RU2249427C2 - Method for correcting vegetative balance in patients suffering from acute myocardial infarction - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves recording electrocardiogram and cardiorhythmogram on the background of medicamentous therapy beginning from 7-10 day of the disease. The cardiorhythmogram is shown to the patient. Respiratory training session is carried out. Inspiration and expiration are to be equal in duration, each making Ѕ of cardiorhythmogram breathing wave.

EFFECT: enhanced effectiveness of treatment.

2 cl, 3 tbl

Description

The invention relates to medicine, in particular to preventive and rehabilitation medicine, therapy, cardiology. It can be used in individual treatment in hospitals, specialized cardiological sanatoriums, cardiac dispensaries for functional disorders, as well as for organic pathology, for example, the cardiovascular system, in particular in patients with acute myocardial infarction (AMI) with uncomplicated course to correct the autonomic balance, namely to restore parasympathetic activity in the autonomic nervous system.

There is a standard drug therapy method used in patients with coronary artery disease, with acute coronary syndrome, in particular, undergoing AMI, aimed at compensating for hemodynamics, preventing relapse of AMI, and preventing possible complications of the disease, such as early post-infarction angina pectoris with an outcome in angina of various functional classes, rhythm and conduction disturbances, especially ventricular arrhythmias (extrasystole, tachycardia, ventricular fibrillation), sometimes due to autonomic imbalance ohm, in conditions of a damaged myocardium. Drug therapy as a whole includes: the use of nitrates from the early stages of the disease by intravenous drip with the subsequent transition to tablet forms in individual doses under the strict control of blood pressure (because nitrates can significantly reduce it); intravenous with the transition to subcutaneous administration of anticoagulants (usually heparin at a dose of 20,000 units per day) with a gradual decrease in dose to 5,000 units per day for 7-10 days, followed by complete cancellation, it is now possible to use low molecular weight heparins that do not require gradual reduction of the individual dose, also used for 7-10 days of acute coronary syndrome with subsequent cancellation; antiplatelet agents - aspirin (acetylsalicylic acid) in a dose of 100-300 mg per day from the early stages of the disease for life; beta-blockers (atenolol, metoprolol, anaprilin, etc.) from the early stages of the disease and for life, in the absence of contraindications, in individual dosages under strict control of blood pressure and heart rate (because beta-blockers can significantly reduce blood pressure and heart rate); angiotensin converting enzyme inhibitors (ACE inhibitors) (enalapril, captopril, perindopril, lisinopril, etc.) from the early stages of the disease in the absence of contraindications, in individual doses, under strict control of blood pressure (because drugs in this group can significantly reduce it). The presented set of medications can undergo various changes, depending on hemodynamic parameters (blood pressure, heart rate), the presence of comorbidity, the course of the underlying disease (AMI) and possible complications at different stages of the disease [1].

Despite the previously proven validity of the appointment of the above series of medications, the significant disadvantages of this method are the strict individual approach to the prescription of drugs, due to individual hemodynamic parameters initially and in conditions of damaged myocardium, the presence of one or another concomitant pathology that requires the replacement of standard medications or their the withdrawal, finally, great attention requires the possibility of side effects of drug t Therapies and a non-absolute guarantee of protective ability in terms of preventing possible, sometimes expected complications of the underlying disease (AMI) both in the early stages and in the future. In addition, drug therapy has practically no positive (normalizing or restorative) effect on the existing imbalance in the autonomic nervous system (high sympathetic activity and decreased parasympathetic tone), which is one of the unfavorable factors for the development of such formidable complications as ventricular arrhythmias. Only beta-adrenergic blockers contribute to a decrease in sensitivity to a high level of sympathetic activity, while an increase in parasympathetic tone is almost impossible to drug.

Known methods of correction using the method of biological feedback (BFB).

The well-known "Method of functional correction of blood pressure" [2]. The method is carried out by presenting for visual monitoring to the patient his own cardiac rhythmogram arriving on the screen of a two-beam oscilloscope, simultaneously with the objective function, which is a sinusoid with different periods of oscillation. For one session, at least 6 samples are carried out lasting 2-2.5 minutes with a rest break of 2 minutes. The total number of sessions is from two to twelve. The methodology for implementing the method involves 3 training options, depending on the combinations of presented sinusoids, the sequence and time factors of presentations, rest, session and their number.

