[Treatment and prevention of critical states in cardiovascular diseases].
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Biomedical subjects
Publications and source records attributed to A P Golikov.
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The paper deals with application of modern medicines (ebrantil, dalargin, dilzem-retard, nematop, enalapril) for treatment of hypertensic crisis, and the authors' experience in application of the antioxidative agent mexicor in complex therapy of this disorder.
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Mexicor (5% solution and capsules) was used in 40 of 80 conventionally treated patients with acute myocardial infarction. The drug was given intravenously for 5 days, than intramuscularly (6-9 mg/kg) for 9 days and orally (0.1 mg t.i.d.) thereafter until discharge. Severity of oxidative stress was evaluated by K coefficient. Calculation of this coefficient required data on degree of oxidation of lipids in blood serum, serum levels of diene conjugates, malonic dialdehyde, alpha-tocopherol and ceruloplasmin. These parameters as well as activity of superoxide dismutase, glutathione peroxidase and catalase in erythrocytes were measured at admission, on days 2, 3, 7, 14 and at discharge. Mexicor treated compared with untreated (n=40) patients were characterized by diminished severity of oxidative stress at the account of lower levels of lipid peroxidation products and augmented compensatory potential of the endogenous antioxidant system.
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AIM: To study efficacy of cytoprotector mexicor in patients with unstable angina (UA), acute myocardial infarction (MI), hypertensive crises (HC) in combined therapy with conventional drugs. MATERIAL AND METHODS: An open randomized study included 338 patients with acute forms of ischemic heart disease (IHD) and arterial hypertension running with crises. Combined therapy of 20 patients with UA, 90 patients with MI and 43 patients with HC (study groups) was supplemented with mexicor in a dose 6-9 mg/kg/day. The control matched patients (20, 86 and 79 patients, respectively) received conventional treatment alone. The effects of the treatments were assessed by ultrasound investigation of the heart in M-, B- and Doppler modes, by ECG and arterial pressure 24-h monitoring, by activity of lipid peroxidation (LPO). RESULTS: Adjuvant therapy of urgent cardiological conditions with mexicor diminished oxidant stress, left ventricular dysfunction. In MI patients mexicor promoted reduction of the akinesia zones, recovery of disturbed segmentary contractility. In UA patients mexicor contributed to more pronounced decrease in the frequency, duration and severity of myocardial ischemia, enhanced stabilization of angina. In HC patients mexicor promoted earlier normalization of a 24-h AP profile and variability of cardiac rhythm, recurrence rate of HC decreased 2-fold. CONCLUSION: The addition of mexicor to conventional therapy of UA, MI, HC improves clinical course of these diseases, reduces oxidant stress, accelerates recovery of cardiac contractility and left ventricular diastolic function, normalization of central hemodynamics.
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AIMS: To evaluate the safety and efficacy of levosimendan in patients with left ventricular failure complicating acute myocardial infarction. METHODS AND RESULTS: Levosimendan at different doses (0.1-0.4 microg x kg(-1) x min(-1)) or placebo were administered intravenously for 6h to 504 patients in a randomised, placebo-controlled, double-blind study. The primary end-point was hypotension or myocardial ischaemia of clinical significance adjudicated by an independent Safety Committee. Secondary end-points included risk of death and worsening heart failure, symptoms of heart failure and all-cause mortality. The incidence of ischaemia and/or hypotension was similar in all treatment groups (P=0.319). A higher frequency of ischaemia and/or hypotension was only seen in the highest levosimendan dose group. Levosimendan-treated patients experienced lower risk of death and worsening heart failure than patients receiving placebo, during both the 6h infusion (2.0% vs 5.9%; P=0.033) and over 24h (4.0% vs 8.8%; P=0.044). Mortality was lower with levosimendan compared with placebo at 14 days (11.7% vs 19.6%; hazard ratio 0.56 [95% CI 0.33-0.95];P =0.031) and the reduction was maintained at the 180-day retrospective follow-up (22.6% vs 31.4%; 0.67 [0.45-1.00],P =0.053). CONCLUSION: s Levosimendan at doses 0.1-0.2 microg x kg(-1) x min(-1) did not induce hypotension or ischaemia and reduced the risk of worsening heart failure and death in patients with left ventricular failure complicating acute myocardial infarction.
