Method for treating acute coronary thrombosis cases

FIELD: medicine.

SUBSTANCE: method involves additionally administering vitamins B6, B12 and folic acid to patients receiving anticoagulation therapy. Protein content is limited in daily food allowance to 0.8-1.1 g/kg of body weight and cysteine content is increased to 400-500 mg/day.

EFFECT: enhanced effectiveness of treatment; eliminated homocysteine link in pathogenesis.

 

The invention relates to medicine and can be used in the treatment of acute coronary thrombosis.

There is a method of treatment of coronary heart disease through the use of anticoagulants, beta-blockers and calcium antagonists, taken as the analog of (1).

There is a method of treatment of acute coronary thrombosis, through the use of anticoagulants adopted for the prototype (2). Prototype method involves the use of aspirin inside of 325 mg/day and intravenous heparin.

However, this therapy does not take into account the possible risk of coronary thrombosis due to heterozygous mutation methylenetetrahydrofolate (MTHFR) (mutation MTHFR CT) with the development of hyperhomocysteinemia.

The aim of the invention is to increase the effectiveness of treatment of acute coronary thrombosis.

The technical result is achieved in that when detecting in a patient heterozygous mutations (GTZ) methylenetetrahydrofolate (MTHFR) ST patients in addition to anticoagulant therapy prescribed pyridoxine in doses of 450 to 500 mcg, folic acid dose 7-8,5 mg and vitamin b12dose 400-520 int. units, and in the diet limit the content of protein in the daily diet to 0.8-1.1 g/kg of body weight and increase the cysteine content of up to 400-500 mg/day.

The method is implemented as follows.

At admission the patient complains of the intensity of the positive or dull pain behind the breastbone. Sometimes develops an intense painful sensation of pressure in precordial area. The pain may irrationality in the left shoulder, often extending down the inner surface of the left forearm and even the fingers. Possible irradiation of the pain in the throat, jaw, teeth, and occasionally down on the right hand. Discomfort sometimes localized in the upper abdomen. Sometimes the patient complains of pain in the region of the apex of the heart.

May increase heart rate often increases blood pressure, heart sounds become muted, the apical impulse is vague. The electrocardiogram revealed ST segment depression or elevation, decreasing the amplitude of the wave, the disturbance of intraventricular conduction.

Diagnosed with small myocardial infarction. In the early postinfarction period in the face of anticoagulant therapy reappear anginal attacks. In the study reveal a pronounced disturbance of the coronary circulation.

Patient conduct genetic research, identifying homozygous or heterozygous mutation of the enzyme methylenetetrahydrofolate (MTHFR) ST. In the presence of heterozygous mutations in methylenetetrahydrofolate (MTHFR) ST patient along with anticoagulant therapy prescribed pyridoxine in doses of 450 to 500 mcg, folic acid is in the dose 7-8,5 mg and vitamin b 12at a dose of 400-500 int. units, and in the diet limit the content of protein in the daily diet to 0.8-1.1 g/kg of body weight and increase the cysteine content to 470-520 mg/day course for 20-30 days.

After treatment electrocardiographic signs of acute coronary thrombosis not visualized, anginal attacks do not recur.

Way of the following examples.

Example 1.

The patient, Mr., 62 years old, was admitted with complaints on a periodic dizziness, headaches accompanied by heart palpitations against the background of increasing blood pressure, aching pain in left shoulder with irradiation of the outer surface of the shoulder. In 1965 he suffered a closed craniocerebral injury, brain concussion, and then began recording high blood pressure to 160/100 mm Hg diagnosed hypertension II senior Periodic hypertensive crises with increased AD to 230/150 mm Hg at the same time identified clinical manifestations of atherosclerosis of coronary vessels - pressing pain in the chest during exercise and rises HELL. Suffered a small anterior myocardial infarction. In the early postinfarction period began to bother anginal attacks, and when held koronaroangiografii revealed stenotic lesion of the anterior interventricular Cherie - 90%. Conducted angioplasty with good hemodynamic effect - complete recanalization of the anterior interventricular artery. Before angioplasty revealed high hyperhomocysteinemia

Patient conduct genetic research, identifying homozygous or heterozygous mutation of the enzyme methylenetetrahydrofolate (MTHFR) ST. Revealed the presence of heterozygous mutations (GTZ) methylenetetrahydrofolate (MTHFR) ST in connection with which the patient along with anticoagulant therapy started therapy with pyridoxine in doses of 500 mcg, folic acid at a dose of 8.5 mg, and vitamin b12dose of 520 int. units, restrict protein in the daily diet to 1.1 g/kg of body weight and increase the cysteine 500 mg/day rate at 30 days.

