The pathophysiological basis of the destabilization of the clinical course in ischemic heart disease

The role of the coagulative blood system in initiation of acute coronary events was investigated on patients with different clinical forms of ischemic heart disease (IHD). The obtained results indicate that unstable angina (UA) and myocardial infarction (MI) are two independent forms of the acute IHD with distinct qualitative peculiarities. The most common feature of UA was an increase in the functional activity of platelets both in cases proceeded in MI and in uncomplicated cases. It means that these changes may be treated as the main pathogenic factor if UA but not as a mechanism of its transformation to MI. But high degree of the risk of MI development appears if these changes are combined with preceding significant disturbances in the haemostatic balance as a result of inhibition of the activity of anticoagulative and fibrinolytic blood systems. These data show that differentiation of the diagnosis between UA and MI in its initial stage and the choice of the treatment principles should be based on the careful investigation of the coagulative potential of blood and of its most important components.     

The effect of long-term Enduracin monotherapy on the clinical and biochemical status of patients with ischemic heart disease

13 patients aged 39 to 60 years with coronary atherosclerosis confirmed at selective coronary angiography combined with primary hyperlipidemia (phenotypes 2a and 2b) received enduracin in a dose 1500 mg/day. As a result of the treatment total cholesterol (TC) and LDL cholesterol lowered by 10.3 and 13.1%, respectively, whereas HDL cholesterol rose by 15.2%. Half of the patients demonstrated activation of hepatic transaminases, but discontinuation of the drug was not necessary. In 3 out of 4 patients after 2 years of enduracin treatment stabilization of atherosclerosis was observed. Thus, long-term enduracin is able to inhibit progression of atherosclerosis in coronary heart disease patients.     

Sotahexal pharmacodynamics in patients with ischemic heart disease

Therapeutic and prophylactic antiarrhythmic efficacy of sotalol hydrochloride (Sotahexal, "Hexal", Germany) and its effects in intracardiac hemodynamics and ECG parameters were evaluated in 95 patients with ischemic heart disease (IHD). The highest response to the drug was observed in ventricular extrasystoles, arterial flutter and fibrillation. Acute episodes of arrhythmia are managed by bolus administration of Sotahexal [correction of Hexal]. In this case greater risk of side effects exists. It is desirable to decide on the drug dose, mode of administration on the individual basis with due consideration of the risks and dangers which could be avoided in case of adequate instrumental control.     

Cardiopulmonary diagnosis in patients with ischemic heart disease

It may be established that the complex cardiopulmonary functional diagnostics in patients with chronic ischaemic heart disease obtained the following essential results: 1. The ergometrically achieved total functional capacity is clearly decreased in all age groups compared with the healthy persons, the differences are highly significant. 2. The proof of a coronary insufficiency got by the electrocardiogram after work is to be regarded as a factor limiting the functional capacity. 3. 72% of the patients reveal under load a PAEDP increased more than the normal of 25 Torr. After exclusion of a respiratory insufficiency these findings must be regarded as a disturbed myocardial function. 4. Thus the increased PAEDP under load apart from the well-known triad (angina pectoris under load, decreased total functional capacity, pathological ECG after work) is a sensitive and decisive factor for proving the disturbed cardial function in chronic ischaemic heart disease.     

The effect of latent carbohydrate metabolic disorders on the serum lipid spectrum in patients with ischemic heart disease and hypertension

Overall eighty four patients suffering from ischemic heart disease (IHD) and hypertensive disease (HD) were evaluated for levels of glycated hemoglobin (gly-Hb) in blood and effects of glycating on blood serum lipid spectrum. Elevated gly-Hb levels were recordable in 51.1% of the patients. Such patients showed significant augmentation of content of total lipids, triglycerides, total cholesterin, Burstein's test, rise in the coefficient of atherogenicity as compared to those subjects having normal gly-Hb level. Positive correlation was established between gly-Hb, levels of total lipids, triglycerides. Given in this paper are the following recommendations for IHD and HD patients presenting with increased gly-Hb level: restricted consumption of easily assimilable carbohydrates, diet N 9, no diabetogenic drugs.     

The treatment of ischemic heart disease in patients with chronic kidney failure

An analysis of the initial type of central hemodynamics and the postoperative period in 177 patients aged older than 70 years having calculous cholecystitis has shown that surgical treatment of patients with the normo- and hyperdynamic types of circulation even with concomitant diseases can give positive results. The least favourable regimen of blood circulation proved to be the hypodynamic type characteristic of patients with pronounced disturbances of homeostasis and/or with recent myocardial infarction.     

