WAYS FOR IMPROVEMENT OF CENTRAL AND PERIPHERAL HEMODYNAMICS IN PATIENTS WITH ACUTE CORONARY SYNDROME (MYOCARDIAL INFARCTION), WHO UNDERWENT BALLOON ANGIOPLASTY AND STENTING OF THE CORONARY ARTERY
DOI:
https://doi.org/10.11603/1811-2471.2019.v0.i1.10071Keywords:
acute coronary syndrome, percutaneous coronary intervention, reperfusion syndrome, L-arginine, L-carnitineAbstract
In Ukraine, there is an increase in the incidence of myocardial infarction among people of working age (48.9 per 100 thousand), and coronary heart disease (IHD) ranks first among the causes of primary disability (22.8 %). Considering the above facts, the development and improvement of treatment methods for patients with acute coronary syndrome (myocardial infarction) (ACS) is a priority.
Material and Methods. 45 patients with acute coronary syndrome with ST segment elevation were examined, who underwent urgent balloon angioplasty and stenting of the infarction-dependent coronary artery. The age of patients was from 43 to 75 years, on average (59.57±8.07) years. Men prevailed among them (82.2 %). The experimental group consisted of 30 patients who received standard protocol treatment of ACS (MI) and who were additionally prescribed 4.2 g of L-arginine and 2.0 g of L-carnitine (Tivorel, Yuriia Farm, Ukraine) in the form of a solution for infusion of 100 ml once a day course of 5 days intravenously. The control group included 15 patients with ACS (MI), who also underwent urgent balloon angioplasty and stenting of the infarct coronary artery, but patients of this group received only standard protocol treatment.
The aim – to improve the efficiency of treatment and prevention of the reperfusion syndrome in patients with coronary stenting by means of the inclusion of L-arginine and L-carnitine (Tivorel) in therapy patients with acute coronary syndrome (miocardial infarction).
Results and Discussion. It was established that in patients with ACS after percutaneous coronary intervention, reperfusion syndrome with manifestations of left ventricular insufficiency and rhythm disturbances most often developed. Substantial clinical and functional improvement was noted under the influence of standard medical treatment in patients of the control group, but postinfarction remodeling with systolic and diastolic function of the heart, with the development of heart failure syndrome and endothelial dysfunction of blood vessels, and also remained resistant to extrasystole therapy, progressed.
Patients with ACS (MI) of the experimental group under the influence of complex medical treatment with the inclusion of L-arginine and L-carnitine marked a significant decrease in the frequency of violations of rhythm and conduction for the second day of observation, as well as a decrease in the manifestations of post-infarction remodeling of left ventricular, which ultimately manifested itself a significant improvement in myocardial contractility (EF increased by 13 %) and decreased diastolic dysfunction. Improvement of the inotropic function of the heart and a significant reduction in the frequency and severity of reperfusion arrhythmias were achieved through the cardiometabolic effect of L-carnitine, and restoration of endothelial function of the vessels was induced by the therapeutic effects of L-arginine.
Conclusion. An increase in inotropic cardiac function and a significant reduction in the frequency and severity of reperfusion arrhythmias was achieved due to the cardiometabolic effect of L-carnitine, and the restoration of endothelial vascular function occurred under the therapeutic influence of L-arginine.
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