A significant disadvantage of this method is the presentation of fixed periods of sinusoids, which do not always correspond to real respiratory fluctuations located in the ranges of fast waves from 0.15 Hz to 0.4 Hz and slow waves from 0.04 Hz to 0.15 Hz heart rate (SR ) There is also the possibility of negative consequences such as hyperventilation due to the patient’s state exceeding the individual norm, due to the absence of objective restrictions on the amplitude of the sinusoid and average heart rate, which is a constant component of the sinusoid. When implementing the method, the state of autonomic nervous regulation of the heart rhythm is not taken into account, and therefore, the choice of the parameters of the reference sinusoids is subjective and not optimal for various conditions of the patient. At the same time, there is a compulsory effect on the patient, which in some individuals counteracts the rapid involvement in the cardio training process, excessive stress during training, the rapid development of fatigue, that is, it is, a kind of stress for the patient, which represents an additional risk that can aggravate disorders in autonomic regulation of heart rhythm, as well as lead to inefficiency of the procedure. The use of cardiotraining according to this technique in patients with AMI in the early stages has not been used before and is undesirable, since the initial state of autonomic nervous regulation of SR is not taken into account, and therefore it is impossible to assess the qualitative and quantitative changes in the autonomic regulation of heart rhythm achieved during cardiotraining. In addition, a significant drawback in relation to patients who have undergone AMI is that, regardless of the duration of the disease, training in the cardiovascular system with the help of biofeedback cannot be used in isolation, i.e. cannot rule out drug therapy in such patients, including a certain number of drugs.

There is a “Method of functional psychophysiological correction of a person’s condition and diagnosis" [3], which is the closest in technical performance to the proposed method and selected by us as a prototype. The essence of the implementation of this method is a visual presentation to the patient of his own cardiac rhythmogram, where the oscillation of the frequency of his own heart rhythm is used as a target function, respiratory movements are synchronized with heart rate variability. Inhalation is performed at an increase in heart rate, and exhalation is performed at a decrease in heart rate, while forming a respiratory rhythm in the range of fast or slow waves, depending on the individual characteristics of a particular patient. The results of preliminary measurements, training tests and final measurements of the patient’s parameters are automatically recorded in the computer database and presented in the form of graphic information and text information.

A significant disadvantage of this method is that its implementation does not provide for the use of any medication, which, accordingly, is impossible in patients with AMI both in the early stages and in the delayed period, and when using the method, the possibility of excessive stress during training, especially in the first session, since the absence of respiratory waves in the cardiac rhythmogram in such patients, due to the rigidity of the heart rhythm in conditions of imbalance in the autonomic nervous system topic, does not allow the patient to perceive his own rhythmogram as a target function. Nor is a 5-minute ECG recording performed an assessment of the temporal and frequency indicators of heart rate variability, reflecting the degree of imbalance between the parasympathetic and sympathetic parts of the autonomic regulation of the heart rhythm, which has the highest diagnostic value and information, which allows assessing the state of the autonomic nervous system before training, upon completion , as well as in dynamics for 1 year.

Thus, the known methods do not solve the problems of a high therapeutic, prophylactic and diagnostic effect, the safety of patient treatment, which limits the use in organic pathology of the cardiovascular system, namely in AMI.

The objective of the invention is to reduce recovery time and increase the duration (at least 1 year) of maintaining the autonomic balance by normalizing the activity of the links of the autonomous nervous system.

The problem is solved in that patients with AMI in the early stages starting on the 7-10th day of the disease, against the background of drug exposure, conduct a cycle of correction of the autonomic balance, including visual presentation of the cardiac rhythmogram to the patient, where the oscillation of the frequency of the own rhythm is used as the objective function in order to restore autonomic balance by increasing parasympathetic effects on heart rate. Inhalation is performed with an increase in heart rate, and exhalation is performed with a decrease in heart rate. During a respiratory training session, inhalation and exhalation are counted, while inhalation and exhalation should be equal in duration and each should be 1/2 a period of the respiratory wave of the cardiac rhythmogram. The first training session excludes the presentation of the cardiorhythmogram to the patient, i.e. the patient carries out respiratory movements without using biological feedback. Subsequent sessions of the correction course are carried out by synchronizing respiratory movements with heart rate variability. The correction course is 8-10 sessions. The level of autonomic innervation disturbance is determined by studying HRV using 5-minute ECG records before the start of the cycle, and the effectiveness of the training and the level of restoration of the vegetative balance after the completion of the training are evaluated.

