Method for normalising functional reactivity of cardiovascular system in stenocardia function classes i-ii

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to cardiology and concerns normalising functional reactivity of cardiovascular system (CVS) in stenocardia function classes I-II. That is ensured by estimating the condition of functional reactivity of the CVS in psychoemotional load by recording systolic, diastolic, average dynamic pressure. These data are used to evaluate a functional responsiveness index (FRI) before and after stress by formula: FRI=(BPav.dyn. x HR)/100 (standard units). The PFR gain by more than 20 standard units requires administration of lisinopril in a dose 5 mg a day in the morning and metoprolol in a dose 50 mg a day in the morning.

EFFECT: method provides normalising functional reactance of cardiovascular system and higher psychoemotional load tolerance in the given group of patients within two-month therapeutic course.

3 ex

 

The invention relates to medicine, cardiology, and can be used in therapeutic departments of clinics and hospitals. Analogues of the method of normalization of the functional reactivity of the cardiovascular system angina I-II functional classes (FC I-II) does not exist.

The aim of the invention is to increase the efficiency of correction of the functional reactivity of the cardiovascular system With FC I-II.

The essence of the proposed method of correction of the functional activity of the cardiovascular system is to increase the tolerance of patients With I-II FC to emotional stress and increase the functional reactivity of the cardiovascular system in the execution of their metered emotional load and reducing the risk of cardiovascular complications during emotional stress, measured after holding dosed emotional load with the ever increasing speed for 18-20 minutes with every minute logging of the Central hemo dynamics: blood pressure systolic (SBP), diastolic blood pressure (Add), arterial pressure medium dynamic Map. Dean) and heart rate (HR), determine the value of the functional reactivity (FIU), which is the work of the AD medium dynamic on heart rate, calculate the relative increment values FIU when performing load compared with the value at rest and largest values FIU assess the type of functional reactivity of the cardiovascular system: when the FIU is more than 20 usled reactivity assessed as hyperfunctional, when FIU is less than 10 usled response to the load estimate as Hypo-functional and, when values of the FIU from 10 to 20 usled type functional reactivity assessed as normal. Time psychoemotional load no more than 20 minutes. To normalize the indicator functional reactivity in patients with I-II FC uses a combination of lisinopril and metoprolol for at least 2 months.

The inventive method is carried out as follows. The value of the FIU is determined by Lebedeva OD, Radziejewski S.A., Bugaeva S.A. Method of assessment of the functional reactivity of the cardiovascular system, EN 2207044. The patient is seated in front of the screen. The patient on the left shoulder impose cuff for measuring blood pressure systolic blood pressure diastolic arterial pressure medium dynamic and heart rate prior to loading and during loading. The patient offer two sets of 4 letters: 'ÀNEU and BLOG, of which he must choose on what I remember one. After registration of the hemodynamic parameters within 3 minutes and the memory (30) of the selected set of letters, begin conducting psycho-emotional loads, namely, that the subject pressing notes scattered letters from the selected set of progress on the monitor screen square frames situated in a random sequence the letters of the alphabet. The speed of advancement of the frames in the series of letters in the process of conducting samples increases with 3 letters 1 at the beginning of the load up to 6 letters 1, starting from 6 min load, and this provides a gradual vrabatavaemomu patient. Errors in elevation of letters from a selected set of auditory signals, for which the subject may be oriented in the proper execution of the load and try to adjust its execution. After the load calculates the average value of the BPA, Add, Map. Dean and heart rate in the periods: prior to loading and during loading. HELL the average dynamic calculated by the formula: Adsin=Add+[0,42(SBP-Add)].

HELL the average dynamic is a complex resultant of all variables HELL. The test with emotional stress in healthy individuals the HELL the average dynamic changes slightly, and the heart rate usually increases. According to studies, increased heart rate and HELL leads to increased potrebnostyami in oxygen and increase its energy costs. In pathology, for example in coronary artery disease, the blood vessels in a state of spasm, unable to provide the required increased amount of oxygen, which can increase hypoxia, incoming cerebral circulation, develop angina, etc.

On the basis of the data used to calculate the functional reactivity, which allows an integrative measure of the increase in hemodynamic load on the heart and, consequently, the risk of developing cardiovascular complications, defined as follows: FIU=(Adsens)*/100(used).

The increment values FIU during the transition from rest to execution of the load determines the index:

FIU-PFR-PFR,

where the FIU is the dierence between the values of the FIU before and during loading

PFR - averaged value of the index before load

PFR - averaged value of the index under load.

The relative increment values FIU assess the type of functional reactivity of the cardiovascular system: if the value is *, then divide by 100 to obtain conventional units (used - the double digits).

When you study in the dynamics of treatment the patient was given to remember a different set of letters in order to prevent addiction.

When the increment values after conducting dosed psychoemotional the load FIU from 10 to 20 usled functional type of reactivity is assessed as normal. When the FIU to load more than 20 usled patient With FC I-II must be assigned to at least 2 months, the combination of lisinopril 5 mg in the morning of 1 times and metoprolol 50 mg 1 time in the morning.

Timely and effective correction of the FIU in patients With I-II FC will allow in the short term to normalize the functional reactivity of the cardiovascular system that will reduce these patients the period of temporary disability, renders prophylactic action against strokes and heart attacks, reduce the number of outputs on disability and reduce mortality among patients With I-II FC.

