Prolonged microelectrostimulation method for treating the cases of acute myocardial infarction

FIELD: medicine.

SUBSTANCE: method involves acting with bipolar pulsating current of 30-100 mcA having frequency of 0.5-10 Hz upon electrode position during 10 h. The treatment course is 4-10 days long. The electrodes are arranged in known manner. The first electrode position is anterior chest wall in heart projection zone to interscapular space on the back; the second one is from front to back of the head zone; the third one takes space from right anteroinferior part of chest in liver projection to dorsal liver projection zone.

EFFECT: enhanced effectiveness of treatment.

 

The invention relates to medicine, namely cardiology, cardiac surgery and Pediatrics, and can be used for the treatment of patients with acute myocardial infarction (mi) and other diseases of the heart.

Although the basic pharmacotherapy of patients with THEM in the acute and acute stages is comprehensive and focused on the elimination of pain, prevention of arrhythmia and limitation of focus necrosis, mortality from THEM even at the hospital stage remains high, and the quality of life of undergoing THEM is determined by the level of developing them and coronary heart failure. Sometimes even neuroleptanalgesia, especially with THEM extensive, the patient cannot completely arrest the pain, but because of late admission or contraindications in a significant number of patients is not possible the use of thrombolytic drugs. As an alternative pharmacotherapy of acute or additions to it was proposed short-term transthoracic microelectrochemical diseased heart [1], and for treatment-resistant forms of coronary artery disease widely used percutaneous electrical stimulation and electrical stimulation of the spinal cord [2].

The most advanced and closest way to the same destination to the claimed invention in conjunction with Nakov and adopted as a prototype is the way to treat THEM briefly transthoracic microelectrochemical. This method [1] based on non-invasive single exposure to the affected myocardium weak low-frequency current (amperage 30-100 mA, frequency 0.5-10 Hz, the exposure duration 10 min). The disadvantage of short-term transthoracic microelectrochemical is the inability to completely suppress pain, weak stopping by neuroleptanalgesia, or difficult drug therapy tachyarrhythmias, especially when extensive THEM. With only a short transthoracic microelectrochemical cannot shoot often caused significant disturbances of the Central nervous system and liver. No standard basic pharmacotherapy THEM in the acute stage or one-time short-time transthoracic microelectrochemical not focused specifically on the processes of healing invertirovannoi infarction, stretched in time not less than three months [3], and hence the regulation of the healing process of the patient and the correction electrocardiographic and hemodynamic parameters.

However, analysis of remote results of treatment of patients treated in the acute stage the short transthoracic microelectrochemical revealed they have better hemodynamic performance and subjective assessment of treatment than in the control group, which allowed the respect is to live partial reprogramming of their healing process invertirovannoi infarction and revise the scheme of therapy is short-term transthoracic microelectrochemical in favor of increasing the duration and repetition of its impact, in order to achieve even better both immediate and distant therapeutic effects.

The invention is directed to a method of treatment to THEM, allowing long-term and re-impact not only on inparticularly myocardium, but also involved in the pathological process in the brain and liver, controlling the parameters of this exposure and the manifestation of therapeutic effects and thereby controlling the healing process invertirovannoi attack.

The invention consists in the use in the treatment of THEM and called them brain damage and liver non-invasive prolonged and repeated stimulation of weak low-frequency current.

The claimed method differs from the prototype in that make transthoracic microelectrochemical hearts and clinical indications of transcranial microelectrochemical brain and transabdominal microelectrochemical liver pulse current of 30-200 μa, 0.5 to 10 Hz, the exposure time is 30-60 minutes, the course of treatment - 4-10 procedures.

The effects of weak low-frequency current on partioularly myocardium induced pathological changes in the brain and liver aimed at interrupting the unfolding cascade of molecular and cellular damage and blocking the development of pathological homeostasis, advance the Finance of protective mechanisms and the inclusion of regenerative processes. Occur in the acute period THEY metabolic intoxication forms in the myocardium abnormal internal environment and volume transmission [1]inducyruya remodeling, and runs in invertirovannoi area due to the diffusion of fission products into the circulation slowly unfolding aseptic inflammation that often manifests clinically syndrome "for the second day in the form of rising temperatures, changes in blood and other Through the nervous system implemented rapid response of the brain and liver, and immune system [4] on the affected heart that burdens THEM. It is known that the area of inflammation when THEY are much wider zone insufficiency and necrosis and ischemia contain not only lost, but also a viable and damaged cardiomyocytes [5]. The outcome of the inflammatory response is the death of all of cardiomyocytes in the area of inflammation and scarring. Conservation of cardiomyocytes on the periphery of the zone of inflammation and damaged and viable cardiomyocytes in the ischemic region would limit the inflammatory response of the body. To reprogram the body's response to THEM requires a long time to modify or discontinue the flow of information coming from the affected area, and change invertirovannoi hearth. This task implements prolonged microelectrochemical (PMS) is expressed in the heart or other vital organs in THEM, adjusting the deployment of various defensive reactions of the organism.

