RU2160588C2 - Method for treating the cases of acute myocardial infarction - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves including antioxidant component into a medicamentous complex therapy with angiotensin-transforming enzyme inhibition. Antioxidant and angiotensin-transforming enzyme therapy is administered beginning from the fourth day from the beginning of the disease. EFFECT: prevented left ventricle remodeling, perivascular edema and arteriole spasm; enhanced effectiveness of treatment.

Description

 The invention relates to medicine, namely to cardiology.

 A known method of treating acute myocardial infarction, which consists in the use of emoxipin (antioxidant) from the first day of myocardial infarction for 15 days in combination with the basic treatment of acute myocardial infarction - AMI (see, Journal of Cardiology, 1994, N 2, S. 122- 126, Cardiosphere Publishing House, Moscow).

 A known method of treating AMI by using perindopril (an angiotensin converting enzyme inhibitor) from the first day of AMI for 6 months in combination with basic therapy. This method (see the journal "Clinical Pharmacology and Therapy", 1997, No. 1, pp. 30-31, Pharma Press publishing house) was taken as a prototype. A disadvantage of the known methods is that they do not prevent remodeling of the left ventricle within 1 month of treatment, namely: there is no significant decrease in the final systolic volume of the left ventricle and the final diastolic volume of the left ventricle. In addition, the known methods do not have a positive effect on such microcirculation parameters as perivascular edema and spasm of arterioles.

 The essence of the claimed invention lies in the fact that, according to a method of treating acute myocardial infarction by conducting drug therapy using an angiotensin converting enzyme inhibitor, an antioxidant is additionally used, while an antioxidant and an angiotensin converting enzyme inhibitor are used for a month from the 4th day from the onset of the disease.

 The application of the proposed method will allow by the end of the first month of AMI development to prevent remodeling of the left ventricle, namely, to significantly reduce the final systolic and diastolic volumes of the left ventricle. By the end of the first month of treatment, perivascular edema significantly decreases and the spasm of arterioles completely disappears. The frequency of anginal pain compared with the control decreases by 7-10 days AMI.

 The method is as follows.

 Patients with acute myocardial infarction receive in combination with basic therapy (thrombolytic, antianginal, analgesic drugs) therapy with an angiotensin-converting enzyme inhibitor (enalapril maleate) and antioxidant (vitamin E) from the 4th day of the disease to 26-30 days in general therapeutic doses (during the first three days AMI angiotensin-converting enzyme inhibitors are not used due to increased mortality in patients).

 Examples of specific performance.

 Example 1. Patient A., 62 years old, was admitted with a diagnosis of coronary heart disease, Acute repeated large-focal anterior septal-apical-lateral myocardial infarction from 07.24.96. Postinfarction (1994) cardiosclerosis. Symptomatic arterial hypertension. POC II.

 Delivered to the hospital by an ambulance team (SMP) with complaints of bursting pain behind the sternum with radiation to the lower jaw, shortness of breath, fever up to 37.4. Health deterioration 5 days, during which there was an increase in angina attacks. Upon admission - rapid breathing, in the lungs - hard breathing, no wheezing. Arrhythmic heart sounds (5 extrasystoles per minute). I tone = II muffled. Heart rate 82 rpm, BP 160/90 mm Hg. Art. The level of lipid peroxidation (POL) is 167 cpm, ceruloplasmin (Cp) 0.632 mg / ml, membrane stability (St) 144 sec. Pain was controlled by non-narcotic analgesics. Nitroglycerin infusions, heparin injections, nitrosorbide (40 mg / day), furosemide (40 mg), aspirin (0.25 mg / day) were prescribed. According to echocardiography, the sizes and volumes of the left ventricle were as follows: final diastolic size (CDD) 53 mm, final systolic size (CSD) 41 mm, final diastolic volume (CDW) 148 ml, final systolic volume (CSR) 54 ml, ejection fraction (PV ) 55%. The state of microcirculation (MC) by biomicroscopy of the bulbar conjunctiva: perivascular edema and sludge phenomenon - 2 points, spasm of arterioles - 1 point. On day 4, enalapril maleate (vazolapril) 5 mg and α-tocopherol (vitamin E) 600 mg / day were added. On day 5, in satisfactory condition, transferred from PIT to the department. Sore throats did not recur. The further course of AMI without complications. Discharged on the 27th day. Before discharge from the hospital, heart rate 78 per minute, blood pressure 130/85 mm RT. The level of LPO, Cp and St, respectively: 94 pulses / sec; 1.1 15 mg / ml; 220 sec According to the echocardiography, the CDD is 49 mm, the DAC is 38 mm, the BWW is 132 ml, the CSR is 50 ml, the PV is 60%. The condition of the MC at the time of discharge: perivascular edema, spasm and sludge phenomenon - About points.

 Example 2. Patient B., 45 years old, was admitted to the hospital with a diagnosis of CHD. Acute repeated large focal posterior diaphragmatic myocardial infarction from 10/17/97. Postinfarction (1989) cardiosclerosis. Symptomatic arterial hypertension. PMC 1.

 He complained of pressing pain behind the sternum with radiation in both hands, back, weakness, sweating, shortness of breath. The daily intake of nitrosorbide 40 mg, two days before admission increased by 2 times. Twice caused SMP. Delivered to the clinic in connection with non-stopping pain with nitrates. At the prehospital stage, promedol, analgin, diphenhydramine was administered intravenously, in the hospital - infusion of a polarizing mixture, nitroglycerin, heparin. Nitrosorbide is prescribed orally (40 mg / day). On day 2-3 - recurrent intense pressing pain behind the sternum, for the reduction of which neuroleptanalgesia, relanium were used. From the 4th day enalapril maleate (vazolapril) 5 mg / day and α-tocopherol 600 mg / day are included in the complex therapy. Heart rate = 86 rpm, BP 145/95 mm Hg. Art. By echocardiography, BWW of the left ventricle 136 ml, CSR 53 ml, PV 58%. Data from the MC of the conjunctival vessels: perivascular edema, the phenomenon of sludge and spasm of arterioles at 2 points. After 2 days, anginal pain disappeared, the dose of nitroglycerin was reduced. LPO intensity upon admission 215 imp / sec, erythrocyte resistance to peroxide hemolysis - 100 sec, ceruloplasmin level - 0.483 mg / ml, upon discharge, there was a decrease in LPF to 82 imp / sec, an increase in CP to 1.243 mg / ml, membrane stability increased to 182 sec The indicated combination had practically no effect on the heart rate, but contributed to a moderate decrease in blood pressure (heart rate at discharge of 80 per min, blood pressure of 125/85 mm Hg). Parameters of echocardiography showed a pronounced tendency to decrease signs of LV remodeling: BWW at discharge amounted to 124 ml, CSR - 49 ml, PV - 60.4%. Data from the MC of the conjunctival vessels indicated an improvement in the “final” blood flow of the conjunctival vessels: perivascular edema, the phenomenon of sludge and spasm of arterioles disappeared.

Claims (1)

 A method of treating acute myocardial infarction by conducting drug therapy using an angiotensin converting enzyme inhibitor, characterized in that an antioxidant is additionally used, wherein an antioxidant and an angiotensin converting enzyme inhibitor are used for a month from the 4th day from the onset of the disease.