The method is as follows. Cardiotraining sessions (respiratory training using BFB) are carried out starting from 7-10 days of uncomplicated AMI, against the background of individually selected and ongoing standard drug therapy, including anticoagulants (usually heparin, starting from 20,000 DB per day with a gradual decrease to 5,000 units per day and cancellation for 7-10 days), nitrates (mononitrates - nitrosorbide from 40 to 80 mg per day or mononitrates - monochinque, monomak, cardicet, etc. from 20 to 80 mg per day, two or four times admission), beta-blockers ( atenolol 12.5 to 100 mg per day or metoprolol from 25 to 100 mg per day, two-time intake), ACE inhibitors (enalapril from 5 to 20 mg per day or captopril from 18.75 to 37.5 mg per day, two or three-time administration), antiplatelet agents (aspirin 125 mg per day, a single dose). The first session includes informing the patient about the goals and methods of the cycle, as well as verbal training in the correct execution of respiratory movements, namely: breathing should be calm, shallow, inhalation and exhalation should be equal to each other and be each 1/2 period of the respiratory wave heart rhythmograms. Subsequent sessions are performed using respiratory synchronization using biofeedback. Training is held daily, in the afternoon (at 14-16 hours), i.e. immediately between morning and evening medication or after lunch (with three meals), after half an hour of rest in a moderately lit, soundproof, well-ventilated room with a comfortable temperature. The patient is seated in a comfortable functional chair at a distance of 1.5-2 meters from the monitor screen. The nasal passages should be free, clothing should not impede normal breathing and blood circulation. A clip is applied to the index finger of the left hand, which is a pulse wave sensor, from which the heart rate monitor enters the cardiac signal registration unit. Blood pressure (BP) is measured, for example, using a standard blood pressure monitor. At the same time, the essence of the training is explained to the patient, presenting on the monitor screen in real time the patient's own CRH associated with the state of the cardiovascular system of the body. The patient is offered to breathe smoothly, paying attention to the nature of breathing (breathing should be calm, shallow), as well as the duration of inhalation and exhalation, that is, equalize them. In the absence of periodicity, they suggest breathing in such a way that when an increase in the pulse rate of the pulse (raising the curve up) takes a breath, and when the pulse frequency of the pulse decreases (decreasing the curve), exhale. Pay attention to the dependence of its fluctuations on the frequency and amplitude of respiration. The necessity of relaxation during cardio training sessions is also emphasized, while the patient is given 4-5 minutes to get used to the situation. Considering that patients with AMI often have extrasystoles that cause fluctuations in amplitude and period on the presented cardiac rhythmogram, in this case the patient is asked to stop monitoring the rhythmogram visually (close his eyes) and perform only respiratory movements, trying to produce a smooth and uniform inhale and exhale. With the normalization of the cardiac rhythmogram, the patient is again invited to perform subsequent tests using visual control.

The presence of a cardio-training doctor in the sessions provides psychological preparation for the patient, especially in the first, introductory session, when only respiratory movements are performed per account, in accordance with the period of the breathing act, equalizing the duration of inhalation and exhalation, and subsequently verbal adjustment phases of inhalation and exhalation in accordance with the rise and fall of the shock frequency of the heart rhythm (curve KRG).

After each training sample, blood pressure is measured and its values are entered into the computer's memory, and the patient rests for 2-3 minutes with his eyes closed. The number of samples in a session can be from 6 to 8, each of which has a duration of 120-150 seconds. Before and after each session, with closed eyes in a relaxed state, the initial and final KRG, blood pressure and other parameters are recorded. Beginning of a training cycle on days 7-10 of AMI in the absence of severe complications: early post-infarction angina pectoris, severe extrasystole, other significant rhythm and conduction disturbances, severe circulatory failure. 1 session is carried out daily, and the correction course is 8-10 sessions depending on the objectives of the study, the diagnosis of the initial state of the patient and his dynamics based on the training results based on objective computer analysis data presented in the form of graphs, tables, textual conclusions on the monitor screen or printouts on the printer, patient self-reports and the doctor’s opinion.

