[Prognostic evaluation of the effects of nitroglycerin and corinfar in the prevention of stress-induced myocardial damage].
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Biomedical subjects
Publications and source records attributed to V G Rusetskaia.
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Two groups of patients with myocardial infarction were compared for outcomes of rehabilitation. In group 1, rehabilitative therapy was performed by using conventional methods. In group 2, that was done on the basis of early activation and application of physical trainings 2 weeks following myocardial infarction. Physical trainings caused an increase in exercise tolerance and myocardial contractility and a decrease in left ventricular failure, which enhanced the proportion of individuals who returned to work and diminished deaths at a 2-year follow-up.
Intensive physical training were examined for their impact on tolerance for information loading at various stages of restorative therapy in 62 males of productive age who had extensive myocardial infarction. It was established that the physical training performed at the hospital stage reduced the incidence of ischemic responses to information loading at all stages of restorative therapy. At the same time the physical training in patients with myocardial infarction promote higher frequency of ischemic angiospastic responses during the information test. With this, it is expedient to combine physical training with the drugs that prevent angiospasms.
Physical stress tolerance and its hemodynamic support were examined in 95 patients with early myocardial infarction, 50 normal subjects and 25 coronary patients. It is suggested that the stress tolerance test is advisable at an early stage of complicated macrofocal myocardial infarction. The safety of the test improves considerably where it is performed under continuous electrocardiographic and chest-rheographic control. An abnormal diastolic impedance wave, emerging during exercise, may serve an additional diagnostic indicator of stress intolerance.
The efficiency of rehabilitation can be improved through early activation of the patients and the beginning of exercise as early as the hospital stage of rehabilitation. The intensity of exercise should be rationed on a strictly individual basis, with regard to the patient's functional status. Hospital exercise in combination with purposeful psychotherapy are major prerequisites for the recovery of working capacity.
Cardiovascular response to physical stress simulated by paired bicycle ergometry was evaluated in 33 patients with coronary disease of functional class 3 or 4, within 1-1.5 months after myocardial infarction. In third-class patients, stress tolerance and hemodynamic support improved after the second bicycle ergometry performed 30 minutes after the first test. In the fourth-class patients, repeated exercise revealed a reverse pattern in the parameters examined.
A bicycle-ergometric study under continuous electrocardiographic and hemodynamic monitoring demonstrated that physical stress tolerance is conditioned by pre-existing myocardial contractility disturbance rather than the depth of heart muscle involvement (as evidenced by ECG) at early dates of myocardial infarction. The patients' capacity for doing exercise, on a stepwise basis, was limited by transitory myocardial ischemia as well as inadequate and incompetent hemodynamic support.
Tolerance to physical stress and hemodynamic support of the latter were compared in normal subjects, patients with chronic coronary disease and those at early stages after large-focal myocardial infarction. Tolerance to stress and its hemodynamic support were shown to be virtually identical in patients at early postinfarction stages and chronic coronary patients. It was therefore suggested that controlled bicycle ergometry was a safe test for patients at early stages after large-focal myocardial infarction (6 days, on average), and a useful one for the objective assessment of individual tolerance of varying load regimens.
Thirty-five patients with large-focal myocardial infarction were divided into the main (21) and the control (14) groups. The main-group patients were subjected to intensive exercise beginning with day 10-22 of the disease; its program was designed so as to match the data of bicycle ergometry checkups and included bicycle-ergometric riding and rationed walking. It was demonstrated that the main group patients showed better physical stress tolerance, improved myocardial functional potentials, better psychological outlook and smaller pulmonary venous congestion at the time of transfer to the sanatorium stage of rehabilitation. It is suggested that exercise be incorporated in the hospital rehabilitation complex for patients with large-focal myocardial infarction.
A study of 44 coronary patients and 11 normal subjects (all of them males) demonstrated different patterns of circulatory response to psychoemotional stress in coronary patients, as compared to normal subjects. Hypokinetic circulatory response to psychoemotional stress is indicative of reduced myocardial contractility due to myocardial ischemia induced by a psychogenic stimulus, while hyperkinetic circulatory transformation in response to stress is a more adequate hemodynamic reaction in coronary patients.
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The findings of two-projection large-image fluorography of the thorax of 134 men aged 32 to 60 with a history of myocardial infarction are presented. Physical rehabilitation of these patients was either traditional (controls) or enhanced by physical training (test group). X-Ray characteristics of the pulmonary vascular bed help to detect left ventricular insufficiency even in cases when there are no clinical symptoms of it. Time course of X-ray and cardiometrical data helps not only to assess the efficacy of training, but permits detection of the progress of left ventricular insufficiency as well. Cardiometrical parameters (volume of the heart, left ventricular coefficient, hvs index, right-atrial coefficient) may be used to predict the course of coronary heart disease in the postinfarction period.