SU1766425A1 - Method for curing stenocardia - Google Patents

Abstract

Use, field of medicine, in particular 1 urgent cardiologists and psychiatrists. Objective: To prevent acute myocardial infarction and sudden cardiac death in the treatment of variant Printsmetal angina (VSP). Essence: after administering to a patient VSP of nitrates and calcium antagonists, the helium-neon laser blood flow is irradiated every other day. The GNL-fiber light guide is inserted through the puncture needle into the vein 1-2 cm beyond its cut, and after the needle is removed, the GNL is irradiated with radiation at the end of the fiber with a wavelength of 1-1.5 mW at 40-45 minutes per session. Starting from the 3rd procedure in the blood, the indicator of the activity of antithrombin - III (AT-III) after its release on the plateau is determined (when the difference of indicators in two conjugate samples is 8% or less), laser therapy is stopped. Additionally prescribed aevit. Positive effect: 26 patients with Prinzmetal variant angina were treated. The reduction of complications in the form of acute myocardial infarction and sudden cardiac death was established. cl

Description

The invention relates to the field of medicine, in particular to emergency cardiology, and can be used to reduce the incidence of sudden cardiac death and acute myocardial infarction in patients with variant angina pectoris of Prinzmetal.

There is a known method of treating patients with variant Prinzmetal angina by using nitrates and calcium blockers in combination.

However, the basic method has a number of significant drawbacks. Thus, nitrates are, as a rule, effective drugs for arresting the attacks of vasospastic angina, but the duration of their influence on the course of Prinzmetal's variant angina, the cause of the disease and the prevention of complications is limited. A number of papers have described the possibility of a spasm of the coronary arteries for the itcoronary administration of nitroglycerin, calcium antagonists. It has been shown that systematic administration of calcium blockers to patients with VSP can eliminate angina attacks in no more than 50–68% of cases, while maintaining the risk of developing acute myocardial infarction (AMI) and sudden cardiac death (HCC).

The purpose of the invention is to prevent acute myocardial infarction and sudden cardiac death in patients with variant Prinzmetal stenocardia, which is achieved by the fact that a patient with a VSP during basic treatment with

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The use of nitrates and calcium blockers (calcium antagonists) additionally carries out a course of intravenous laser therapy.

The proposed method is carried out as follows. After administering to a patient WBC nitrates and calcium antagonists in individually required doses; TfepeT day is the current of the blood stream irradiated with a neon laser. For this, the longitudinal light guide of the apparatus is inserted through a puncture point into the available vein (on the NGSM, then its ffpeaa under the control of the light beam) and blood is irradiated (after removing the needle) at a power of GNF radiation at the end of the fiber in 5 mW, exposure 40-45 minutes per session. Beginning with the 3rd procedure in the blood, the indicator of the activity of antithrombin-III (AT-III) is determined and, after reaching the plateau, in two subsequent irradiations and measurements of AT-III, complete the course of intravenous laser therapy. AEVIT is used to prevent undesirable effects.

The method of laser therapy of VSP patients is demonstrated by a number of examples of its specific implementation.

PRI me R 1. Patient Art. V. A., 53 years old, I. B. No. 1408, was admitted to the cardiology department of City Clinical Hospital No. 13 with a clinical picture of Prinzmetal variant angina in the last three days. Angina attacks occurred alone at 4-5 am. In connection with this, the patient was prescribed nitroglycerin, which he took up to 20 tablets per day without any particular effect. The condition of the patient is of average weight. In the lungs stagnant wheezing no. The borders of the heart are not extended, the tones are slightly muffled, the rhythm is correct, the heart rate is 76 in 1 min, the blood pressure is 120/80 mm Hg. Art. On a daily ECG, during examinations during nighttime attacks of angina pectoris, transmural changes (at V4-V4) were revealed, transient of ventricular extrasystoles in the bigeminia type. Coagulogram: fibrinogen - 496 mg%, AT-III56.6%, plasminogen - 3.9 KE / ml. fibrinogen B (+), blood coagulation time - 2 h 20 min.

A course of intravenous blood irradiation with a beam power of 1.5 mW at the output of the light guide, 40 min exposure time per session in a mode every other day on a background of nitroglycerin, corinfar, AEVIT, a. By the 5th procedure of laser therapy, the attacks of night angina and pathologists on the monitor ECG were completely stopped, the need for antianginal drugs was reduced to a minimum (1-2 tablets of sustac). Coagulogram: fibrinogen - 286 mg%, AT-III - from the 3rd procedure 107%, 4- - 154%, 5-

-152%; plasminogen - 4.9 KE / ml, fibrinogen B (-), blood clotting time - 6 min 30 s.

EXAMPLE 1 Demonstrates the achievement of a clinical effect in the form of the disappearance of strokes and signs of VSP on an ECG and the corresponding AT-III dynamics with a plateau after 5 procedures of laser therapy, which turned out to be sufficient for this patient. Complications of laser therapy and VSP were not, which corresponds to the description of the method. It is important to emphasize at the same time that, according to the daily monitoring of the syndromological pattern of pain and monitoring of ECG characteristics, performed during the period of traditional treatment of the patient before the start of laser therapy, the complex of electrocardiographic indicators could be qualified as a preinfarction condition. Such phenomena already after the second session of GNL blood irradiation were reduced, and then completely disappeared, which suggests that it is possible to prevent serious complications of VSP in the form of myocardial infarction and CS in this particular case of the disease.

However, another example emphasizes the legitimacy of the proposed regime.

0 laser therapy every other day.

