The effect of the morphofunctional state of the thrombocytes on the activation of destabilization processes in patients with acute forms of ischemic heart disease

With the purpose of assessing the influence that platelet morphofunctional state may have on the degree of destabilization in patients with different forms of unstable angina we examined 198 patients using stress tests, Holter ECG monitoring, studying activation of thrombocytes with the aid of a luminescent-microscopy technique, and performing an analysis of aggregation. Important differences have been revealed in the studied parameters in those patients presenting with freshly detected and progressive stenocardia and with a developing, despite of the treatments administered, myocardial infarction, that might be caused by abnormal shifts in the thrombocyte intact/activated forms ratio.     

The inotropic reactions of the human heart muscle in ischemic heart disease

The investigation were performed on trabeculae extracted from right auricle of IHD patients aged 40-55 years during aortocoronary bypass. In transitory increase of stimulation frequency from 0.5 up to 1 Hz, a significant decrease of developed tension (Tmax), of the rate of its increase (T'max) and decrease (T'min) by 37% on the average were observed. On the contrary, stimulation frequency decrease up to 0.1 Hz caused, Tmax, T'min and T'max increase, by 20 + 4, 16 + 3 and 13 + 4 respectively (p < 0.05). The effect of hypercalcium (4 mM Ca2+) solution led to Tmax increase by 324%, T'max--by 254% and T'min by 383%, meanwhile the T'min/T'max ratio being initially equal to 0.3, increased to 0.4. Adrenalin caused not only the same Tmax increase (by 322%) as did Ca2+ but the same response of the rate parameters (T'min/T'max, 0.4--fold). The decrease of stimulation frequency to 0.1 Hz associated with Ca2+ or adrenalin effects resulted in additional increase of contractile activity. It was concluded that the contractile apparatus of myocardium in IHD patients retained sufficient functional reverse, accompanied by changes in the regulation of Ca(2+)-transporting systems.     

Thrombosis in ischemic heart disease

Thrombus formation on a fissured or disrupted atherosclerotic plaque is the main pathogenetic mechanism for the acute coronary syndromes of myocardial infarction and unstable angina. Myocardial infarction results from an acute total occlusion of the artery, while unstable angina is secondary in most cases to mural thrombus formation. Thrombus formation has also been implicated in chronic atherosclerotic disease progression and in restenosis following coronary angioplasty. Therapeutic measures to treat thrombus rely on the ability of drugs to either prevent thrombus extension, dissolve its fibrin component, or prevent further platelet aggregation. Other measures rely on the ability of intracoronary techniques to open coronary arteries. The primary prevention of intracoronary thrombus formation is evolving. Measures to stabilize plaques or to reduce hypercoagulability are being tested or have been tested in recent trials.     

Stenting for ischemic heart disease

This article examines current indications to intracoronary stenting for percutaneous cardiac revascularization. The data sources are a review of the published English literature, with focus on clinical and randomized trails of coronary artery stenting. Stents reduce the need for emergency bypass surgery in the setting of acute or threatened vessel closure after percutaneous transluminal coronary angioplasty (PTCA). In selected cases, when deployed electively in large native vessels with focal stenosis, clinical and angiographic recurrence are significantly reduced. Preliminary studies have also suggested a potential role in the treatment of saphenous vein graft lesions and restenotic lesions, and in improving on suboptimal results in lesions refractory to balloon dilatation. To prevent stent thrombosis, adjunctive antiplatelet therapy has been shown to be more efficacious than anticoagulation, and optimal stent apposition to the vessel wall appears to be critical. A recent exponential increase in the use of coronary stents has revolutionized the contemporary practice of interventional cardiology. Although technical factors and feasibility have been well refined and shown, evidence-based practice is lacking for many patient subsets.     

