[Classification of the functional state of patients with ischemic heart disease according to the results of exercise test].
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Biomedical subjects
Publications and source records attributed to L S Matveeva.
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The time indices and the indices of changes in left ventricular diameter in accordance with the phases of diastolic relaxation were studied by simultaneous recording of the echo-, electro-, phono-, and apexcardiograms in 24 patients with ischemic heart disease and in 8 individuals with no affection of the coronary arteries. The findings were compared with the results of selective coronaroangiography. The dependence of the degree of the disturbed left ventricular diastolic relaxation on the extent of coronary atherosclerosis is shown.
Stenosis and thrombosis of the main renal artery were detected in 248 of 867 patients with arterial hypertension (28%). The combination of renal artery stenosis with pyelonephritis was encountered in 19% (46 subjects) of patients with the affected main renal artery. The syndrome of malignant arterial hypertension in the combined affections was diagnosed in 39.1% of patients. The study of the total renal filtration function in combined diseases may be of prognostic importance from the standpoint of normalization of arterial pressure after surgical treatment.
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Correlation-statistical analysis of the roentgenocardiometric indices and the findings of left ventriculography in 30 patients with arterial hypertension was conducted. A significant inter-relationship of the roentgenometrical criteria of enlargement of the heart (cardiothoracic index, the extent of convexity of the arch of the pulmonary artery and, to a lesser measure, the cardiac volume) with the mass of the myocardium and the thickness of the left ventricular wall was revealed. The roentgenological criteria may complement the existing methods of the assessment of the degree of myocardial hypertrophy in arterial hypertension.
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Echocardiographic examination was conducted in 41 patients with ischemic heart disease. The results were compared with the findings of ventriculography. It was established that echocardiography reveals the presence of zones of asynergia in the left ventricular myocardium in the diaphragmatic and anterolateral areas in a high percentage of cases, but it is practically impossible to determine affection of the apical segments by this method.
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Thirty patients with panarteritis of the aorta and its branches were investigated. The disease was verified by aortography, coronarography and autopsy data. On third of the patients had no clinical signs of the lesions of the coronary arteries, and ECG did not show myocardial hypertrophy. Coronaroangiography demonstrated lesions of the openings of the major coronary arteries by the type of the "burnt tree". Morphological picture and localization of the lesions were typical for the disease.
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The clinical course of ischemic heart disease was followed-up for 3 to 5 years after coronarography in 91 patients with atherosclerotic affection of the coronary arteries who had not been given purposeful treatment. In 30.8 per cent in cases the clinical picture of the disease grew worse: angina of effort became more frequent angina at rest occurred (19.8%), and myocardial infarction (7.7%) and symptoms of circulatory insufficiency (3.3%) developed. A lethal outcome was recorded in 16.5% of cases. A connection between the extent of the atherosclerotic process (the number of vessels involved) and the advancement of the disease was revealed.
A distinct increase in the aggregative property of blood platelets, displayed by an increased degree of aggregation and enlargement of the platelet aggregates, was revealed in patients with ischemic disease of the heart. The more severe the atherosclerotic process in the coronary arteries (according to the findings of selective coronarography), the more is the aggregative property of platelets intensified. The stimulating effect of smoking on platelet aggregation was also established.
The ventriculograms of patients with chronic postinfarction aneurysm of the heart were studied with the use of separate analysis of the contraction indices of the functioning and non-functioning parts of the left ventricular myocardium. Relatively high indices of the ejection fraction of the functioning part of the myocardium with low indices of the total ejection fraction were noted. A correlative dependence was found between the total ejection fraction and the ratio of the volumes of the nonfunctioning part of the myocardium during systole and diastole to the total volume of the left ventricle during the same phases, which is evidence that these indices are important in appraising myocardial contractile function in aneurysm of the heart.
The results of long-term continuous ECG recording during 24 hours in 50 patients are presented. A comparison of these data with the results of a clinical examination and selective coronary angiography has revealed that patients with chronic ischaemic heart disease and distinct atherosclerotic changes in the coronary arteries have rhythm disorders twice as often as those free from ischaemic heart disease. The employment of the method of long-term continuous ECG recording during normal patients' activity will permit to evaluate the effect of different factors on the development of cardiac rhythm disorders.
The purpose of the work was to investigate the relationship between immediate results of the electroimpulse therapy and such roentgenocardiometric data as the voloume of the heart, the cardio-thoracic index, Moore's coefficient, the extent of the left atrium enlargement and of the radius of the contrasted esophagus deviation. An analysis of the experience gained with 197 defibrillation of the heart in patients with rheumatic heart diseases complicated by auricular fibrillation bears proof to a high degree of reliability achieved through inclusion of roentgenocardiometric data in prognosing the resultant effect of the electroimpulse therapy.