Method for the prevention and treatment of coronary heart disease

 

(57) Abstract:

The invention relates to medicine, namely to emergency cardiology, and can be used in the prehospital and hospital patients for the prevention and treatment of coronary heart disease (CHD). Precardiac blockade spend subcutaneous injection 20,0-30,0 ml of local anesthetic with low doses of heparin in the area of greatest pain. Additionally perform compression on subcutaneous infiltration prior to his disappearance. For the prevention of heparin is administered at a dose of 50 ME/ml of local anesthetic once and for treatment - 120 ME/ml of local anesthetic daily not more than two times per day on the background antianginal therapy until the stabilization of the General condition. The method allows for a more effective prophylaxis and treatment of patients with ischemic heart disease due to early elimination of pain, improved hemodynamics, respiration and reduce complications. 2 C.p. f-crystals.

The invention relates to medicine, namely to emergency cardiology, and can be used in the prehospital and hospital patients for the prevention and treatment of coronary heart disease (CHD).

CHD in our time remains the primary and most frequent is tion, etc.

The classical approach to the prevention and treatment of coronary artery disease is the use of drugs aimed either at increasing oxygen delivery to the heart muscle or reducing the need for hospitalization of it.

Angina is one of the most common topics of coronary artery disease, leading to severe morbidity and significant economic costs. Worldwide there is a trend of increasing prevalence of coronary artery disease and its manifestations. Among the adult population is about 10%, gradually increasing with age and reaching 20% among the elderly. Although older people make up 13% of the population, they take over 30% of all prescribed drugs, the bulk of which falls on cardiovascular drugs (Hui K. K. Cardiovascular Pharmacology and Therapevtics Edinburgh, UK. 1994, 1127-1136).

However, the ability of these medicines are often insufficient to prevent the development of angina and acute myocardial infarction (AMI). In addition, the high cost of these drugs, the presence of contraindications or development of side effects are extremely limit their widespread use, creating a potential risk of myocardial infarction and worsening the quality iesniedzami and complications of ischemic heart disease (2000).

“Since first meeting the doctor at the prehospital stage for the first time with sick, indicate the importance of correct and timely assessment of pain in emergency cardiology. Acute transient failure of coronary circulation occurs most often attack squeezing or pressing pain in the chest, on the left edge of the sternum and the heart. The duration of the attack is usually within 5-10 minutes nitroglycerine is not suppressed, and in many cases, and does not reduce pain” (Megaseta, 1995, No. 69, S. 8). “So, Sampson K. noted that out of 100 patients with stroke in 22 effect of nitroglycerin was unstable, and 10 did not exist” (A. C. Sumarokov et al. In the book: Clinical cardiology, 1995, S. 13) for the differential diagnosis of angina is to use the “sign Levin”: more fingers or palm, pressed sick to the sternum, are characteristic signs of ischemic nature of pain.

It is well known that untreated pain causes cardiogenic shock, which can lead to death, regardless of age and sex of the patient. “Pain is a pathological syndrome that occurs as a consequence of untreated or resoundingly body, that can lead to the development of irreversible critical States. The treatment of pain syndromes, thus, requires consistent correction of all vital functions in the background of effective analgesia, which should be attributed to the task not only of anesthesiology, and intensive care (C. N. Cibulec et al., W-l “Practical medicine and rehabilitation”, 1966, No. 1, S. 5). “Analgesia reduces adrenergic stimulation, making no arteriospasm and improves microcirculation of tissues” (ibid., S. 12).

Existing guidelines for pain relief in angina and myocardial infarction are sometimes contradictory and not every patient can give the best therapeutic effect.

To date neither pharmacists nor clinicians, unfortunately, do not have universal and effective drug or method for the elimination of pain syndrome, the underlying etiopathogenesis of coronary heart disease.

In all cases when a heart attack requires the use of devices that impede blood clotting. Currently widely used in all clinics of the world heparin, however, its effect is still not fully understood.

Anesthetic drug in bahania and cardiac activity, to improve coronary microchromosome and lymph circulation, possess antiagregatini and antithrombotic effect with the restoration of the organ lymphocirculation and microcirculation.

“For the treatment of false angina widely used narcotic analgesics, inhalation drugs, methods of regional anesthesia local anesthetics, cervical vagosympathetic blockade, blockade of the stellate and upper thoracic sympathetic nodes, chest blockade, subpleural blockade, spinal and epidural analgesia.....the most effective of the currently existing methods of regional anesthesia in relation to intensive therapy in patients with anginal status is epidural blockade (W-l "Emergency medical service", 2001, No. 1, S. 14-15).