Therapeutic manifestations of pulse current on the body are numerous. Among them, analgesic and spasmolytic effects, activating blood circulation and reduce swelling inflammation, increased trophic tissue and regeneration. The effect of prolonged microelectrochemical is most evident in the perturbation of intercellular medium body and established in him volumetric transmission, which is based on diffuse chemical and electrical signals that are transmitted through the extracellular fluid [6]. Since the electrical resistance of the cell components by several orders of magnitude higher than those in the extracellular fluid, the potential targets weak pulse currents are mainly small charged molecules in the extracellular environment, the interaction of various ligands with membrane proteins and longest charged domains themselves membrane proteins. The primary screening of membrane protein structure, conducted on the basis of the data Bank system, Internet (National Center for Biotechnology Information, USA), showed that many of them contain blocks of charged amino acids potentialenergy domains jet on PMS. In addition, the lipid components of membranes do not behave neutrally in an external electric field [7]that war is eget from attempts to explain the effects of PMS exposure to any single molecular target. According to the principles of synergetics [8] lump under the influence of PMS fluctuative many processes in the body leads to self-organization in new homeostasis, which restores the functioning of viable cells, suppressed intoxication, and accordingly changes coming from him, the flow of information. This changes not only the homeostasis of the processed microelectrochemical body, but also the state of the nerve endings in the body and all cellular elements of the blood, because the PMS through the heart, for example, goes through dozens of times the entire volume circulating in the body blood.

Positive therapeutic effects of PMS related, apparently, not only with the interruption of processes of destruction of the myocardium, but also to stimulate the process of partial regeneration cardiomycytes, as already shown, that under pathological conditions of the heart is greatly increased number of mitoses [9, 10]. In addition, animal models have shown the possibility of full functional recovery invertirovannoi heart [3] and a clinical observation of a significant reverse remodeling of the left ventricle with dilated cardiomyopathy after a long course of short-term microelectrochemical, the explanation of which is impossible without the recognition of the possibility of regeneration of the heart [11].

Tie the positive immediate and distant therapeutic effects of mi patients in the acute and acute stages with PMS supported by several facts:

1. Already during the first treatment PMS appear pronounced antinociceptive, anxiolytic and hypnotic effects, decreases the pale skin, cyanosis of the lips and nail Lodge, coldness of limbs, removed heavy, compression and tightness in the chest. Very characteristic is the disappearance of the fear of the patient and restore his people.

2. When the first procedure PMS often arise quickly passing rhythm disturbances mainly in the form of a single extrasystoles. Their nature is due, apparently, to improve coronary circulation ischemic region of the myocardium, which is indirectly confirmed by the changes in unusually short periods of electrocardiogram and echocardiogram

3. After the first treatment PMS disappear induced THEM arrhythmias, poorly amenable to drug therapy

4. Usually by the end of the first day THEY almost all patients after PMS showed sharp changes in the electrocardiogram. Most pronounced when they front a heart attack in the peripheral zone of the hearth necrosis: ST segment elevation to elevation contours, reducing the amplitude of the complex QS. General changes for different localization was forming after the first PMS deep negative Q wave, which is regarded as favorable electrocardiographic sign of evolution [12]

5. By echocardiography, usually held at the end of the first week of hospitalization and at discharge, there is a mismatch between the vastness of the affected area, reflected electrocardiographically to treat PMS, and slightly abnormal hemodynamics and contractility.

6. Addition transthoracic PMES heart transcranial and transabdominal PMS respectively of the brain and liver were provided elimination of clinical symptoms associated with the reaction of these bodies on THEM, and prevented the development of depressive symptoms.

7. Patients receiving PMS, differed physical activity, sociability, good mood and friendliness, interest in the continuation of a procedure during the outpatient period, linking improvement in their condition with PMS.

8. Compared with the control group, the patients receiving PMS, previously transferred from the Department of cardiac intensive care on normal mode hospitalization.