For a quick assessment of the initial, current state of patients in the proposed method, indicators are used that are determined before, during (after each sample) and after the session: blood pressure, the average heart rate for the sample is automatically measured, and the average dynamic and pulse pressure, respiratory rate are determined automatically heart rhythmogram and its rhythmic composition (spectral power) is calculated, indicating the state of the autonomic (sympatho-vagal) balance, and heart rhythm scatterograms (CP) are constructed, signaling the presence of and some types of arrhythmias, histograms of the distribution of RR-intervals, which with a number of calculated parameters and indices (minute and stroke volume of blood circulation, cardiac index, peripheral resistance, heart energy, cardiorespiratory coefficient, endurance coefficient, variational range, indexes of functional state, voltage) indicate the degree of tension of the regulation mechanisms of the cardiovascular system.

Before the start of the training cycle, as well as after their completion, the heart rate variability is analyzed, estimated by time and frequency (spectral) analysis using 5-minute ECG records. To assess the duration of the restoration of the autonomic balance, heart rate variability is estimated 1 month and 1 year after completion of the correction course by a similar methodology.

Distinctive essential features of the proposed method are:

1) the method is used in the early stages of acute myocardial infarction (starting from 7-10 days);

2) the method is carried out against the background of drug therapy;

3) inhalation and exhalation are counted, while inhalation and exhalation must be equal in duration and each comprise 1/2 the period of the respiratory wave of the cardiac rhythmogram;

4) during the first session, the patient conducts respiratory movements without using biological feedback;

5) the study of HRV by 5-minute ECG recordings, assessed by time and frequency analyzes before the start of the course and after its completion, allows a better assessment of the level of disturbance, restoration of the vegetative balance, and also to evaluate the duration of maintaining the vegetative balance after the correction course.

The proposed differences make it possible to more effectively restore and increase the duration of maintaining the autonomic balance due to the development of cardiorespiratory synchronization, which contributes to an increase in the intensity of respiratory sinus arrhythmia (respiratory arrhythmia) - a non-invasive indicator of the level of parasympathetic activity, which is favorable (when balanced with sympathetic influences) in terms of the course of AMI and IHD as a whole, providing tread antiarrhythmic function, contributing to the sustainable recovery of thermodynamics in the earlier stages of the disease.

The reliability of the high efficiency of the correction of the condition of patients is presented on specific examples of the method.

Example 1. Patient S. 49 years. I / B No. 33073-С. He suffered an acute penetrating myocardial infarction from 12/07/00, which was the debut of coronary heart disease. In terms of concomitant pathology - the anamnesis is not burdened. In terms of drug treatment - standard therapy (antiplatelet agents, anticoagulants, beta-blockers, I-ACE, nitrates). On the 8th day of AMI, in addition to general clinical examination methods, a HRV study was performed, which revealed changes (disturbances) in the autonomic balance characteristic of the current disease, consisting in a decrease in indicators reflecting general variability, parasympathetic effects on the heart rhythm, as well as an increase in the activity of the ANS sympathetic link. As of December 15, 00, he did not present any active complaints, objectively, his condition is relatively satisfactory, blood pressure 110/80 mm Hg, heart rate 86 beats per 1 min, BH 18 per 1 min. According to the rhythmogram - the absence of the oscillatory nature of the rhythm. The proposed training cycle was intended to correct the imbalance in the ANS. The patient was explained the purpose of the training, methodology. The patient underwent 10 sessions, the first of which included only respiratory movements per account in accordance with the established period of the act of breathing, and the breath should be equal to the expiration in duration. Subsequent sessions were carried out by synchronizing respiratory movements with their own rhythmogram; for 1 session, 6-7 samples were performed, each lasting 2 minutes. During training, the appearance of the oscillatory nature of the rhythmogram, which reached a maximum (respiratory arrhythmia in the range of slow waves, respiratory rate of 6 in 1 min) by the 8th session, was noted. From the side of blood pressure - without dynamics, heart rate within 70-74 in 1 min. On the ECG for the whole time - Sinus rhythm, with a heart rate of 72 in 1 min, from the side of repolarization processes - the regular dynamics of MI, there are no rhythm and conduction disturbances. In general, there was an improvement in mood associated with a manifestation of interest in the method, which led to positive motivation, clinically from the side of well-being and objective data of negative dynamics were not noted. In the control study of HRV (after completion of 10 sessions), an increase in indicators of general variability, parasympathetic activity of ANS was noted.