The analysis of diagnosis and treatment of myocardial infarction (MI) at a prehospital stage and in critical care units suggested measures how to improve qualification of prehospital and critical care cardiological staff. Realization of the measures promoted a reduction of lethality in MI patients.
When used for the treatment of hypertensive crises enalaprilat produced pronounced lowering of both systolic and diastolic blood pressures. Lowering of blood pressure was accompanied by regression of clinical symptoms. There were no episodes of excessive blood pressure drop. The use of enalaprilat was associated with normalization of parameters of central and cerebral hemodynamics, lessening of degree of strain of regulatory systems of the body. Diminishment of left atrial dilatation and augmentation of left ventricular ejection fraction occurred in patients with initially dilated left atrium.
Parameters of oxidative stress were studied in 44 patients with grade II-III essential hypertension and cerebral variant of hypertensive crisis. All patients received antihypertensive treatment. Mexidol was administered intravenously (300 mg o.d.) for 7 days starting with the second day of a hypertensive crisis. Control group consisted of 27 patients who were not treated with mexidol. The level of lipid peroxidation products and parameters of antioxidative system were used for assessment of the state of oxidative stress. Significant increases of the coefficient of oxidative stress were registered at all study points in patients who were not treated with mexidol. Treatment with antioxidant mexidol was associated with decreased coefficient of oxidative stress throughout the whole study period (up to 14-th day).
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AIM: To study effectiveness of natural combined medicine pumpan in patients with ischemic heart disease (IHD) including cases with concomitant arterial hypertension (AH). MATERIAL AND METHODS: 35 patients with different forms of IHD (myocardial infarction, stable and unstable angina pectoris of functional class III-IV) received conventional treatment combined with pumpan given for 7-11 weeks. Changes in clinical condition, biochemical blood indices, ECG, echo-CG, 24-h arterial pressure monitoring data were investigated. RESULTS: The addition of pumpan to the standard therapy reduced frequency of anginal attacks, improved intracardiac hemodynamics, psychic and adaptive indices. CONCLUSION: Pumpan is a good adjuvant to conventional treatment of various IHD forms including combination of IHD with AH. Pumpan enables reduction in the required doses of beta-blockers, ACE inhibitors, nitrates, sedatives. It also provides hypocoagulatory and hypocholesterolemic effect.
Examination of 159 diphtheria patients diagnosed myocarditis in 64 of them. The latter were divided into 3 groups: with mild, moderate and severe myocarditis. The patients with and without diphtheria have undergone two-dimensional echocardiography with estimation of the asinergia index (AI) and left ventricular (LV) ejection fraction. Pronounced systolic dysfunction was revealed only in severe diphtheric myocarditis (DM). AI rose in moderate and severe DM. By the degree of AI elevation it can be judged about myocarditis severity and the disease prognosis. Regional LV contractility and LV systolic dysfunction were correlated. A group of patients with severe DM was identified who had a high risk of death in akinesia of LV segments (IA > 2) and lowering of LV ejection fraction below 35%.
Current trends in the treatment and outcome of acute myocardial infarction were studied in a trial entering 2411 patients with macrofocal myocardial infarction (MI) treated in 1993-1998. There were many cases of severe and repeated MI. The age of the patients tends to increase. Lethal outcomes' probability is very high in multiple stenosis of the coronary arteries. This condition is associated with a high risk of cardiac insufficiency progression because of inadequate blood supply to necrosis-free myocardial zones. Thrombolytic therapy (TLT), ACE inhibitors reduce lethality but their use is limited by such factors as concurrent diseases, time from MI onset, rethrombosis risk. As a result, only 1/5 of the patients received pharmacological treatment. Balloon angioplasty is indicated in contraindications to TLT, in TLT failure or large residual stenosis. ACE inhibitors slow down the progression of cardiac insufficiency giving time for surgical revascularization. Updated treatment of MI improved its outcomes, but further progress in lowering MI lethality will be insignificant unless efficient methods providing adequate blood supply to the myocardium are introduced.