“Many authors prefer morphine and its derivatives as analgesic drugs in myocardial infarction. This takes into account their positive properties: pain relief and the emergence of euphoria, ventilatory effect, a positive effect on the function of the ventricles of the heart during the development of the syndrome of left ventricular failure. At the same time do not take into account unwanted side effects. Morphine inhibits the function of external respiration is stop, cause bradycardia, nausea and even vomiting, inhibits motor function of the stomach, intestines and bladder. When intravenous bolus introduction of 20 mg of morphine analgesic effect occurs no earlier than 10-15 minutes, and the full analgesic effect is achieved only in 30% of cases. Prehospital after injection of morphine persons 60 years and older in each of the third was marked depression of respiratory function, when it wasn't full of pain” (Megaseta, 1995, No. 69, S. 8).

Local anesthetics (M. A.) long used for emergency treatment of pathological conditions in cardiology. “Their action is based on the interruption of afferent activity at different levels as near the place of occurrence of pathological impulses and ways of their implementation. Pharmacological denervation and induced sympathectomy can have a simultaneous beneficial effect on the respiratory system and blood circulation, as the main sources of formation of the nerve plexus of the heart and lungs are one” (ibid., S. 11).

You know the widespread use of anti-self - heparin as the representative nefrackzionirovannam heparin (NFG).

“Specific therapy anticoagulatory. According to Selye, the introduction of heparin may cause thrombosis hemorrhagic syndrome” (D. P. Pawlowski et al. Warning hypercoagulability of blood. Method recommendations. Krasnoyarsk, 1978, S. 5).

Recent publications emphasize that “ the Use of PG (heparin) is associated with a number of practical difficulties in the adequate implementation of the anticoagulant properties of the drug due primarily to its pharmacological characteristics. It is known that the anticoagulant effect of heparin is often unpredictable because of the individual variations in binding and, accordingly, neutralization of proteins and cellular elements of the blood. Practically difficult to provide a minimum 2-day intravenous infusion of the drug, as well as individually to monitor the effectiveness of injected dose (C. C. Shalaev et al. Low molecular weight heparins in the treatment of unstable angina and myocardial infarction without teeth Q. a Manual for physicians, 2001, S. 6). Tactics dosing of heparin in intravenous infusion set forth in domestic publications: I. N. A. Graciansky. Unstable angina acute coronary syndrome. II. Current status of treatment. W-l "Cardiology", 1997, No. 1, S. 8-23).

Sutisa using PG (heparin), is not uncommon thrombocytopenia, and the development of withdrawal syndrome” and “reactivation of unstable angina after cessation of drug” (P. Theroux et al., W-l N. Engl. J. Med, 1992, 327, p. 141-145).

Main disadvantages (heparin) (C. C. Shalaev et al., there with. 6):

practical difficulties in achieving adequate mode gipokoagulyatsii,

- the need for individual dose selection under the control of analyses gipokoagulyatsii,

- the need for long-term (several days) intravenous

the inability of prolonged use

- “reactivation” of the disease after cessation of infusion.

The prototype of the invention is epidural blockade (EB) as the most effective not only to relieve pain, but also multivariate positive effect on the vital systems and organs.

“Indications for using DL in patients with CHD is expressed pain syndrome. EB causes the interruption of afferent pathological activity. After 30-40 min after the introduction of M. and. the normalization of hemodynamic (blood pressure, heart rate, increased stroke volume, cardiac output and cardiac index, enevitsa freer, reduced shortness of breath, the exhalation is complete, reduce the phenomenon of hypoxia, the work of breathing is reduced, increased tidal volume, respiratory minute volume, vital capacity of lungs, increases pH and RA O2decreases Pa CO2.

Despite the high efficacy of epidural analgesia in patients with CHD, wide application it is not found due to the potential for serious complications and a very complex technique (C. A. Korochkin et al. in the book: Spinal and epidural anesthesia. St. Petersburg, 2000, S. 63), which makes it inaccessible prehospital and therapeutic hospitals.

Puncture and catheterization of the epidural space is performed by a qualified physician on the level Th3-Th4 thoracic vertebrae with the introduction of 5-8 ml of 2% solution of m and. and the blockade from C5 to Th6. The duration of the siege 4-5 hours. During the puncture can damage the vein, to perforate the Dura membrane and enter m and. in the subarachnoid space with obtaining total spinal block and fall AD with General toxic action of m and. If the catheter, it may withdraw from the epidural space, knot or twisted, not allowing the introduction of m and. and the possibility of rupture of the transmission, and further - purulent epidural.

