Heart rhythm disturbances are the most formidable complications of coronary heart disease. The pathogenesis of ischemic heart disease and complicating its arrhythmias, the outcome of the disease largely depends on the metabolic disorders that result from ischemia and myocardial hypoxia. The leading role in the realization of the metabolic response belongs to the processes of lipid peroxidation. Activation of processes of lipid peroxidation is an important pathogenetic link in the development of arrhythmias in patients with chronic ischemic heart disease. The emergence of dystrophic changes in the myocardium, signs of atherosclerotic and post infarct cardiosclerosis, heart rhythm disturbances against the progression of atherosclerosis of coronary arteries – all this is largely due to the development of a small-controlled process of biochemical reactions with the formation of highly active free-radical peroxide compounds. The clinical efficacy of the combination of phinoptin and alpha-tocopherol was studied in 36 patients, in patients with cardiac arrhythmias with chronic ischemic heart disease, whose treatment with phinoptin did not have a positive effect (21 patients) or gave a satisfactory therapeutic effect (15 patients): 31 men and 5 women aged from 30 to 78 years. Because of hypertension, arrhythmias occurred in 29 patients, without hypertension – in 7 patients with circulatory disturbance IIA – in 28, IIB – in 6, III stage – in 2 patients. In this group of patients who took phinoptin and alpha-tocopherol, supraventricular extrasystole was observed in 7, atrial fibrillation and flutter – in 18, ventricular extrasystole – in 11 patients. All patients were under constant cardiomonitor observation, electrophysiological and hemodynamic control. Prior to treatment and after treatment with combined therapy, metabolic factors and neurohumoral aspects of the regulation of the cardiovascular system were studied. Finoptin was administered in the same dosage. Alpha-tocopherol was prescribed in a daily dose of 100-200 mg orally as a 10% oily solution or by intramuscular injection of 1 ml of 10% oily solution in a warmed state for 2-3 weeks. Thus, comparing the therapeutic, metabolic, neurohumoral and hemodynamic efficacy of phinoptin and alpha-tocopherol, the following conclusions can be made: More positive significant shifts in hemodynamics, metabolism and neurohumoral indices than with monotherapy with phinoptin. More pronounced positive metabolic, neurohumoral and hemodynamic shifts in the treatment of phinoptin with alpha-tocopherol are noted with good therapeutic effect in patients with atrial fibrillation and flutter, with supraventricular forms of arrhythmia. When treated with a combination of phinoptin and alpha-tocopherol, more significant positive changes were noted in the lipid peroxidation of lipids and the antioxidant system, the exchange of electrolytes, hemodynamics, and intracardiac kinetics.
Keywords: phinoptin, alpha-tocopherol, chronic ischemic heart disease, supraventricular extrasystole, ventricular extrasystole
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