9. In the control group of patients receiving only basic therapy, rapid changes in their condition is not checked.

The method is as follows. For its realization can be used by anyone authorized by the Russian Ministry of health physiotherapy apparatus, generating a weak low-frequency bipolar is current. In our medical practice we used the device electronics. Elite-4M and special electrodes with graphitized surface. The parameters of the pulse current during stimulation are 30-100 μa, 0.5 to 10 Hz. The duration of the pulses in one position of the electrodes is 30-60 minutes For transthoracic PMS use electrodes with a size 6×15 cm, with one of them on the anterior chest wall in the area of projection of the heart, the other on the back in the interscapular area, closer to the inner edge of the left scapula. For transcranial PMS brain one of the electrodes of size 3×15 cm placed on the forehead, another $ 3×6 cm on the back of his head. For transabdominal PMS liver one of the electrodes 6×15 cm was placed horizontally right above the bottom edge of the costal arch (closer to the midline) and in front of him on the back had another electrode of the same size. With abundant hairs on the body of men recommended to ensure contact of the electrodes with the skin surface additionally to put under them soaked in warm running water gauze pads, and the electrode cover with plastic wrap to avoid wetting the gauze strips of linen. The electrodes may be fixed overlay around the body elastic textile clasp.

To perform the process is URS the patient is in bed in a horizontal position. The first procedure transthoracic PMES of the heart is performed at the time of admission to the intensive care unit. Most patients in the first 10 min of the procedure disappears tightness of the chest and limits the excursion of the chest with a deep breath and exhale, almost disappears residual after neuroleptanalgesia pain and the patient begins to doze. But this should not be cause for termination of the procedure, because its purpose is blocking development in the heart of the damaging processes, in particular extensive inflammatory process. Therefore, the procedure of PMS should be continued for up to 1 hour. By the end of the first procedure the patient to decrease the color and moisture of the skin, cyanosis of the lips, the patient comes into contact, commenting on changes occurring in it. Follow-up procedures transthoracic PMS hearts are held daily at 1 time per day during the patient's stay in intensive care unit and the intensive care unit. Therapy PMS was 4-10 treatments. Depending on the mental status and the severity of the condition of the patient, pain liver palpation and spasticity gastrointestinal tract, especially when THEY lower wall, transthoracic PMS was supplemented by transcranial or transabdominal PMS for stimulation, respectively, of the brain the liver. Usually a 2 transcranial procedures and transabdominal PMS to achieve a breakthrough in the health of patients.

The experimental group consisted of 23 patients with THEM, not treated with thrombolytic therapy had their contraindications.

Any complications or discomfort during and after PMS none of the 23 investigated patients are not marked. To prevent confusion patients about the lack of "feeling" the procedure it is advisable to pre-inform them that the effect is very weak and practically does not cause sensations in addition to the weak heat in the chest. The effect of improving remained stable and increased with each procedure during hospitalization.

Examples of extracts from the history.

Statement 1.

Patient L. W., 44 years old, was admitted in kardioreanimatsionnoj branch of the Institute of ambulance to them. Glj 11.07.2003 was expressed about chest pain (the history N 23529). As a result of clinical and electrocardiographic study of diagnosed coronary heart disease, acute penetrating THEM in the lower wall of the left ventricle from 11.07.2003, hypertension Art. III were treated non-narcotic analgesics, nitrates and streptokinase. By the end of the first day the pain syndrome was not t the d was arrested, so advanced was appointed transthoracic and transabdominal PMS. The result was complete relief of pain. In the following days the patient's condition has stabilized, signs of heart failure were not expressed, and on the fourth day he was transferred to intensive monitoring, which helped to limit the course of therapy PMS four procedures. Dynamic ECG study, there has been a rapid progress, confirmed stable echocardiographic hemodynamic data before discharge of the patient for rehabilitation in cardiological sanatorium and in the following period:

Study date:16.07.2003,23.07.2003,2.09.2003,
UO (ml)566456
PV (%)616060
LG (mm)515052
LIS (mm)333031

Legend: PP - stroke volume; EF - ejection fraction; LG, LIS respectively end-diastolic and systolic dimension left ventricle.

Statement 2.

Patient A. N.A., 50 years old, was admitted in kardioreanimatsionnoj the internal medicine Institute for an ambulance to them. Glj 31.07.2003 was expressed about chest pain and ventricular fibrillation (history N 23874). In clinicalelectrocardiology study diagnosed with ischemic heart disease, acute penetrating THEM in the area of the septum, anterior wall of the left ventricle and the apex from 31.07.2003, hypertension III senior Complications: ventricular fibrillation, circulatory insufficiency of the I century Therapy with nitrates and preparations potassium were cut short by ventricular fibrillation. In subsequent therapy was supplemented with beta blockers and antiplatelet agents. For stable relieving pain and removing fear the patient was assigned to a course of 5 treatments transthoracic and transcranial PMS. Already after the first procedure PMS showed a dramatic improvement of the patient's condition, the disappearance of the fear and pain in the chest, rapid positive changes in the electrocardiogram. On the fifth day the patient was transferred from intensive care in the cardiology Department and further rehabilitation sanatorium. About the lack of negative changes in hemodynamics evidenced by the data below echocardiography during hospitalization and in the following period:

Study date:21.07.2003,29.07.2003, 30.08.2003,
UO (ml)475652
PV (%)605958
LG (mm)484746
LIS (mm)293031

Designations are the same as in the statement N 1.

