The method of treatment of alexithymia in angina in elderly patients

 

(57) Abstract:

The invention relates to medicine, namely cardiology, and for the treatment of alexithymia (violations recognition and describe their own feelings), in patients with angina. To do this, in addition to the standard treatment of angina elderly patients aged 55-60 years are assigned melatonin at a dose of 1.5 mg once a day and at night for 10 days. The method leads to lower levels of alexithymia, sleep improvement, termination of angina attacks at night.

The invention relates to medicine, namely to cardiology.

The aim of the invention is to increase the efficiency of treatment of patients with angina and alexithymia elderly, improving their quality of life.

There is a method of treating angina voltage, including medication treatment with nitrates (nitroglycerin, the isosorbide dinitrate treatment and Mononitrate), beta-blockers (atenolol, metoprolol, bisoprolol, betaxolol) or calcium antagonists (verapamil, nifedipine, diltiazem) in various combinations. In addition, apply Trimetazidine as metabolic myocardial protection, aspirin and other antiplatelet sledstvie voltage means, set forth in article A. L. Syrkin not restore the structure of sleep, and the elderly, often due to age-related changes in the pineal gland is disturbed sleep architecture (violation of falling asleep, frequent night waking, in the morning after waking up feeling tired, exhausted). A sleep disorder negatively affects the regulation of the tone of the coronary arteries, the mean HELL, which leads to the strengthening of strokes voltage, especially in alexithymics of patients with angina.

Melatonin is used to treat hypertension [Clinical medicine, 12, 1998], and also as an antioxidant, immunostimulant - to treat depression, seasonal emotional disorders, insomnia, rapid time zone change in flexible work [Nishiyama K, Yasue H, Moriyama Y, et al. Am. Heart J. 2001 May; 141(5):E9].

It is known that the indication for use of melatonin are sleep disorders. Us in the use of melatonin in patients with stroke received not only improve the quality and duration of sleep, and reducing the severity of clinical and ECG signs of myocardial ischemia, as well as reduction in total score of alexithymia. This effect of melatonin may be obnesti, with the other properties of the vasodilator, antiplatelet agent and an antioxidant (Scalbert, E., Guardiola-Lemaitre Century, Delagrange P. Melatonine and regulation of the cardiovascular system. Therapie. 1998; 53(5): 459-465), what can be used as a pathogenetic therapy of patients with coronary artery disease, angina pectoris.

In addition, the available sources of information there are no descriptions of known methods of treatment of alexithymia in angina in elderly patients, which leads to the absence of a prototype.

The aim of the invention is to increase the efficiency of treatment of patients with angina with alexithymia in the elderly, improving the quality of life of these patients.

This goal is achieved by the fact that in addition to the standard treatment of angina elderly patients are prescribed melatonin at a dose of 1.5 mg once daily at night for 10 days.

The level of alexithymia was determined according to the Toronto scale TAS-26 proposed by G. Tailor (1985) and adapted in Neuropsychiatric Institute. C. M. Bekhterev (D. N. aresco, G. L. Isurin, E. C. Kaidanovsky et al. Alexithymia and methods of its determination at the edge of psychosomatic disorders. - S.-Pb., 1994). Alexithymics are scored 74 points or more, alexithymic the Noah R. , 64 years old, history - 5917, entered GBSN 16.03.01, complaining of attacks of discomfort behind the breastbone up to 7 times a day, the nature of which it was difficult to put into words ("I feel that hurts the heart, but as it is, can't explain"), radiating into the left axillary area. Pain occurred at rest and at night, was relieved by the intake of 2 tablets of nitroglycerin after 10 minutes, resumed after 40-50 minutes. In addition, there were complaints about General weakness during the day, insomnia (hard to fall asleep, often wakes up at night, sleep shallow, feeling tired upon awakening).

Clinical diagnosis: ischemic heart disease: angina, functional class (FC) III. Atherosclerotic cardiosclerosis. Atherosclerosis of the aorta, the coronary arteries. Circulatory insufficiency of the I century Alexithymia.

The survey: complete blood count, urinalysis, determination of blood glucose, cholesterol, urea, ALT, AST, coagulogram, electrocardiogram, daily monitoring of ECG; psychological testing for alexithymia in Toronto scale TAS - 26 (G. Tailor, 1985), and personal and situational anxiety according to the method of Spilberger Hanina, the determination of the total score of quality of life according to method A. Gladkova Gctl (on 1 tab. 3 times a day, aspirin (0,125 1 time per day). Further appointed melatonin at a dose of 1.5 mg 1 time a day at night the course of 10 days.

As a result of treatment, the patient noted improvement of sleep (rapid, easy falling asleep, night waking, wakes up in the morning cheerful, in good spirits), reducing the number of pain attacks during the day to 1-2 times a day, the attacks are reduced by the smaller number of nitroglycerin (1 tablet), night pain, not notes. It is also noted positive dynamics of ECG results (standard and Holter).

Conclusion monitoring ECG Holter (18.03.01 year): Sinus rhythm. Dynamics of heart rate without features, a decrease in the heart rate at night is insufficient. Registered the following types of arrhythmias: single supraventricular premature beats (49), single ventricular arrythmia (only 43). Episodes of ST-segment depression, expressed in leads characterizing the potentials of the anterior and lateral walls of the left ventricle, accompanied by pain that occurs during exercise and at rest when the threshold heart rate, typical for FC III.

Conclusion monitoring ECG Holter (28.03.01 year): Dynamics of heart rate without features, a decrease in the heart rate at night within Noro 11). Episodes of ST-segment depression in leads characterizing potentials peredneperegorodochnoj region of the left ventricle, accompanied by pain that occurs during exercise and at rest when the threshold curves, characteristic II FC.

Conclusion ECG (18.03.01 year): Sinus rhythm, EOS rejected to the left. Single ventricular premature beats. Expressed diffuse changes in the myocardium.

Conclusion ECG (28.03.01 year): Sinus rhythm, EOS rejected to the left. Moderate changes in the myocardium of the left ventricle.

Marked improvement in test results on a scale of "Personal and situational anxiety" Spilberger Hanina, on a scale TAS - 26, improve quality of life questionnaire A. Gladkova, and co-authors (1982).

The result of the questionnaire TAS - 26 (17.03.01,) - 82 points, the result of the questionnaire TAS - 26 (9.03.01,) - 71 points. The result of questionnaire, Personal and situational anxiety" (17.03.01,) - 59 points; the result of questionnaire, Personal and situational anxiety" (28.03.01,) - 51 points. The result of the questionnaire "Quality of life" (17.03.01 g): 26 points; the result of the questionnaire "Quality of life" (29.03.01 g): 21 points.

We treated 53 patients. As a result of treatment the patients improved sleep, reduction priest who observed positive dynamics of ECG manifestations of myocardial ischemia according to the daily monitoring of ECG Holter. In elderly patients with angina inclusion in therapy of melatonin leads to a statistically significant reduction in total score of alexithymia. Under the influence of melatonin average level of alexithymia in patients with angina significantly decreased with 72,8 to 61.4 points (p <0.05 t-test).

The method of treatment of alexithymia in angina in elderly patients, including the standard treatment of angina and supplementation of melatonin at a dose of 1.5 mg 1 time a day at night for 10 days.

 

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