Differential diagnostic technique for cardiogenic myocardial ischemia and genital-cardial inhibitory reflex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to cardiology and gynaecology, and can be used in the differential diagnostics of cardiogenic myocardial ischemia and the genital-cardial inhibitory reflex accompanied by pain syndrome caused by a gynaecological pathology. That is ensured by ECG recording. That is followed by two-side block of round ligaments of the uterus by an anaesthetic solution in an amount of 15.0-20.0 ml from each side. The ECG is recorded again 60-90 min after the block, and the recording is compared to the pre-block ECG. If the ECG findings tend to be positive, ischemia caused by the genital-cardial inhibitory reflex accompanied by pain syndrome caused by a gynaecological pathology is diagnosed. If no positive dynamic is observed, cardiogenic myocardial ischemia is diagnosed.

EFFECT: technique provides the effective differential diagnosis of cardiogenic myocardial ischemia and the genital-cardial inhibitory reflex accompanied by pain syndrome caused by a gynaecological pathology.

1 ex

 

The invention relates to medicine, cardiology and gynecology and directly to the differential diagnosis of cardiogenic myocardial ischemia and genitale-cardiac reflex brake on the background of gynecological pathology, accompanied by pain.

In the available literature we have not met publication devoted to the differential diagnosis of cardiogenic myocardial ischemia and genitale-cardiac reflex brake.

At the same time, on the background of gynecological pathology, accompanied by pain syndrome ECG changes, might not be attributable to pathology of the heart, and the implementation genitale-cardiac reflex brake, in which the spasm of the vessels of the myocardium in the transmission of pathologic impulses on the background of pain from the uterus and appendages to the heart. On the one hand, in this situation the presence of gynecological pathology is undeniable, but to exclude cardiogenic etiology of myocardial ischemia is also not possible. Moreover, the implementation genitale-cardiac reflex and its role in the development of myocardial ischemia, accompanied by ECG changes, has not been studied. This error in diagnosis makes it difficult to determine the tactics of the patient that may endanger her life and health.

Pain in gynecology� diseases may be due to acute inflammatory diseases of uterus and appendages, endometriosis, dyspareunia, algomenorrhea, etc., that is pathology, which in the pathological process anyway parietal peritoneum becomes involved. Essentially genitale-cardiac reflex is a special case of abdominal-kardialnogo braking reflex.

The technical objective of the proposed method is to optimize the differential diagnosis of cardiogenic myocardial ischemia and genitale-cardiac reflex brake on the background of acute pain syndrome in gynecological pathology.

The technical result is achieved in that the first ECG recording, then bilateral blockade of the round ligament of the uterus by the anesthetic solution in the amount of 15.0-20.0 ml on each side, then after 60-90 min after blockade re-entry ECG, which is compared to the ECG recording, made before the embargo. In case of positive dynamics of pathological changes on ECG diagnose ischaemia, due genitale-cardiac inhibitory reflex on the background of pain, and in the absence of positive dynamics of ECG diagnose cardiogenic myocardial ischemia.

The invention consists in that the first recording of the ECG, then the bilateral blockade of the round ligament of the uterus by the anesthetic solution in the amount of 15.0-20.0 ml on each side, then after 60-90min re-entry ECG, which is compared to the ECG recording, made before the blockade, and in case of positive dynamics of pathological changes on ECG diagnose ischemia caused genitale-cardiac inhibitory reflex on the background of pain, and in the absence of positive dynamics - cardiogenic myocardial ischemia.

The method is carried out as follows. In pain due to gynecological diseases produce ECG recording, then bilateral blockade of the round ligament of the uterus by the anesthetic solution in the amount of 15.0-20.0 ml on each side, then after 60-90 minutes to re-produce the ECG recording, which is compared to the ECG recording, made before the blockade, and despite positive dynamics is diagnosed on ECG ischaemia, due genitale-cardiac inhibitory reflex on the background of pain, and in the absence of positive dynamics of ECG - cardiogenic myocardial ischemia.

In the experiment on 20 cadavers of women, we conducted a scoping anesthetic that provides for adequate blockade of the round ligament of the uterus. For this, conducting a blockade of the round ligament of the uterus, introduced colored solution and evaluated the infiltration solution of the round ligament and mesosalpinx. It was found that for adequate blockade of mesosalpinx you must enter not less than 15,0 ml of solution on each side.

Method �differentsialnoi diagnosis of cardiogenic myocardial ischemia and genitale-cardiac reflex brake on the background of the pain syndrome in gynecologic pathology was used in 14 women with chest pain and signs myocardial ischemia on ECG gynecological pathology, accompanied by severe pain. Of these, 11 were identified myocardial ischemia caused genitale-cardiac inhibitory reflex, and at 3 - myocardial ischemia due to cardiac pathology. Diagnostic errors was not.

Example patient: Patient N. 27 years old appealed with complaints of marked pain in the lower abdomen, radiating to the rectum, the appearance of which it's associated with sexual intercourse on the eve of the pain. However, several earlier had pain behind the breastbone, interruptions in heart work, "fear of death". In history after intercourse noted dyspareunia (pain in the abdomen), but prior to the appearance of pain in the heart, interruptions in heart work, "fear of death" first appeared, and what was the reason for the referral to the cardiologist. The patient had a consultation with a gynecologist, the diagnosis of dyspareunia is confirmed, with data for acute pathology requiring invasive treatment methods, at the time of inspection have been identified. On the ECG showed ST-segment depression and mild negative T wave, single ventricular extrasystoles, tachycardia (92-98 heartbeats per min). To exclude cardiogenic etiology of ECG changes was made of bilateral blockade of the round ligament of the uterus in 15.0 ml of 0.5% solution �of novocaine on each side. When re electrocardiographic study 1 hour after blockades marked positive dynamics, ECG changes regressed. Furthermore, it was observed and regression of chest pain, erratic heart disappeared "fear of death". Cardiac etiology ischemia was excluded.

Additional symptoms consider new and significant, which allows to increase the efficiency of the differential diagnosis of cardiogenic myocardial ischemia in the pathology of the heart and genitale-cardiac reflex brake on the background of pain caused by gynecological diseases.

Method of differential diagnosis of cardiogenic myocardial ischemia and genitale-cardiac reflex brake on the background of pain caused by gynecological diseases, including ECG recording, followed by bilateral blockade of the round ligament of the uterus by the anesthetic solution in the amount of 15.0-20.0 ml on each side and in 60-90 min after blockade re-record the ECG and the recording is compared with the ECG recording made before the blockade, with positive dynamics of ECG results diagnose ischemia caused genitale-cardiac inhibitory reflex on the background of pain caused by gynecological diseases, and in the absence of positive dynamics�and - cardiogenic myocardial ischemia.



 

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1 tbl, 10 ex

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3 tbl, 3 ex

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1 tbl, 4 ex

FIELD: medicine.

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3 cl, 9 dwg, 2 ex

FIELD: medicine.

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EFFECT: accelerated noninvasive method.

1 tbl

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