The stress-limiting action of low-intensity laser radiation in patients with ischemic heart disease

In 20 patients with exercise-induced angina, the cold test brought about activated lipid peroxidation, modified the lipid phase of a red cell membrane, which correlated with systolic changes. Following a month laser therapy, it did not cause no activation of lipid peroxidative processes, significant changes in the organization of a cell membrane lipid bilayer, or any profound cardiac performance abnormalities, which gives grounds to state that laser radiation exerts membrane-stabilizing and antistress effects. The findings suggest that laser therapy should be used in coronary heart disease patients having a functional component of coronary insufficiency.     

Some metabolic relationships in young patients with ischemic heart disease

The interrelationships between body weight, insulin secretion and serum lipids were studied in 40 young white patients (mean age 37 years) with established ischemic heart disease (IHD), living in Johannesburg. None was severely obese, hypertensive or overtly diabetic. In general, strong positive correlations were found between body weight and insulin concentrations and between insulin levels and fasting serum triglycerides. However, insulin levels were relatively low in 4 patients with marked hypertriglyceridemia (above 350 mg/dl). These data are consistent with the postulate that insulin promotes (hepatic) triglyceride synthesis, but when there is gross hypertriglyceridemia peripheral triglyceride clearance becomes defective. Insignificant correlations were observed between body weight and serum lipids and between cholesterol and other metabolic variables. We conclude that there is a sequential link between increasing body weight, insulin secretion and triglyceride levels in young patients with IHD, but that cholesterolemia is independent of this axis.     

Frequency of silent ischemic heart disease in patients with diabetes mellitus

Early detection of silent ischaemia plays an important role in prevention of sudden cardiac death and acute myocardial infarction. More frequent occurrence of silent ischaemia in patients with diabetes mellitus and manifestations of ischaemic heart disease has been relayed in several studies. No studies aimed at frequency of occurrence of silent ischaemia in diabetic patients without clinical symptoms of ischaemic heart disease have been performed yet. Objectives of this study were the examination of the latter case. This study involved 67 patients with diabetes mellitus without clinical symptoms of ischaemic heart disease. The average duration time of diabetes mellitus was 11 years. The patients were divided in two groups. The first group included 26 patients with insulin dependent diabetes mellitus. The second group included 41 patients with non insulin dependent diabetes mellitus. The first control group consisted of 35 non diabetic patients with ischaemic heart disease, and the second control group consisted of 22 healthy volunteers. 24-hours ambulatory Holter monitoring and ECG exercise test were performed in all subjects. The diagnosis of silent ischaemia was established in patients with positive results of both examinations in ECG-records without any following pain. In case of only one positive results the dipyridamole stress echocardiography test with ECG was carried out to prove the diagnosis. It was proved, that silent ischaemia occurs in 19.2% of patients with insulin dependent diabetes mellitus and in 22% non insulin diabetic patients. No statistic differences between frequency of silent ischaemia occurrence in both groups were revealed. The application of 24-hours Holter monitoring combined with ECG-exercise stress test seems to be the best method in early recognition of silent ischaemia in diabetic patients.     

Clinical significance of the urinary oxygen tension in patients with ischemic heart disease

The clinical significance of the urinary oxygen tension (PuO2) was evaluated in 60 patients with ischemic heart disease. The PuO2 had fair relations to cardiac index and serum creatinine level (r = 0.73 and r = 0.73, respectively). Although the PuO2 had a fair relation to serum creatinine in patients with a low cardiac index, there was no relation to the cardiac index. In patients with increases in PuO2 from day 1 to day 2, the cardiac index increased, and the serum creatinine level decreased on the 2nd day, whereas a sustained decrease in cardiac index and an increase in serum creatinine were observed in patients with a decrease in PuO2 from day 1 to day 2. Thus, PuO2 can be used as an indicator of the renal function in patients with ischemic heart disease.     

Quantitative composition of blood plasma prostaglandins in patients with ischemic heart disease

A 6-month prospective study was conducted among 1739 women who underwent therapeutic abortion at Kandang Kerbau Hospital in Singapore to ascertain the aftereffects of abortion. Results of the study indicate that induced abortion has no observable bad effects on the mental health of the patients. In fact, somatic and psychiatric complaints were reduced and sexual adjustment increased 6 months postoperative. Those who were also sterilized at the time of the abortion showed a slightly lower rate of somatic symptom reduction than the rest of the group.