Role of noninvasive examinations in the management of ischemic heart disease.IV. Nuclear cardiology in chronic ischemic heart disease

We evaluated the circadian rhythms in the plasma concentrations of cortisol, cortisone and their free forms, and in the cortisone/cortisol ratios by means of reversed-phase high performance liquid chromatography in normal adult subjects. Plasma concentrations of cortisone, as well as cortisol, exhibited a circadian rhythm. The ratios of cortisone/cortisol remained almost constant during the waking hours of normal subjects. Changes in the cortisone/cortisol ratios previously reported in patients with various diseases exceeded the diurnal changes detected in the present study. Thus, the determination of the cortisone/cortisol ratio provides information that is useful in assessing the adrenal function of patients with various diseases.     

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.     

Changes in hemostasis in ischemic heart disease

The relationship between changes in blood coagulation, the occurrence and severity of risk factors of ischemic heart disease and the clinical condition of the patient was investigated. The at risk group of patients 42.2% had more than 3 pathological parameters. Intravascular blood coagulation was not activated in any of the patients. In patients with acute myocardial infarction (MI), 62.2% had more than 3 pathological parameters on the first day of MI development. Demonstrable activation of intravascular blood coagulation was found in 28.2% of these patients. On day 5 of MI, activation of intravascular blood coagulation was recorded in 57.7% of the patients treated by classical approach and in 15.4-30.8% of the patients on thrombolytic treatment. In the at risk group, primary hemostasis and the fibrinolytic system were more affected, in patients with MI the whole hemostatic mechanism was involved. On day 5 of MI, in patients with classical therapy pathological laboratory findings still persisted or were even more deteriorated, particularly increases in fibrinogen level. At that time, in patients on thrombolytic therapy no substantial changes of initial values were recorded. No correlation was found to exist between changes in hemostasis and the risk profile or between changes in hemostasis and the clinical severity of MI. The obtained results justify the administration of antithrombotic substances, especially in patients with unstable angina pectoris. On observing time constraints, administration of thrombolytics is justified in MI. (Fig. 9, Ref. 25.)     

Postexercise systolic blood pressure response: clinical application to the assessment of ischemic heart disease

Stress test parameters indicating the presence and extent of coronary artery disease have traditionally included such variables as exercise duration, and the blood pressure and ST-segment responses to exercise. The three-minute systolic blood pressure ratio, another important indicator of significant coronary artery disease, is a useful and readily obtainable measure that can be applied in all patients who are undergoing stress testing for the evaluation of known or suspected ischemic heart disease. The ratio is calculated by dividing the systolic blood pressure three minutes into the recovery phase of a treadmill exercise test by the systolic blood pressure at peak exercise. A three-minute systolic blood pressure ratio greater than 0.90 is considered abnormal and has a diagnostic accuracy of approximately 75 percent for the detection of coronary artery disease (i.e., an accuracy comparable to that of ST-segment depression). Higher values for the ratio are associated with more extensive coronary artery disease, as well as an adverse prognosis after myocardial infarction. Thus, the three-minute systolic blood pressure ratio provides information that is complementary to the traditional exercise test parameters for identifying high-risk ischemic heart disease.     

Ergometry and the risk factors in ischemic heart disease

The correlational connection between some factors of risk and ergometric indices in patients with ischemic heart disease was studied. The results of an examination covering 188 patients and 56 practically healthy persons which involved the use of a graded stepwise increasing loading on a veloergometer under a monitored control of the pulse rate, ECG and arterial pressure were analyzed. To the risk factors were referred hypercholesterinemia, hypertension, smoking, obesity and hypodynamia. With a rising number of risk factors a significant and progressive decline of the patients' physical performance capacity was ascertained. The most essential correlational connection between the risk factors and the maximally tolerable load and chronotropic and aerobic reserves was educed.     

Disorders of intraventricular conductivity in ischemic heart disease

An experience of the vascular surgery department with reconstructive interventions on large arteries of patients with malignant tumors of the lower extremities soft tissues, located in the zone of large vessels of the inguinal region, femur and popliteal fossa, is reported. According to the author's opinion, it is necessary to take into account the fact that in reconstructive procedures on large arteries in patients, subjected to massive repeated radiotherapy, there is an increased danger of occurrence of arrosion hemorrhage, extensive thrombosis of vascular grafts and arteries changed under the effect of ionizing radiation.