First aid kit emergency self-help when the atrial cardiac arrhythmias

 

The kit contains three medicines for the impact on the basic pathological processes that cause atrial arrhythmias. The kit includes one single therapeutic dose of propranolol and verapamil 80 mg and six single doses of quinidine 200 mg each. The selection algorithm of the drug takes into account the primary pathological condition and involves the use of verapamil mainly in the absence of heart disease and propranolol in the presence of heart disease. In case of insufficient effect in the application of funds after 1 hour treatment include quinidine, used according to the scheme: first receiving 400 mg every 2 hours at 200 mg maximum dose of 1200 mg Kit provides relief of acute atrial rhythm disturbances and prevents repeated attacks on the level of emergency first self - help and mutual aid. 1 C.p. f-crystals, 4 Il.

The invention relates to medicine, namely to create MiniPack emergency self - help and mutual aid.

Cardiac rhythm accompany many diseases of the cardiovascular system, significantly impairing their forecast. Okotie heart. - M.: Medicine, 1996. - Volume 1. - S. 383-387). Full range of these rhythm disorders includes, on the one hand, single extrasystoles atrial, do not pose any threat, and on the other - atrial fibrillation, atrial flutter. Between these two extremes there are many types of atrial tachycardia, distinguished by the frequency and regularity of the rhythm, such as paroxysmal tachycardia involving the sinus node, chaotic multifocal atrial tachycardia, pure atrial tachycardia, etc. Despite this variety, the atrial rhythm disturbances have a lot in common both in terms of electrophysiological mechanisms of their occurrence and principles of treatment.

The occurrence of atrial arrhythmias may contribute to pathological States and processes directly related to heart disease, such as rheumatic affection of the heart valves, coronary heart disease, hypertension, pulmonary heart, etc. in Addition, other States and processes in the chest (injury, infection, etc) can cause arrhythmia due to a sharp change of tone of the autonomic nervous system, as well as due to physical or tip of the e l e C nicotine, caffeine, etc. can cause arrhythmia can neuromuscular disorders and metabolic disorders, such as at low or excessive activity of the thyroid gland, diabetes, anemia, pheochromocytoma, etc. (M, Glaser, G. A. Glezer. Reference pharmacotherapy of cardiovascular diseases. M: "Avicenna", 1996. C. 171-205).

Abnormal electrophysiological mechanisms explaining the occurrence of atrial arrhythmias include the following concepts: 1) strengthening of focal automaticity; 2) circulation of circular re-excitation; 3) trigger activity. On the basis of the prevailing views about the physiological regulation of cardiac activity and pathological mechanisms of arrhythmias, antiarrhythmic agent should have the total ability to significantly reduce the excitability of the myocardium, reduce the conductivity to increase the effective refractory period, slow depolarization in the absence of effects on the resting potential (Leadership in cardiology under the editorship of academician E. I. Chazov. M.: Medicine, 1982. - So 3. - S. 466 - 478).

In clinical terms, the use of antiarrhythmic drugs is perfectly justified in two situations: 1) obviously, there is a certain risk of using antiarrhythmic drugs must be balanced reasonable actions and precautions. The concept of pharmacotherapy of heart rhythm disturbance is as follows. The first step is to verify the diagnosis: 1) by carefully represa patient about his illness; 2) when the ECG pattern of existing arrhythmias; 3) using 24-hour ECG monitoring. The data obtained can be used for drug testing, clinical evaluation of its effectiveness and further study of each patient methods for providing self - help and mutual aid in the event of cardiac arrhythmia.

To date, the task of providing self - and mutual assistance in the event of a severe arrhythmia does not fully resolved due to the lack of MiniPack containing effective pharmacological means, suitable for use in any environment, and lack of education among patients and their relatives, providing current information on treatment to stop acute arrhythmias and the prevention of repeated attacks.

In our opinion, the scheme diagnostician is neparoksizmalnyh supraventricular tachycardia (PNET):

1) assessment of clinical symptoms - sudden onset, tachycardia with a heart rate of 160 to 220 per minute, at the end of the paroxysm - polyuria; 2) identification PNET based ECG data: shortening of the RR interval; ectopic wave R; normal QRS complex, postprandially long pause, decreased ST segment and negative wave T; 3) identification PNET on the basis of reflex tests (breath, massage carotid sinus, pressure on the eyeballs, the root of the tongue, in the solar plexus area, the immersion of the face in cold water). Atrial fibrillation (MP), tahisistoliceskih the form of: 1) assessment of clinical symptoms - sudden onset, erratic heart beat with a frequency greater than 100 beats in 1 min, shortness of breath, pain in the retrosternal area, polyuria; 2) identification of the MP-based ECG-data - no P wave, wave f different heights and widths with a frequency of 350-600 1 min, ventricular complexes with different RR intervals and frequency > 90-200 1 min, decreased ST segment and negative wave So With atrial flutter (TA): 1) assessment of clinical symptoms - sudden onset, tachycardia with rate reductions 150-160 1 min, dizziness, weakness, nausea, sweating, feeling of fear is obraznye waves pounding (F), deformation of the ST segment and the waves So

The possibility of a decisive evaluation in the choice of anti-arrhythmic drug is determined on the basis of research by the leading Russian and foreign clinics, dealing with the problem of treatment of cardiac arrhythmias (P. M. Fogoros. Antiarrhythmic agent. Practical guide. M: "Binom", 1999. C. 140-150; Centuries Gorbachev. Practical cardiology. M: Minsk, 1997. S. 171-195; A. A. Gorbachenko, Y. M. Pozdnyakov. Coronary club. M.: 1999. S. 181-197 and others).