Absolute contraindications to puncture and catheterization of the epidural space is started anticoagulant and fibrinolytic therapy” (ibid, s 70)

Technical result - improve the prevention and treatment of coronary heart disease due to early elimination of pain, improved hemodynamics and respiration, reducing the number of complications (angina, acute myocardial infarction, death) and simplification of the way.

This technical result is achieved by subcutaneous injection in the precardiac region, the area of greatest pain, local anesthetics with low-dose heparin followed by compression to subcutaneous infiltration to extinction.

The authors of the scientific medical and patent literature not found information on the application of precardiac blockade for the prevention and treatment of coronary heart disease by subcutaneous injection of local anesthetics (novocaine, trimekain, lidocaine) in combination with low-dose heparin or fraxiparina with the formation of subcutaneous infiltration and subsequent compression on the area of the subcutaneous infiltration to extinction.

Thus, the present invention which is not the sum of positive effects indication of the way but multivalently pharmacological activity:

- quickly eliminate pain,

eliminates the syndrome of generalized clotting lymph,

eliminates the microthrombi,

- causes anticoagulation effect in the lymph and circulatory systems,

- inhibits all phases of coagulation and activates fibrinolysis,

- improves lymph circulation and microcirculation,

- eliminates vascular spasms,

- improves coronary circulation improves hemodynamics and respiration

- increases the aeration of the blood,

- increases the resistance of tissues to oxygen deficiency,

- increases tolerance to hypoxia,

- promotes penetration into the cell ion To and exit from cell ion Na

- causes antilipemics effect,

- inhibits the action of histamine, serotonin,

- reduces the permeability of blood vessels and tissues

- stabilizes leukocyte peroxidase,

- activates alkaline phosphatase and esterase blood,

- depressing effect fumarate, ribonuclease, serum proteases and trypsin,

the region is the series: “inventive step”.

In recent years increasingly used low molecular weight heparins as the most effective in comparison with heparin. We used Fraxiparine as low molecular weight heparin in 9 patients with angina pectoris. Statistically significant benefits MWF (Fraxiparine) before NFG (heparin) is obtained, probably because the heparin itself is a mixture of mucopolysaccharides having different molecular weight from 12 thousand to 15 thousand daltons. If chemical and/or enzymatic degradation of heparin formed smaller fragments, called low molecular weight heparins, which primarily block the X factor-and of importance in the early stages of the formation of a blood clot (C. C. Shalaev et al.; ibid, s 7).

Method for the prevention and treatment of CHD is as follows: patient complaining of heart pain syndrome (“sign Levin”) prehospital and/or hospital perform precardiac blockade by subcutaneous injection of local anesthetic (novocaine, trimekain or lidocain) 0.5% solution in the amount 20,0-30,0 ml in an area of greatest pain with heparin 50 IU/ml of local anesthetic to prevent (angina) once and 120 IU/ml of local anesting injection of local anesthetics with low doses of heparin in precardiac area is formed subcutaneous infiltration, which produce weak, slightly increasing the compression ratio, for example, the inner surface of palm with a slight offset subcutaneous infiltration to the left edge of the sternum to the disappearance of subcutaneous infiltration. Effective analgesia occurs within 4-6 minutes

Example 1. Clinical case. Patient D., 58 years, a resident of the Far North, the teacher. Calls an ambulance due to the appearance of pain in the chest, stabbing character, shortness of breath and General discomfort that's bothering her for the past 3 months. The patient does not smoke. In the Far North is home to 11 years. At the time of inspection: complaint of pain in the chest stabbing character that appeared after minor physical activity.

On examination: patient low power (height 164 cm, weight 62 kg), above the light vesicular breathing, wheezing no. Respiratory rate in 1 minute - 12, the breath is shallow. Heart sounds clean, HELL 132/80 mm RT.article Pulse 88 in 1 minute, rhythmic, satisfactory filling and voltage.

Palpation of the precardiac area defined by the greatest pain in the middle of the sternum and to the left of the sternum. Diagnosed with angina.

Order Bystrice is lidocaine to 20.0 ml with 1000 IU of heparin (50 IU/ml) in the middle of the surface of the sternum with the direction of the needle to the left edge of the sternum. After injection of lidocaine heparin formed infiltrate in the middle part of the sternum. The palm of the left hand hold the light of the increasing compression on the infiltration offset it to the left edge of the sternum to the disappearance of infiltration with exposure time up to two minutes. Pain disappeared in the fourth minute.