Example 2

Patient G., 54 years old. I.B.No. 32397 suffered from coronary heart disease. Angina pectoris voltage 2 f.c., with a progressive course with an outcome in AMI, penetrating anterior localization from 11.25.01. In terms of concomitant pathology, the anamnesis is calm. Drug therapy is standard. At the time of inclusion in the study, complaints of some general weakness, periodically occurring discomfort in the heart region, not associated with physical exertion, body position, rare, but quite well-felt interruptions in the heart rhythm, did not indicate typical anginal pains. Objectively, the condition is relatively satisfactory, blood pressure 115/80 mm Hg, heart rate 90 in 1 min, NPV - 18 in 1 min. When assessing HRV on the 10th day of AMI, signs of imbalance in the ANS were noted. A cardio training cycle was performed using the BOS method. The number of sessions held - 9, each of which included 6-8 2-minute samples. In terms of motivational attitude - without interest, I was not always willing to go to the session. Signs of establishing a significant oscillatory nature of the rhythmogram (respiratory arrhythmia of the heart, respiratory rate of 6 cycles in 1 min), initially unexpressed, appeared in 2-3 sessions and was maintained until the end of the training cycle. It is worth noting that starting from the 5th session, a visually determined extrasystole appeared (2-3 in 1 min), accompanying a noticeable emotional stress of the patient, probably caused by external factors, which greatly complicated the further course of training. The patient at each session with the occurrence of extrasystoles, determined on some of the samples, was asked to complete such a test by closing his eyes, performing only respiratory movements on the account in accordance with the periods of the act of breathing. Such a modification made it possible to eliminate the tension in the psychoemotional sphere, aggravated, probably, by the visual perception of extraordinary bursts on the rhythmogram caused by extrasystole. On the part of hemodynamic parameters - blood pressure at the same level, heart rate at 80 beats. 1 minute. On the ECG in dynamics - Sinus rhythm, with a heart rate of 78-80 per 1 min, single ventricular extrasystoles, from the side of repolarization processes - do not exclude the formation of aneurysm in the apex area of L.Zh .. When evaluating the control HRV (at the end of the training cycle), the following changes in indicators: characteristics of general variability decreased, but spectral analysis showed an increase in sympathetic and mainly parasympathetic influences, their ratio reflected a larger increase in the direction of vagal influences.

Example 3. Patient P., 51 years old. I.B.№29929 s / o. Acute penetrating myocardial infarction of anterior localization from October 2001 was the debut of IHD. In terms of concomitant pathology - an anamnesis without features. Medication for the underlying disease is standard. To correct the autonomic imbalance established in the study of HRV, a course of respiratory training using the BOS method was proposed on the 10th day of AMI. At the time of the inclusion of active complaints did not show, objectively - the condition is relatively satisfactory, blood pressure 110/80 mm Hg, heart rate 78 in 1 min, NPV 18 in 1 min. On the ECG - sinus rhythm with a heart rate of 80 in 1 min. The regular dynamics of AMI, no rhythm and conduction disturbances. 10 sessions were conducted (the first session contained only respiratory movements per account) for 6-8 2-minute samples. During the training cycle, a positive mood for classes was observed, clinically - without negative dynamics. The intensity of respiratory arrhythmias of the heart with a respiratory rate of 6-7 cycles in 1 min was noted from 4 sessions. When studying HRV at the end of a training cycle, despite a decrease in indicators reflecting overall variability, a shift in the power spectrum towards indicators reflecting parasympathetic influences was observed.