After 3 weeks achieved normalization on homocysteine 36 mmol/l to 10 mmol/L. further anginal attacks not had anticipated within six months. When control of Bicycle ergometry tolerance to physical load average, the response of hypertensive type. Holter monitoring: continuously recorded sinus rhythm with heart rate 50-114 min; supraventricular extrasystoles - 15, VT - 12; changes typical of myocardial ischemia were observed. HELL remains stable at the level of 130-160/80-95 mm RT. Art., the patient's prognosis in CHD favorable.

On the Les treatment electrocardiographic signs of acute coronary thrombosis is reduced, reduced pain intensity.

Example 2.

Patient, 47 years old, was admitted with complaints of pain in the heart region with irradiation to the left arm and left shoulder. Periodically the patient on the rise HELL to 170-190 /100-110 mm RT. Art., 3 years ago, I had a small myocardial infarction. In the early postinfarction period in the face of anticoagulant therapy again began to bother anginal attacks, and when koronaroangiografii revealed stenotic lesion of the anterior branch of the left coronary artery was 70%. Conducted angioplasty with hemodynamic effect of recanalization of the anterior branch of the left coronary artery. Before angioplasty revealed high hyperhomocysteinemia with heterozygous mutations (GTZ) methylenetetrahydrofolate (MTHFR) ST in connection with which the patient along with anticoagulant therapy started therapy with pyridoxine dose of 450 μg, folic acid in a dose of 7 mg and vitamin b12at a dose of 400 int. units, restrict protein in the daily diet to 0.8 g/kg of body weight and increase the cysteine 400 mg/day course for 20 days.

After 4 weeks achieved normalization of the content of homocysteine - 12 mmol/L. further anginal attacks not had anticipated within six months. Control Holter monitoring reveals sinus rhythm with a heart rate of 60-85 in the in, single ventricular and supraventricular extrasystoles. HELL remains stable at the level of 130-150/80-90 mm RT. Art., the patient's prognosis in CHD favorable.

Example 3.

A patient With s, 53 years old, suffered a small myocardial infarction. In the early postinfarction period in the face of anticoagulant therapy again became concerned about the attacks of chest pain with radiating to both shoulders and left arm. If koronaroangiografii revealed stenotic lesion of posterior branch of the left coronary artery is 80%. Conducted angioplasty with satisfactory hemodynamic effect is incomplete recanalization of the posterior branch of the left coronary artery. Before angioplasty identified high hyperhomocysteinemia with heterozygous mutations (GTZ) methylenetetrahydrofolate (MTHFR) ST in connection with which the patient along with anticoagulant therapy started therapy with pyridoxine dose 470 mg, folic acid at a dose of 7.5 mg and vitamin b12at a dose of 450 int. units, restrict protein in the daily diet to 1 g/kg of body weight and increase the cysteine to 450 mg/day rate for 25 days.

After 30 days, the homocysteine - 8 mmol/L. further anginal attacks not had anticipated during the year. Controlling blood pressure measurement - 120-130/75-80 mm RT. Art., Holter monitoring reveals sinus rhythm with a frequency of a heart condition who's cuts 65-90 min; single ventricular and supraventricular extrasystoles. The patient's prognosis in CHD favorable.

According to the claimed method is executed the treatment of 39 patients, follow-up observations have confirmed the effectiveness of the treatment of acute coronary thrombosis in 32 patients.

Sources of information

1. Berkow R. (ed.). Manual medicine. t.ii. M., Mir, 1997. - 1045 S.

2. Ibid.

Method for the treatment of acute coronary thrombosis by anticoagulant therapy, characterized in that when detecting in a patient heterozygous mutations (GTZ) methylenetetrahydrofolate (MTHFR) ST patients in addition to anticoagulant therapy prescribed pyridoxine in doses of 450 to 500 mcg, folic acid dose 7-8,5 mg, and vitamin B12 at a dose of 400-520 int ed, and in the diet limit the content of protein in the daily diet to 0.8-1.1 g/kg of body weight and increase the cysteine content of up to 400-500 mg/day.



 

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