The technology of functional normalization of the cardiovascular system parameters by means of the alternating biofeedback on cardiac rhythm (cardiorespiratory training) with the use of a turning bed (verticalizer) is described, which allows to implement the oscillatory postural effects of ortho- and antiorthostatic nature automatically. Aim of the study. Increasing of application area of cardiorespiratory training due to the variety of options for biofeedback signals. Methods. The oscillation of the turning bed controlled by means of the parameters of heart rate variability sets for the examinee the order of alternation of the inspiration and expiration phases and the phases of the inspiration/expiration beginning. The method is available to patients with low vision, bedridden patients, early ages children; patients who are not able to understand the essence of the procedure. Results of researches. Positive dynamics of the test subjects’ functional state is, in particular, the normalization of activity of components of the autonomic nervous system; the reinstatement of the natural breathing pattern lost due to various reasons; increasing the variability of the heart rate; the cardiovascular system training due to moderate alternating ortho- and antiorthostatic load, estimated by number of physiological parameters.
The results and pattern of therapy were analyzed in 772 patients with acute myocardial infarction (AMI) who were treated at two Saint Petersburg hospitals in 1998 to 2007. A follow-up indicated that drug treatment quality and therapy adherence improved a year after AMI, resulting in a significant reduction in sudden cardiac death rates. At the same time, inadequate primary myocardial reperfusion and myocardial revascularization failed to significantly reduce mortality from chronic heart failure and incidence of myocardial reinfarction. Key words: acute myocardial infarction, sudden cardiac death, myocardial reinfarction, guidelines for the management of myocardial infarction, drug therapy adherence.
BACKGROUND: The clinical features of vasospastic angina are well known, but pathogenesis remains a subject of discussion. Changes in the autonomic regulation of coronary artery tone and endothelial function that contribute to the development of vasospasm are not well understood. The data on the subject from the published studies are contradictory. AIM: To evaluate features of endothelial function and autonomic regulation of heart rhythm in patients with vasospastic angina. MATERIALS AND METHODS: The study included 16 patients with proven vasospastic angina. All the patients have been evaluated for the heart rate variability at rest and vegetative tests (deep breathing, and active standing tests). Endothelial function has been assessed in terms of reactive hyperemia index by peripheral arterial tonometry using an Endo-PAT 2000 device. RESULTS: The baseline of the total heart rate variability was borderline with the normal parameters SDNN 50 (32.5; 50) ms in the patients with vasospastic angina. There were 14 patients who have demonstrated an imbalance of the autonomic nervous system at rest, mainly due to an increase of parasympathetic influences. The appropriate reaction of the autonomic nervous system, characterized by an increase of vagal influences, has been determined in 13 patients in the deep-breathing test. A paradoxical reaction, characterized by an increase of vagal influences on the heart rhythm, has been registered in 13 patients in the active standing tests. Endothelial dysfunction has been observed in half of the studied patients. Furthermore, a combination of both pathophysiological mechanisms, i.e., endothelial and autonomic dysfunctions have been observed in all the patients with a reduced reactive hyperemia index. CONCLUSIONS: According to the results of our study, the parasympathetic influences of the autonomic nervous system on the heart rhythm were predominant in the patients with vasospastic angina, which is not typical for coronary heart disease. All the patients had autonomic or endothelial dysfunction. A combination of both pathophysiological mechanisms has been observed in half of the examined patients.
This article presents the clinical observation of hereditary thrombophilia, complicated by the formation of a thrombus in the cavity of the right ventricle, in a 40-year-old patient with first diagnosed ulcerative colitis. Despite the standard drug therapy, the patient had a persistent fever. Transthoracic echocardiogram revealed a formation in the right ventricle. A differential diagnosis was made between the vegetation and thrombus. Due to the high risk of infective endocarditis, the antibacterial therapy was started. The addition of deep vein and common iliac vein thrombosis required the exclusion of thrombophilia. Molecular genetic testing allowed to diagnose hereditary thrombophilia: heterozygous carriage of mutations in the genes of factor V Leiden, fibrinogen, platelet receptor for collagen, plasminogen activator inhibitor I. The diagnosis of thrombophilia and ineffectiveness of antibacterial therapy led to the conclusion that there was a thrombus in the right ventricle. The treatment of ulcerative colitis was continued. At the same time, anticoagulant therapy was started, and antibiotics were canceled. As a result, clinical remission of ulcerative colitis, regression of venous thrombosis and complete dissolution of the thrombus in the cavity of the right ventricle were achieved. Ulcerative colitis may be complicated by venous trombosis and hereditary thrombophilia increases this risk.
In current work, it were evaluated clinical predictors for the success of biofeedback (BF) sessions during cardiorespiratory training (CT) by cardiac rhythm for the development of cardiorespiratory synchronization (CRS) in addition to standard therapy in patients with myocardial infarction (MI) in early periods. The study included 50 patients with uncomplicated MI on 6–10 days of disease. 21 patients developed stable CRS during training in the hospital. All patients underwent general clinical examination: control of blood pressure, heart rate, ECG, echocardiography, assessment of heart rate variability (HRV). Using of discriminant analysis of initial clinical parameters, heart rate variability parameters and cardiorespiratory training, a mathematical model was constructed that allows predict the success of CT in patients in early period of MI with a probability of 96.7%. f = −8.85 + 0.21X1 + 3.87X2 − 4.96X3 − 1.72X4 + 3.5X5 − 1.57X6 − 1.58X7 − 0.69X8 + 1.63X9 + 0.008X10 − 0.069X11 + 0.089X12 + 2.71X13 − 2.61X14 + 5.65X15 where X1 is the left ventricular ejection by echocardiography, X2 is the number of MI, X3 is the presence of previous history of coronary artery disease, X4 is diabetes, X5 is smoking, X6 is thrombolysis, X7 is coronary artery stenting, X8 is SDNN by HRV, X9 – CV by HRV, X10 – TP by HRV, X11 – HR in the first active test, X12 – diastolic blood pressure in the first inactive test, X13 – change in the HRV in the first active test as compared to the first inactive test, X14 – change in systolic blood pressure in the last inactive test compared to with the first inactive test, X15 – change in diastolic blood pressure in the last inactive test compared to with the first inactive test. The threshold value is f = −0.21. If the patient's IM value is greater than the threshold value, the patient will belong to the CRS successful group. If the patient's IM value is less than the threshold value, the patient will belong to the CRS unsuccessful group. Conclusion the developed mathematical model allows predict the effectiveness of cardiorespiratory training in patients in early period of uncomplicated MI.
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