Biomedical subjects
Publications and source records attributed to Iu A Surovov.
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The informative value of dipyridamole test, transesophageal cardiac pacing, bicycle ergometer and treadmill exercise tests were compared in 65 patients suspected for coronary heart disease and Functional Classes I-III angina pectoris. The sensitivity, specificity, positive and negative predictive values of the techniques alone and in various combinations were evaluated. The incoincidence of results from exercise tests was ascertained to be 40-48%. The significance of diagnosis increased with combined functional examination and reached the maximum when all the four tests were performed. The use of the sensitivity, specificity, and predictive value of the techniques in assessing the individual test results allows the optimal scope of studies to be determined on an individual basis in order to make or exclude the diagnosis of coronary heart disease.
The diagnostic potentialities of bicycle ergometry (BEM) and treadmill test were comparatively analysed in 57 males aged 37-64 years who were examined to detect coronary heart disease. In 34 cases, the results of BEM and treadmill test were consistent, of them 13 were positive, 15, negative, 3 intermediate, and 3 inadequate. With positive results, the treadmill test was more reliable than BEM in revealing the criteria for ischemia from statistically significantly more pronounced ST-segment depression at a lower threshold heart rate. Inconsistency of the BEM and treadmill test results was found in 23 cases. In 14 of 18 patients who had indefinite BEM results, the treadmill test allowed one to make a definite conclusive diagnosis, showing 6 positive and 8 negative results. This is accounted for by lower cases when the treadmill test was discontinued due to a hypertensive reaction of blood pressure or fatigue. The study indicated that the treadmill test was more sensitive and better tolerated than BEM.
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Changes in left diastolic filling which had been caused by treatment with the beta-adrenoblocker atenolol given in a dose of 50-100 mg/day were studied in 66 patients with Functional Class I-II exercise-induced angina pectoris. Echocardiography was performed during isometric exercise tests before and 7-9 days after drug administration. It was ascertained that not only ino- and chronotropic mechanisms, but redistribution in diastole patterns in the direction of increasing atrial systole were involved to adequately maintain cardiac output during exercise. Ejection fraction became higher in response to exercise with predominant myocardial mass, whereas atrial systolic fraction, with predominant dilatation. The drug produced its negative inotropic effect in the patients with predominant left ventricular dilation; a decrease in the rapid filling fraction was not followed by an increase in the atrial systolic fraction, which may be regarded as an early sign of myocardial failure.
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Problems of early diagnosis, prophylaxis and therapy of chronic cor pulmonale (CCP) were discussed. It was pointed out that the right ventricular hypertrophy could not be regarded as the main diagnostic sign of CCP as it was recognized at late stages of diseases when therapy was of low efficacy. The authors proposed to specify CCP clinico-functional definition with 4 functional classes with relation to the expression of disturbances of ventilation function of the lungs and hemodynamics. The results of isoket and corinfar therapy of 250 patients with obstructive bronchitis of various gravity of ventilation and hemodynamic disturbances were presented. They showed that the use of prolonged nitrates was found appropriate in the patients of the 3rd-4th functional classes with signs of developed CCP. The use of prolonged nitrates in the patients of the 1st-2nd functional classes resulted in an increase of pulmonary functional shunting of the blood. Calcium antagonists made a balanced effect on the bronchial permeability and pulmonary hemodynamics. Their use was indicated at early stages of the process when functional mechanisms played the leading role in the pathogenesis of disturbances.
Thirty-three patients with infectious allergic bronchial asthma and chronic obstructive bronchitis and 47 normal subjects were examined with the aid of a complex of bloodless research methods for the pulmonary circulation and central hemodynamics under graded physical exercise of minor power. Investigation at rest did not disclose any hemodynamic disorders in the greater and pulmonary circulation. Application of bicycle ergometry to patients with chronic obstructive bronchitis and bronchial asthma in a stage of remission made it possible to reveal latent hemodynamic disorders of the pulmonary circulation that manifested by long-term elevation of the pressure in the pulmonary artery and pulmonary vascular resistance, restitution of the central hemodynamics according to the hyperkinetic type. The use of the generally accepted formulas for calculating the proper magnitudes of the ejection period and mechanical systole with the heart rate exceeding 90 per minute resulted in overdiagnosis of the overload of the right ventricle. The authors offer the regression equations for calculating these parameters during tachycardia.
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