Example 1. Examined patient K. 39 years., with coronary heart disease: stable angina I FC, H0, suffering from it for 1 year. The BPA before the load was equal to 116 mm Hg, Add - 78 mm Hg, Adsin. - 93,9 mm Hg, heart rate of 68 beats per 1 minute, the FIU was equal (6389)/100=63,8 used the BPA when conducting load is increased to 129 mm Hg, Add - up to 85 mm Hg, Adsin - to 103.4 mm Hg, heart rate 76 beats per 1 minute FIU equal (7864)/100=78,6 used

When conducting psycho-emotional load was obtained increment values FIU from 63.8 used to 78,6 used, i.e. 14.8 used that lies within the bounds of normal values increment FIU when conducting psycho-emotional activity in healthy individuals and did not require correction of the FIU.

Example 2. Examined the patient So 54 years with diag is oz coronary heart disease: stable angina, I FC, H0 3 years. In the study of hemodynamics in the initial state before the holding of the psychic activities of the Association amounted to 138 mm Hg, Add - 89 mm Hg, Adsin - 109,5 mm Hg, heart rate of 76 beats per 1 minute FIU before psychoemotional load was equal (8328)/100=83,3 used When conducting psycho-emotional loads BPA increased to 163 mm Hg, Add - 102 mm Hg, Adsin to uniforms, 127.6 mm Hg, heart rate up to 94 beats per 1 minute, the FIU is increased to (11996)/100=119,9 used, i.e. the increment on PPV load or what is the same - FIU was 36.6 used (83,3 to 116,9 used), which can be considered as a manifestation of hyperthyroidism cardiovascular system. Patient assigned to the combination of lisinopril 5 mg in the morning and metoprolol 50 mg in the morning. After 2 months of treatment, the magnitude of the FIU fell before the load compared to the same before the treatment: the BPA - up to 124 mm Hg, Add - up to 80 mm Hg, Adsin - to 98.4 mm Hg, heart rate up to 68 in 1 min, FIU - to 66.9 used When performing load marked decrease compared with the condition before treatment the increase in values of SBP 140 mm Hg, Add up to 89 mm Hg, Adsin up to 110.4 mm Hg, heart rate 76 beats per 1 minute, FIU - to 83.9 used then there is a marked increment values FIU, or FIU, 17,0 used (before treatment - 36.6 used), which may be indicative of increased tolerance of the cardiovascular system to psychoemotional load, reduced and hyperthyroidism cardiovascular system and, therefore, the economization of cardiac activity.

Example 3. Examined patient W. 52 years old, suffering from coronary heart disease: stable angina tense and II, respectively, H0 6 years. In the study of hemodynamics in the initial state before the holding of the psychic activities of the Association amounted to 139 mm Hg, Add - 88 mm Hg, Adsin - 109.4 mm Hg, heart rate of 78 beats per 1 minute FIU before psychoemotional load was equal (8534)/100=85,3 used When conducting psycho-emotional loads BPA increased to 164 mm Hg, Add - 100 mm Hg, Adsin up to 126.8 mm Hg, heart rate is up to 92 beats per 1 minute, the FIU is increased to (11672)/100=of 116.7 used, i.e. the increment on PPV load or what is the same - FIU, was 31.4 used (85,3 up of 116.7 used), which can be considered as a manifestation of hyperthyroidism cardiovascular system. Patient assigned to the combination of lisinopril 5 mg in the morning and metoprolol 50 mg in the morning. After 2 months of treatment, the magnitude of the FIU fell before the load compared to the same before the treatment: the BPA - up to 125 mm Hg, Add up to 81 mm Hg, Adsin - to 99.4 mm Hg, heart rate up to 68 beats per 1 minute, FIU - to 67.6 used When performing load marked decrease compared with the condition before treatment the increase in value of the BPA - up to 142 mm Hg, Add up to 89 mm Hg, Adsin to 111,3 mm Hg, heart rate is 78 beats per 1 minute, FIU - to 86.8 used, that is marked increment values FIU, or FIU, 19.1 usle is. (before treatment by 31.4 used), which may be indicative of increased tolerance of the cardiovascular system to psycho-emotional stress, about the reduction of hyperthyroidism cardiovascular system and, consequently, about the economization of cardiac activity.

As a result of application of the proposed method of correction of functional reactivity of the cardiovascular system in patients with I-II FC achieved the normalization of the functional reactivity of the cardiovascular system for dosed psycho-emotional stress, which allows you to use the way for the normalization of the tolerance of patients With I-II FC to psycho-emotional stress, which can reduce the degree of hemodynamic load when exposed to stress, reducing the risk of development of psycho-emotional loads adverse cardiovascular reactions (angina, myocardial infarction, ischemic, and others).

The method of normalization of the functional reactivity of the cardiovascular system (CVS), in patients with angina I-II functional classes, including assessment of functional reactivity SSS during emotional load, which record systolic, diastolic, srednetehnicheskoe pressure, on the basis of these indicators define the indicator functional reactivity(FIU) before and after exercise, using the formula: FIU=(Adsin.∙HR)/100 (used), and when the FIU is more than 20 usled enter lisinopril at a dose of 5 mg daily in the morning and metoprolol dose of 50 mg daily in the morning for at least 2 months.



 

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