Example 4

(by the prototype method). Patient D., 47 years old. I.B.No.33256 s / o. AMI penetrating anterior-lateral localization from 11.26.00, which was the debut of IHD. When studying HRV on the 10th day of AMI, signs of a vegetative imbalance typical for this pathology were revealed. Active complaints at the time of inclusion in the study did not show. Objectively - blood pressure 110-70 mm Hg, heart rate 86 in 1 min, respiratory rate of 18 in 1 min. The training cycle was conducted from 10 days of AMI, 10 sessions were conducted, including 6-8 2-minute samples, and all sessions included samples with a visual representation of their own rhythmogram (no training in respiratory movements was performed). In the study of HRV at the end of the training cycle, an increase in the indicators of general variability, as well as the growth of all indicators evaluated in the frequency analysis, was not found. There was an increase in sympathetic influences, defined in absolute and normalized values, which may be due to stress during the training, i.e., an additional stress factor. In terms of the development of respiratory arrhythmias of the heart, the first signs appeared at 7-8 sessions, however, respiratory cycle rates of less than 10 in 1 min could not be achieved. It is important to note that at the initial stage in the CRG, the patient showed a regid rhythm. HELL, heart rate - without any particular dynamics, at the same level. When assessing heart rate variability after 1 month and after 1 year, the time and frequency characteristics of HRV returned, practically, to the initial level.

The total number of patients who underwent a correction cycle was 20 people. Everyone has achieved a positive result in terms of restoring the autonomic balance, which consists mainly in increasing the activity of the parasympathetic link of the autonomic nervous system. Monitoring of heart rate variability by 5-minute ECG recordings by time and frequency analyzes before the correction course, after its completion, and also in dynamics after 1 month and after 1 year made it possible to evaluate the achieved result in terms of its development time and duration of maintaining it at the achieved level not only in the group of patients who underwent a correction course by the proposed method, but also compare them with the group of patients exposed to the prototype method. Comparative characteristics of groups of patients are presented in table 1. A comparative assessment of the dynamics of heart rate variability indicators, estimated by 5-minute ECG recordings by time and frequency analyzes in groups of patients in dynamics at different times, is presented in tables 2 and 3.

The advantage of the proposed method over the prototype is that it, including pharmacological and non-drug correction of the condition, can be used in patients with AMI, in the early stages of the disease, since it is not associated with physical exertion, it is carried out in the range of physiological fluctuations presented to the patient indicators (presented own KRG in real time, which eliminates the patient’s state during the training beyond the physiological norm), the patient is introduced into the course of correction sparingly a specific, i.e., the first session eliminates visual inspection rhythmogram own, and means training procedure the patient respiratory (inspiratory and expiratory uniformity, the desire to increase the duration of breath, not depth). There is a more rapid achievement of the desired result, which consists in increasing the activity of the parasympathetic link of the autonomic nervous system, diagnosed by studying heart rate variability from 5-minute ECG recordings before and after training. When using the proposed method, these changes in the ANS are already achieved at the 5-6 session of the training cycle, i.e. on the 13-15th day of AMI. When using the prototype method, according to our data, a positive effect is observed only on the 25-30th day of the disease. The achieved results are stored for a long time (1 year) and are also evaluated by the study of heart rate variability. When using the prototype method after 1 year, indicators reflecting the vegetative balance approached the original. The method is not associated with an increased risk of developing possible complications for the current disease, but rather, as the above examples show, it can reduce it. The range of contraindications for the method has been significantly narrowed.

The necessary cycle of operations of the method, carried out with patients for therapeutic purposes, restores the normal biorhythmological structure of the heart rhythm, has a positive effect on the state of the autonomic nervous system, increasing the activity of its parasympathetic link, reducing sympathetic influences and blocking sympathetic receptors (beta-blockers), normalizes heart rate, arterial pressure and other indicators of the cardiovascular system with a significant improvement in the well-being of patients.

Sources of information

1. Selected issues of practical cardiology. A.I. Olesin, A.V. Shabrov, V.K.Sinenko, S.A. Baldueva, G.A. Kuharchik, Ya.V. Golub. MZRF. SPbNMA them. I.I. Mechnikova. S.P. 2001, pp. 110-115.

2. USSR, copyright certificate No. 1745200, IPC A 61 B 5/00, publication 03/08/1992.

3. "A method of psychophysiological correction of the human condition and diagnosis." Suvorov N.B., Bochkarev D.N., Frolova N.L., Chikhirzhin G.M. Bulletin of inventions. No. 30 (1), 2001 p. 8 dated 10.27.01.