Among the numerous spectrum of pharmacological agents most widely used in everyday practice received verapamil, inderal, quinidine. Pharmacological properties of verapamil (Verapamili) due to the inhibition of slow calcium channels responsible for the depolarization of sinoatrial (SA) and atrioventricular (AV) nodes, the suppression of automaticity, slow conduction and increase refractoriness in SA and AV nodes. Because the basic electrophysiological effects are limited to these two structures, the drug is particularly effective when many of the supraventricular tachyarrhythmias, as it affects the mechanism of the arrhythmia. It reduces the tonus of smooth muscles of arteries, decrease the frequency of the Intel atom & trade; is Ty heart of oxygen.

Pharmacological properties propranolol (Propronaloli) associated with the suppression of the arrhythmogenic effects of catecholamines, adrenergic stimulation in the sinoatrial and atrioventricular nodes, where propranolol exerts maximum electrophysiological effects. The result is reduced automaticity, slowed heart rate, longer refractory period. An important feature of propranolol is that expressed their electrophysiological effects he manifests through the ischemic or damaged myocardium, therefore its use is preferable in those clinical cases where the development of arrhythmias is directly linked to heart disease.

Pharmacological properties of quinidine (Chyinidinum) caused membrane, direct and indirect violationsin action, blockade of fast sodium and potassium channels, which leads to the prolongation of the action potential and, accordingly, the refractory period, to improve conduction in the AV node. The effects of the drug appear in atrial and ventricular tissues, which provides exposure to various abnormal electrophysiological mechanisms contributing to arrhythmia.

Strategy for the use of Lakers is Alicia primary heart diseases preference is given to propranolol, in the absence of underlying disease of the heart - verapamil. Basic preparation for the final effect is quinidine, with high efficiency in the treatment of most types of tachyarrhythmias. Thus, the algorithm measures during the paroxysmal arrhythmias (PNGT, MP, TP) is as follows.

At the first stage it is advisable to use the reflex trial for edema paroxysmal arrhythmias (area massage carotid sinus, pressure on the stomach, on the eyeballs, the root of the tongue, the immersion of the face in cold water). If no effect is recommended pharmacological means:

a) in the absence of underlying disease of the heart (chest injuries, inflammation, intoxication, etc.) - verapamil at a dose of 80 mg per dose;

b) in the presence of primary heart disease (CHD, GB, heart diseases and others) - propranolol in a dose of 80 mg per dose;

C) if no effect within 1 hour you must start taking QUINIDINE dose of 400 mg in one day, then 200 mg every 2 hours, within 8 hours - 1200 mg.

The problem of providing self - help and mutual aid in the treatment of paroxysmal arrhythmias atrial solves creation kit, made the Yu termination of an acute attack in any situation. A set of therapeutic tools kit includes three drugs: verapamil and propranolol on a single therapeutic dose of 80 mg and quinidine 200 mg Chestertown therapeutic doses. This kit solves a number of problems. It combines useful for patient information about the clinical manifestations of atrial arrhythmias, the main remedies emergency medical self-help and clear the selection algorithm pharmacological drug. The above first aid kit in addition to the purely therapeutic purposes performs a vital function, as it gives the necessary confidence in the correctness of the action to provide long-term dynamic self-monitor their condition.

The invention is explained in the description of specific examples of its implementation and the accompanying drawings. Fig.1 depicts a first aid kit: A - front view, B - side view, rear view.

The kit consists of a case (Fig.2), orderly located therein set of remedies (21, 22, 23), instructions (Fig.1) on the use of the kit, painted on the walls of the case. The remedies set contains three medications: one tablet verapamil 80 mg (21), one tablet propranolol 80 mg (22), six who's rhythm is used as follows. At the first stage after the first attack occurred palpitations patient is examined by a doctor for any of the following reasons: 1) complaints palpitations in the absence of electrocardiographically documented tachycardia; 2) if first registered electrocardiographic diagnosis of atrial arrhythmias; 3) in the presence of ECG controversial signs of cardiac arrhythmias. The second stage involves the verification of the diagnosis on the basis of 24-hour ECG monitoring and conducting acute drug test with the above drugs. The next step is to educate the patient to self-monitor reaction tolerability of medications, heart rate, and HELL. When exercising proper control over the individual reaction acceptability of the use of the kit safely. The possibility of industrial production of kits obvious, as the release of all of its component parts developed by the domestic industry. With wide over-the-counter its spread among the adult population suffering from cardiac arrhythmias, such a kit can be quite effective in the prehospital self - help and mutual aid.

F. the deposits of rhythm, characterized in that it contains propranolol, verapamil and quinidine in single therapeutic doses, in the presence of heart disease prescribed propranolol, in the absence of heart disease - verapamil, if no effect within 1 hour appointed quinidine.

2. First aid kit under item 1, characterized in that it contains instructions for using the kit selection algorithm of the drug.



 

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