In the clinic the most accessible objective criteria stabilize hemodynamics and reverse remodeling of the left ventricle echocardiographic data of the study. As depicted in the extracts from the history of the disease, PMS opposed to one-off short-term transthoracic microelectrochemical heart calls, apparently, reprogramming healing invertirovannoi myocardium, preventing apoptosis of damaged cardiomyocytes and reducing the formation of scar tissue, allowing you to maintain normal hemodynamics. Characteristically, in the case of pharmacotherapy improved hemodynamic performance after THEM is achieved by continuous intake of angiotensin-converting enzyme inhibitors and termination of their acceptance is the reversion of their deterioration. In the case of PMS stabilization of hemodynamics after THEY achieved, apparently, due to the reprogramming of healing, which prevent the em at least early signs of remodeling.

Start using PMS not limited to the acute phase THEM. Using PMS manages to stop the destabilization of the angina in patients who have had THEM, and arrest acute coronary syndrome. However, in the case THEM to reprogram healing invertirovannoi myocardium and prevent remodeling using PMS preferably at an early stage of hospitalization. The best effect is to restore hemodynamics after THEY achieved during the long course of PMS, not limited only in-hospital period, because the recovery process of the myocardium stretches up to three months. Thus, the claimed method allows to accelerate and regulate the healing process of the patient, to adjust its electrocardiographic and hemodynamic parameters.

The claimed method is simple, does not require sophisticated equipment and can be used in complex treatment of THEM.

References

1. Kharchenko, H.E., Zhirkov A.M. Tiered effect transthoracic microelectrochemical in acute myocardial infarction. / Reports of the Academy of Sciences, 2000, T.374, N 3, c.411-414.

2. Kim M.C., Kini A., Sharma S.K Refractory angina pectoris / J.Am. Coll.Card. 2002, v.39, N 6, p.923-934.

3. Leferovich J.M., Bedelbaeva K., Samulevich S. et al. Heart regeneration in adult MRL mice. / Proc Natl.Acad. Sci USA, 2001, v.98, N 17, p.983-9835.

4. Tracey K.J. The inflammatory reflex / Nature, 2002, v.420 p.853-859.

5. James T.N. Normal and abnormal consequences of apoptosis in the human heart / Annu.Rev.Physiol., 1998, v.60, p.309-325.

6. Kharchenko, H.E., Perekatov T.A., Skoromets A.A. Neuroprotective effect misterbunnie microelectrochemical in acute violation of cerebral circulation. Reports of the Academy of Sciences, 1999., t, N 5, s-710.

7. Radhakrishnan, A., McConnell Electrical field effect on cholesterol-phospholipids complexes /Proc. Natl.Acad. Sci. USA 2000, v.97, p.1073-1078.

8. Haken, Synergetics. The hierarchy of instabilities in self-organizing systems and devices. 19856 M: Peace.

9. Anversa p, Kajstura J. Ventricular myocytes are not terminally differentiated in the adult mammalian heart / Circ. Res. 1998, v.83, No. 1, p.1-14.

10. A.P. Beltrami, Urbanek K, Kajstura J. et al. Evedence meat human cardiac myicytes divide after myocardial infarction / N.Engl.J.Med. 2001, v.344, N 22, p.1750-1757.

11. Kharchenko, H.E., Khubulava GG, Pyryev V.B. have been, Klimenko mathematical SCIENCES. Partial reversal of the remodeling of the left ventricle with cardiomyopathy transthoracic microelectrochemical reports of the Academy of Sciences. 2001, t, N 5, s-839.

12. Bosimini E. et al. Electrocardiographic evolutionary changes and left ventricular remodeling after acute myocardial infarction / J.Am. Coll.Cardiol., 2000, v.35, N 1, p.127-135.

A method of treating myocardial infarction in the acute phase of the stimulation, characterized in that exercise effects bipolar pulse current of 30 to 100 μa with a frequency of 0.5-10 Hz, the exposure time to 1 h at the position of the electrodes, the treatment 4-10 procedures, positioning electrodes in a then the (DKE), namely, the first position of the electrodes is anterior chest wall in the area of projection of the heart - interscapular space on the back, the second forehead, the nape of the neck, the third - right front lower part of the chest in the field of liver projection - the projection area of the liver on the back.



 

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