Table 1
Characteristics of the examined patients Sign Trained group Control group Number of patients twenty twenty Age 57 ± 10.2 50.4 ± 8.2 Front IM 12 eleven Lower my 8 nine Q-IM nine eleven Not Q-IM eleven nine Arterial hypertension 12 14 THERAPY: B-blockers 19 17 Nitrates twenty eighteen Aspirin twenty twenty ACE inhibitors 16 fifteen

table 2
The effect of respiratory training using biofeedback on HRV. Indicator Originally After training I II I II Dx 132.4 ± 84.9 192 ± 108 139 ± 105.1 190 ± 130 Sdnn 24.79 ± 15.0 35.1 ± 14.3 25.79 ± 14.87 32.3 ± 11.5 CV 2.726 ± 1.52 2.562 ± 1.52 2.91 ± 1.508 2.63 ± 1.59 Mo 864.3 ± 135 850.4 ± 126.7 839 ± 116.3 845.4 ± 120.3 Ato 70.9 ± 19.2 72.3 ± 18.94 13.7 ± 23.3 64.83 ± 21.5 OM * 380 ± 57.39 * 356 ± 63.9 426 ± 53.06 * 380 ± 24.31 Lfn 61.856 ± 22 72.2 ± 17.2 70.92 ± 12.6 74.3 ± 12.4 Hfn 38,367 ± 23 33.7 ± 17 29.08 ± 12.67 25.7 ± 11.8 LF / HF 2.62 ± 2.32 2.2 ± 3.5 4.77 ± 7.77 2.89 ± 4.8 % VLF * 66 ± 14.04 * 58 ± 20.4 52 ± 22.06 * 60.4 ± 19.6 % LF * 21.7 ± 13.46 30.7 ± 18.6 33.4 ± 17.96 29.8 ± 12.6 % HF * 12.3 ± 2.17 * 11.3 ± 10.52 14.6 ± 2.87 * 9.8 ± 12.5 - I - the trained group.
- II - control group.
* - differences are significant (p <0.05)

Table 3
The effect of respiratory training using biofeedback on HRV. (continued) Indicator After 1 month After 1 year I II I II Dx 140.5 ± 91.6 180 ± 54 154.6 ± 63.4 193 ± 75.2 Sdnn 26.32 ± 12.8 30.6 ± 9.8 25.44 ± 14.5 28.7 ± 12.6 CV 2.86 ± 1.493 2.73 ± 1.61 2.65 ± 1.58 2.63 ± 1.52 Mo 841.5 ± 106.6 851.4 ± 95.3 824.26 ± 88.9 870.35 ± 115.3 Amo 72.5 ± 20.4 75.34 + 19.74 74.9 ± 17.3 82.61 ± 22.3 OM 430 ± 64.48 329 ± 29.51 419 ± 41.53 351 ± 41.6 Lfn 62.12 ± 13.6 70.5 ± 16.32 64.38 ± 12.3 75.3 ± 19.1 Hfn 37.88 ± 12.83 29.5 ± 12.6 35.62 ± 18.42 24.7 ± 19.1 LF / HF 2.84 ± 3.2 2.39 ± 4.5 2.1 ± 5.1 5.6 ± 4.59 % VLF 38.5 ± 13.5 55.3 ± 12.6 34.4 ± 12.4 50.0 ± 11.1 % LF 38.2 ± 10.46 34.2 + 8.92 42.8 + 14.3 38.3 + 14.1 % HF 23.3 ± 12.5 10.5 ± 6.78 22.8 ± 8.32 11.7 ± 9.2 - I - group using the proposed method
- II - group using the prototype method
- - differences are significant (p <0.05)

Claims (2)

1. A method of correcting the autonomic balance in patients with acute myocardial infarction, including the visual presentation of a cardiac rhythmogram to the patient, where oscillations of the frequency of the own rhythm are used as the objective function, moreover, inspiration is performed when the heart rate is increased, and exhalation is performed when the heart rate decreases, which differs the fact that during a session of breathing training, inhalation and exhalation are counted, while inhalation and exhalation should be equal in duration and each should be 1/2 per iodine of a respiratory wave of a cardiac rhythmogram, moreover, during the first session, the patient carries out respiratory movements without using biological feedback, the method is carried out starting from 7-10 days of acute myocardial infarction against the background of drug exposure, the correction course is 8-10 sessions. 2. The method according to claim 1, characterized in that before and after the course of correction, heart rate variability is assessed by 5-minute ECG recordings by time and spectral analysis.