Breathing, the patient was advanced to 12 breaths in 1 minute. HELL 124/70 mm RT.art., the heart rate decreased to 72 in 1 minute.

With the active survey two weeks later, the patient believes himself completely healed after a single precardiac blockade, participates in competitions in volleyball.

The proposed method for the prevention of coronary heart disease (angina) made it possible to achieve positive results in our patients from a single application of PB from 3 days to 3 weeks or more.

Example 2. Clinical case. Patient M 72-year-old man, retired. At the time of the call complained of frequent bouts of constricting pain in the chest and left her with irradiation to the left hand. Pain occurs with minimal exercise and during sleep.

History: attacks squeezing chest pain appeared 7 years ago. Smoke from childhood, smokes more than 20 sharecall with Muco-purulent sputum. For the past 3 years, suffering from angina, which for the last 7 months dramatically progressed from II to IV functional class.

Antianginal medications the patient has taken irregularly and were not under constant outpatient medical supervision.

Examination: General condition of the patient moderate signs of circulatory failure and arrhythmia no. Above the light - percussion with boxed shade. Auscultation over the lungs breathing hard, scattered dry rales; heart sounds moderately muffled, rhythmic, HELL 168/106 mm RT.article HR - 86 1 min, NPV - 18 breaths in 1 minute ECG ischemic reduction of ST segment 1.2 mV in leads I, aVL, V3-V6.

Palpation of the skin over the heart area of the highest point of pain defined at the level of the third intercostal space at the left sternal border.

The patient underwent precardiac blockade with 0.5% solution lidocaine 26,0 ml 3120 ME heparin (120 IU/ml) by subcutaneous injection in the third intercostal space on the left, some distance of 1.5 cm from the sternum, with the direction of the needle according to the third Mirabello. To infiltrate, resulting from the entered local anesthetic with heparin in the third intercostal space, place your left palm with light usilivayuscayasya pain remained, although subjectively the patient noted significant improvement. In connection with nekupirutayasa pain blunt nature of the hospitalized patient. HELL 156/98 mm RT.article HR - 76 in 1 min,NPV - 12 in 1 min. control ECG after 45 minutes IB ST depression decreased by 0.8 V.

In the hospital the patient received antianginal drugs with aspirin regularly: the isosorbide dinitrate treatment of 100 mg/day, verapamil 0,24 mg/day and aspirin 125 mg per day. Daily twice a day spend precardiac blockade with 0.5% lidocaine solution for 30,0 ml 3600 IU of heparin (120 IU/ml) with subsequent compression of the hand or a bag of sand on subcutaneous infiltration until his disappearance in precardiac region. On the 4th day precardiac the blockade is performed daily (once per day) combination therapy for 4 days, disappeared angina at rest, during sleep, increased exercise tolerance. The patient began to take daily walks. The patient has not refused to receive one tablet of nitroglycerin on walks because of the fear of possible occurrences of pain in the heart area. Discharged home on the 10th day.

In this situation, the purpose of precardiac blockades helped to improve the quality lechaina and compression on subcutaneous infiltration before his disappearance in precardiac area.

A difficult situation at the present time quite often put clinicians in a very difficult position. These patients are extremely hard to tolerate antianginalnye active drugs and require a non-standard approach from the doctor.

The use of precardiac blockade has permitted the prevention of coronary heart disease by one-time use IB for angina with a positive result from 3 days to 3 weeks or more.

Treatment of IBS with double application of PB a day, and then once per day to obtain a stable clinical condition of the patient.

The proposed method for the prevention and treatment of coronary artery disease using precardiac blockade with local anesthetics with low doses of heparin and compression infiltration has significant benefits for patients in emergency cardiology, simple, easily reproducible and achieved the specified technical result. Thus the claimed invention meets the criterion of “industrial applicability”.

1. Method for the prevention and treatment of coronary heart disease by blockade with local anesthetics, characterized in that conduct precardiac blockade subcutaneous is Ino perform compression on subcutaneous infiltration prior to his disappearance, for the prevention of heparin is administered at a dose of 50 ME/ml of local anesthetic once and for treatment - 120 ME/ml of local anesthetic daily not more than two times per day on the background antianginal therapy until the stabilization of the General condition.

2. The method according to p. 1, characterized in that as heparin use low molecular weight heparin - Fraxiparine.

3. The method according to p. 1, characterized in that as a local anesthetic applied lidocaine.

 

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