PRI m e r 2. Patient B. A. S., 75 years old, I. b. № 16492, entered the city clinical hospital №13 12.22.87, with the clinic of variant angina Printsmetal, which was developed in the form of

5 seizures in the pre-morning time (3-5 am) and subsequently their increase at rest up to 8-10 times a day for up to 15-20 minutes, with a sharp decrease in exercise tolerance, increase in consumption of nitroglycerin preparations (up to 20 - 40 tablets per day) and calcium blockers (10-15 tablets), the use of which did not bring a noticeable effect. Concomitant diseases: hypertensive disease, cerebral atherosclerosis and atherosclerosis obliterans of the lower extremities, obesity. On admission, the condition is average. In lungs single dry rales, stagnant

0 no effect, BH - 18 in 1 min. The borders of the heart are extended to the left by 2 cm. The heart sounds are muffled, rhythmic, the heart rate is 60 in 1 min, the systolic murmur and the accent P tone over the aorta. HELL 160/90 mm RT. Art. Reduced bullet Satsi on the arteries x feet. In a laboratory study: leukocytes 8.6; ESR - 9 mm / h, ALT - 96 ME, ACT - 92 ME, KFK - 0.6; fibrinogen - 586 mg.%, AT-3 -56%, PB

-4.5; KE 1 ml; PDF - 10; fibrinogen B (+). JHa ECG data for myocardial infarction is not, but

in case of monitor tracking, VSP inversion of the ST wave (2 mm higher than the isoline), painless ischemic episodes, transmural disturbances are characteristic of VSP. Treatment of angina pectoris by daily intravenous blood HLN simultaneously with AEVIT, and (600 mg per day) - ALOK-1 device, radiation power at the end of the light guide 1.0 mW and exposure of 45 min per session, started for all patients with coronary artery disease in the clinic. Already after two procedures of laser therapy, the patient's condition was improved: pain stopped at rest during the daytime, the intensity and duration of angina pectoris decreased at night, exercise capacity increased, the consumption of nitroglycerin decreased from 30 to 4 tablets per day, BP 130/80 normalized mm Hg Art., i.e. it was possible to talk about a certain stabilization of the disease. On the ECG, the mentioned pathological changes significantly decreased. Improvement of the state was accompanied by positive dynamics of plasma hemostasis: fibrinogen 398.5 mg%, AT-106.2%, PG - 5.2 KU / ml, PDF - 10 µg / ml, fibrinog B (-), blood coagulation time 3 minutes (6 minutes). However, after the 3rd, and isobenno, 4th procedure of GNL irradiation, the patient's condition worsened again, which was manifested by an increase in angina attacks in the night and morning hours at rest, a decrease in exercise tolerance, signs of hyperkinetic syndrome: tachycardia 90 in 1 min. HELL to 180/90 mm RT. Art. At the same time, pathologists were noted on the ECG for two days, as described above, extrasystoles and signs of transmural abnormalities in the period of attacks appeared, which is fraught with the possibility of the most serious complications (AMI and VCS).

Thus, even against the background of prophylactic administration of AEVIT in a patient with variant angina pectoris, Prinzmetal, exacerbation of angina pectoris was observed during daily blood irradiation of GNL. On the days of this exacerbation, the plasma hemostasis values were as follows: fibrinogen 395.1-392.7 mg%, AT - 32.1% (sharp drop), PG - 4.8 KE / ml, coagulation time 3 min 30 s, PDF - 8 µg / ml, fibrinogen B (-). An exacerbation of angina pectoris was accompanied, therefore, by a clinical and biochemical deterioration. And although then the course of the disease stabilized (a course of laser therapy after 3 days was continued in a mode — every other day), the very presence of clinical electrocardiographic and hemostasiological (hypercoagulation syndrome) disorders indicates an unsatisfactory effect of daily sessions of GNF irradiation.

This example demonstrates the fact that the mode of daily laser therapy procedures can cause rebound hypercoagulation on the background of a sharp secondary

0 exacerbations of VSP and deterioration of ECG, fraught with the most serious complications up to the development of AMI and VCS, which makes such a method of conducting OTHL irradiation of the patient's blood unacceptable.

5 The proposed method treated 26 VSP patients and, as a control group, 28 patients were observed on a cardiologic basis. About the Department of the City Clinical Hospital N 13 of the Moscow City Executive Committee

0 in 1987-1989 The results of therapy were evaluated by generally accepted clinical, electrocardiographic, and special biochemical studies. As a result of a general analysis of the data obtained, it was found that the proposed method for treating patients with VSP differs from the prototype by a significantly higher therapeutic efficacy in terms of reducing complications in the form of AMI and VC, what is the bottom

0 show the indicators held in the table,

The table shows that with the proposed method of laser therapy, a good effect in the form of complete elimination of steno-cardia attacks was achieved in the overwhelming majority of patients with VSP, while the prototype gives only 50.0% of such effective results. But most importantly, with the basic treatment method, 28.6% of cases were observed

0 development in patients with AMI and videoconferencing, while the claimed method completely excluded them. This general conclusion of the work was confirmed in those two cases of VSP, which were traced and treated under the conditions

5 Department of Emergency Psychiatry VNII-OSP them. V.P. Serbsky. In both patients, laser therapy (b and 7 sessions per course) contributed to the elimination of angina pectoris manifestations that accompanied

0 development also psychopathological symptoms. Therefore, the method can be recommended not only for emergency cardiology conditions, but also for emergency psychiatry,

Claims (1)

5 Formula of Invention A method of treating angina with the use of nitrates, calcium blockers, and sessions of intravenous helium-neon laser therapy, characterized in that, in order to prevent acute myocardial infarction myocardial and sudden cardiac death in the treatment of variant angina pectoris, the sessions are conducted every other day, the level of antithrombin-III in the blood is determined in the blood from the third session, and if the difference in the two conjugate samples is 8% and less, laser therapy is stopped. Indicators of clinical efficacy of the prototype and the proposed method of laser therapy for patients with variant angina pectoris Prinzmetal