neutral endopeptidase. Basing on theoretical and experimental data novel class of drugs - inhibitors of neutral endopeptidase - has been developed. The paper contains discussion of first results of the use of drugs from this class for the treatment of chronic heart failure.

[Pathogenesis, clinical picture, and diagnosis of myopericarditides]. / Patogenez, osobennosti kliniki i diagnostiki mioperikarditov.

Basing on own data and literature survey the authors analyze clinical course of viral myopericarditides. Special emphasis is made on evolution of electrocardiographical signs in which four stages are distinguished. It is noted that incidence of hemorrhagic myopericarditides probably of viral nature is increasing. The paper contains recommendations on treatment of patients with myopericarditis. The disease has favorable prognosis. However prognosis of diffuse myopericarditis remains unfavorable and its rational treatment - insufficiently established.

[Disorders of the hemodynamics and myocardial structure in patients with infectious-allergic myocarditis complicated by heart failure]. / Narusheniia gemodinamiki i struktury miokarda u bol'nykh infektsionno-allergicheskim miokarditom, oslozhnennym serdechnoi nedostatochnost'iu.

A study of 30 patients with infectious-allergic myocarditis, accompanied with chronic heart failure made use of echocardiography, hemodynamic assessment by cardiac catheterization, endomyocardial biopsy. A relationship is demonstrated between hemodynamic changes and the lesion of cellular ultrastructural apparatus, mitochondria, in particular. Patients with first-stage heart failure associated with infectious-allergic myocarditis showed incomplete diastole, while systolic changes were found in patients with severe manifestation of circulatory insufficiency.

[Various factors determining the fatal outcome in myocarditis]. / O nekotorykh faktorach, opredeliaiushchikh letal'nyi iskhod pri miokarditakh.

A study of 38 patients with infectious-allergic myocarditis included clinical laboratory investigation, echocardiography, catheterization of the right heart compartments and the pulmonary artery and endomyocardial biopsy. It has identified adverse factors contributing to fatal outcome: increased end-diastolic pressure in the pulmonary artery, low cardiac output, signs of macrofocal fibrosis and small ejection fraction.

[Disorders of the central and intrapulmonary hemodynamics as an index of the degree of severity in myocarditis patients]. / Narusheniia tsentral'noi i vnutrilegochnoi gemodinamiki kak pokazatel' stepeni tiazhesti bol'nykh miokarditom.

Central and intrapulmonary hemodynamic parameters were examined by direct and indirect methods in 46 patients with myocarditis (25 females and 21 males), which revealed diminished myocardial contractility, which was followed by a regular and significant pulmonary blood pressure and a reduction in the elastic properties of the pulmonary-arteriolar bed. Central and intrapulmonary hemodynamic changes are mostly associated with the development of hypodynamia and more rarely with that of the phase hemodynamic syndrome and more rarely with the volume overloading syndrome.

[Cardiogenic shock in dilated cardiomyopathy]. / Kardiogennyi shok pri dilatatsionnoi kardiomiopatii.

The present communication is based on an examination of 33 cases with dilated cardiomyopathy and 48 with severe myocarditis. Nine patients with dilated cardiomyopathy were diagnosed as having developed cardiogenic shock. Clinical examination, echocardiography, right heart and pulmonary artery probing were performed. Cardiogenic shock in dilated cardiomyopathy was demonstrated to be characterized by a progressive decrease in cardiac contractility, no increase in peripheral vascular resistance, and high pulmonary hypertension. Profound cardiomyocyte alterations followed by increased fibrosis of intermuscular and perivascular spaces contribute to the development of cardiogenic shock in dilated cardiomyopathy.

[Study of myocardial morphology in chronic obstructive bronchitis complicated by pulmonary hypertension based on the results of endomyocardial biopsy]. / Morfologiia miokarda pri khronicheskom obstruktivnom bronkhite, oslozhnennom legochnoi gipertenziei, po rezul'tatam éndomiokardial'noi biopsii.

Endomyocardial biopsy along with right heart catheterization was first performed in 12 patients with chronic obstructive bronchitis complicated by transient or sustained pulmonary hypertension. Light and electron microscopic findings showed signs of severe myocardial dystrophy in 7 patients and prevalent hypertrophy in the remaining patients. Endomyocardial biopsy provided valuable information on the state of the myocardium, yielding evidence for the heretogeneous nature of right ventricular myocardial changes. Two morphological variants of cor pulmonale--hypertrophic and dystrophic--could be identified with regard to the findings.

[Correlation analysis of hemodynamic and morphological parameters in patients with myocarditis]. / Korreliatsionnyi analiz gemodinamicheskikh i morfologicheskikh parametrov u bol'nykh miokarditom.

Central and intrapulmonary hemodynamic parameters were examined in 40 patients with myocarditis. Morphological evidence for endomyocardial biopsy specimens and morphometric findings were also analyzed. Deterioration of myocardial diastolic relaxation was found to closely correlate with the magnitude of cardiosclerotic changes and cardiomyocytic myolysis. A correlation was also established between the morphometric characteristics of the microcirculatory bed and the parameters of myocardial contractility. Functionally deficiently cardiomyocytic hypertrophy was more profound in severe heart failure.

[Hemodynamics and anaerobic glycolysis during the head-down tilt test in myocarditis patients]. / Gemodinamika i anaérobnyi glikoliz vo vremia antiortostaticheskoi proby u bol'nykh miokarditom.

The analysis is presented of the changes observed in hemodynamics and anaerobic metabolism in myocarditis patients given increasing preload. It is shown that the antiorthostatic test can specify substantial deposition of blood in the lesser or greater circulation. Patients with congestive cardiac insufficiency demonstrate more frequently increased lactate levels in the blood of the coronary sinus and reduced myocardial extraction of lactate.

[Atrial natriuretic peptides reception and physiological effects]. / Predserdnye natriiureticheskie peptidy: osobennosti retseptsii i fiziologicheskie éffekty.

The review presents current data on production, release and reception of natriuretic peptides (NUP) with special focus on NUP effects on blood circulation, urination in arterial hypertension and cardiac failure; analyses interaction between NUP and renin-angiotensin-aldosterone system, effects of new drugs influencing these systems.

[Myopericarditis: clinical picture, diagnosis and treatment]. / Osobennosti kliniki, diagnostiki i lecheniia mioperikarditov.

Clinical characteristics of viral myopericarditis are analysed basing on the original and literature data. Four evolutionary stages of electrocardiographic image of the disease are described. Higher incidence of hemorrhagic myopericarditides is stated. These are suggested to have a viral nature. Steroid glucocorticoids produce a satisfactory therapeutic effect. The prognosis of the disease is favourable.