Disturbances of Ventilatory Function in Patients with Chronic Heart Failure and Effect of an Angiotensin Converting Enzyme Inhibitor Perindopril

Aim of the study. To determine parameters of ventilatory function and acid-base balance in patients with chronic heart failure after myocardial infarction and to evaluate effects of perindopril on these parameters. Material and methods. 25 nonsmokers and 15 smokers with NYHA class III-IV heart failure. Ventilatory function (spirometry) and acid-base balance in capillary and venous blood were studied before and after 6 months of therapy with perindopril. Results. Initial parameters of ventilatory function were lower compared to predicted values in both groups but especially in smokers. In nonsmokers treatment with perindopril was associated with significant decrease of vital capacity (by 14,3%, p<0,05) while changes of other parameters of ventilatory function were not significant. In smokers there was a tendency to improvement of bronchial resistance. Initially all patients had compensated respiratory acidosis. Therapy was associated with significant decreases of pCO2 in capillary and venous blood (25,5%, p<0,05, and 18,2%, p<0,05, respectively,) and of capillary to venous blood sO2 ratio (48,3%, p<0,05)

Application of trimetazidin in combined treatment of postinfarction

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Disturbances of Ventilatory Function in Patients with Chronic Heart Failure and Effect of an Angiotensin Converting Enzyme Inhibitor Perindopril

Aim of the study. To determine parameters of ventilatory function and acid-base balance in patients with chronic heart failure after myocardial infarction and to evaluate effects of perindopril on these parameters. Material and methods. 25 nonsmokers and 15 smokers with NYHA class III-IV heart failure. Ventilatory function (spirometry) and acid-base balance in capillary and venous blood were studied before and after 6 months of therapy with perindopril. Results. Initial parameters of ventilatory function were lower compared to predicted values in both groups but especially in smokers. In nonsmokers treatment with perindopril was associated with significant decrease of vital capacity (by 14,3%, p<0,05) while changes of other parameters of ventilatory function were not significant. In smokers there was a tendency to improvement of bronchial resistance. Initially all patients had compensated respiratory acidosis. Therapy was associated with significant decreases of pCO2 in capillary and venous blood (25,5%, p<0,05, and 18,2%, p<0,05, respectively,) and of capillary to venous blood sO2 ratio (48,3%, p<0,05)

Uric acid levels in the blood of patients with postinfarction cardiac failure

Aim. To evaluate uric acid (UA) levels in patients with postinfarction chronic cardiac failure (CCF) and to investigate correlation between accumulation of uric acid, CCF severity and some other parameters. Material and methods. UA levels were determined with enzyme immunoassay and acid-base status of capillary and venous blood was studied in 120 men 35-78 years of age (mean age 46.3 +/- 1.8 years) with CCF of NYHA functional class (FC) I-IV. CCF was caused by Q-wave myocardial infarction in all the patients. Results. It was found that a close direct relationship exists between FC of CCF and UA content (r = 0.735, p < 0.001), FC of CCF and creatinine levels (r = 0.648, p < 0.001). Analysis of acid-base condition shows the existence of compensated gas acidosis in CCF patients. Acid-base changes were more prominent in FC III and IV. FC and gas acidosis directly correlated. Conclusion. In CCF there is a pathogenetic relation between high uric acid and hypoxia. However, further studies are necessary of the causes of UC rise in CCF and its influence on the severity of circulatory insufficiency

Plasmic hemostasis and some biochemical indices in trimetasidine treatment in patients with chronic heart failure

Aim. The study of trimetasidine effects on plasmic hemostasis and blood biochemistry in patients with chronic heart failure (CCF) of NYHA functional class II-III. Materials and methods. The study enrolled 30 patients (24 mates and 6 females) aged 40-72 years with class II-III CCF, postinfarction cardiosclerosis and ejection fraction under 40%. Previously the patients received perindopril (the inhibitor of angiotensin converting enzyme) in daily close 2-4 mg, on-demand digoxin and diuretics. Trimetasidine,vas given in a daily dose 60 mg for 6 months. Before and after the treatment the patients' blood was examined for: levels of factors VII and X of antithrombin III coagulation, soluble fibrinomonomeric complexes (SFMC), fibrinogen, glucose, uric acid creatinines, total cholesterol, high density lipoprotein, triglycerides, AST, ALT, LDH, acid phosphotase, gamma-GT, sodium, potassium, activated partial thrombin time. Results. Initially, the patients had a 23.9% increase in the levels of factors VII and X, a 14.3% decrease of antithrombin III, 29.8 and 227.6% rise in concentrations of fibrinogen and SFMC respectively, compared to controls. After treatment values of fibrinogen, factors VII and X, SFMC fell by, 21.1, 17 and 35.5%, respectively. The thrombin time arose by 17.9% (p > 0.05). Insignificant inhibition was registered in the activity of acid phosphotase and gamma-GT. Glucose, AST, ALT, LDH levels remained unchanged. Plasma creatinine tended to lowering. Total cholesterol insignificantly increased at high levels of HDL cholesterol (p > 0.05) and reduced levels of triglycerides (p > 0.05). Conclusions, Trimetasidine therapy, given after conventional treatment with diuretics, digoxin, inhibitor of angiotensin-converting enzyme, aspirin has a beneficial effect in patients with circulatory deficiency through improving hemostatic and biochemical parameters

Clinical and hemodynamic efficacy of carvedilol in patients with congestive heart failure

Clinical and hemodynamic (assessed by echocardiography) effects of carvedilol were studied in 20 patients (18 men, 2 women, age 46 - 74, mean age 62,3+/-3,2 years) with NYHA class III-IV heart failure due to postinfarction cardiosclerosis and ejection fraction below 35%. Starting dose of carvedilol was 3,125 mg b.i.d with subsequent titration according to individual tolerance, reaction of blood pressure and heart rate using twofold increments (6,25, 12,5 and 25 mg b.i.d.) each two weeks. Duration of treatment was 3 months. By the end of this period the following changes occurred: significant reduction of NYHA functional class (from 3,5+/-0,1 to 2,7+/-0,1, p<0,01), improvement of tolerance to exercise (exercise time rose from 203+/-15,6 to 314,2+/-16,2 sec, p<0,05), increases of stroke volume (by 20%) and ejection fraction (by 14%), and lowering of total peripheral resistance (by 15%). Positive dynamics of 24-hour blood pressure profile was also observed: average 24-hour, day-and nighttime blood pressures and pressure burden were significantly lowered and the morning blood pressure elevation alleviated.-ln 2-4 hours after the first dose of carvedilol systolic and diastolic blood pressures decreased by 21%(p<0,05) and 18% (p<0,05), respectively. Thus the use of carvedilol in patients with heart failure was accompanied by positive changes of clinical and hemodynamic parameters