SU1508165A1 - Method of differential diagnosis of alcohol injure of heart from ischemia disease of the heart - Google Patents

Abstract

The invention relates to medicine, namely cardiology. The purpose of the invention is to improve the accuracy of diagnosis. For this purpose, a clinical examination of the subject is conducted. Then the right heart catheterization is performed, the coronary sinus is probed, blood is taken and the myoglobin concentration is determined in it, stepwise atrial stimulation is then performed, and when the frequency of stimulation is 140 pulses per minute and above, the blood is taken again and the concentration of myoglobin in it is determined. With an increase in the concentration of myoglobin from 0 to 50% compared with baseline, alcoholic heart damage is diagnosed, and with an increase in myoglobin concentration of 75% or more compared with baseline, ischemic heart disease is diagnosed. The application of the method improves the accuracy of the differential diagnosis of alcoholic heart damage from coronary heart disease by 15% compared with the prototype.

Description

The invention relates to medicine, namely cardiology.

The purpose of the invention is to increase the accuracy of diagnosis.

The method is elucidated.

There are complaints in the patient: pain in the left half of the chest, feeling of lack of air at rest and (or) during exercise, feeling of disruption of the heart. In the presence of these complaints, or in case of suspicion of these diseases, by puncture of the subclavian veins

From the supraclavicular or subclavian access, right heart sections are catheterized with the probe inserted into the coronary sinus (under the control of the x-ray image), 2 ml of blood is collected and the concentration of nioglobin is determined in it. After that, the probe electrode is led to the right atrium and the EKSK-02 device is connected and an external temporary asynchronous stimulation of the atria is started with a stepwise increasing stimulation frequency of 100, 120, I40 pulses in I min for 3 min each

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frequency, 3 minutes after the end of the stimulation, with a frequency of 140 pulses per 1 minute, blood is taken from the coronary sinus for the determination of myoglobin content. The concentration of myoglobin in the blood from the coronary sinus is determined by radioimmunoassay method, based on the competition of labeled antigens in binding to a specific antibody,

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As a label, J reagents for radioisotope immunoassay are used. After determining the concentration of myoglobin in the blood from the coronary sinus, proceed to the interpretation of the results obtained 1; atovg with an increase in concentration from 0 to 50% compared with the initial diagnose alcoholic heart damage, and with an increase in concentration from 75% or more compared with the initial diagnose ischemic heart disease,

The method is confirmed by the following examples:

Example 1, Patient M ,, 43 years. Complaints of prolonged, persistent pain in the region of the heart, in the left half of the chest, not associated with physical exertion. Abuse of alcohol for more than 10 years. Cardiovascular diseases are not noted in amnesia. Abstinence from alcohol - 21 days. For the last two weeks, short-term repeated Gotsies episodes of compressive pain in the chest, cell, passage - at rest, after taking nitroglycerin, but not always quickly, have been observed. On ECG, diffuse changes in the myocardium, bicycle ergometry : submaximal heart rate is not reached due to lack of air. Dipyridamole test is negative. Thus, the clinical examination of conventional conventional methods of research did not allow s. To establish the diagnosis with full confidence. The preliminary diagnosis was: alcoholic heart damage, IHD; angina pectoris- (Przhen a patient in a patient

The X-ray X-ray operation of the right heart was catheterized, the coronary sinus was probed with blood, and the concentration of myoglobin was determined, which is 58 IU / ml. We connected the EKSK-02 device and started external temporary asynchronous stimulation of the atria with a stepped increasing frequency of stimulation of 100, 120, 140 pulses per minute, 3 minutes at each frequency. Then repeated blood sampling from the coronary sinus was performed. The concentration of myoglobin at this stimulation frequency is 69 ng / ml. The change in concentration was 19%. The final diagnosis: alcoholic heart damage, Dg1 diagnosis check, myocardial biopsy was performed, plastic failure of cardiocytes was found in the bioptate with a pronounced decrease in protein synthesis in them, Diffuse coarsening of the myocardial stroma, which was confirmed by the previously diagnosed

And p 2 2, Patient H, 42 years old Complaints: squeezing pains when walking, mostly behind the sternum, sometimes passing at rest. Nitroglycerin is effective, but in the last 10 days its effect is short-lived and not permanent. Alcohol is used sparingly, for 10 years, the last 3 years - almost eliminated alcohol, ECG alone did not reveal any pathological changes, Bicycle ergometry: the test was not brought to diagnostic criteria due to patient fatigue. Thus, the clinical data suggested the presence of coronary artery disease, admission diagnosis - angina pectoris (), made it difficult to diagnose the presence of alcohol history. In this connection, to correct the diagnosis, right heart catheterization was performed, coronary sinus was sampled. It determined the concentration of myoglobin, amounting to 48 ng / MP. The EKSK-02 device was connected and started external temporary asynchronous stimulation of the atria with a stepwise increasing stimulation frequency: 100, 120, 140 pulses per minute, 3 minutes at each frequency, i

With a frequency of 140 pulses per minute, the blood was re-sampled, the concentration of myoglobin in it was determined, it was 120 kg / ml. Change of concentration 150%, Final diagnosis: ischemic heart disease, stenocardi unstable. The diagnosis was confirmed by the further course of the disease: after 13 days, the patient developed a large-focal myocardial infarction of the anteroperoneural area of the left ventricle.

Claims (1)

The application of the method allows to increase the accuracy of the differential diagnosis of alcoholic heart disease from coronary heart disease by 13% compared with the prototype. The method of differential diagnosis of alcoholic heart disease from coronary heart disease by examining a patient’s blood, characterized in that, in order to improve diagnostic accuracy, probe the coronary sinus, determine 3 blood myoglobin content, then gradually increase atrial stimulation to 140 pulses per 1 minute, determine the content of myoglobin in the blood and in the case of an increase in its concentration compared to the initial 50% and less diagnosed with alcoholic heart damage, and with an increase of 75% or more - nschemic heart disease. Editor M.Kelemes Compiled by A. Bobrov Tehred M. Morgental Order 3536/48 Circulation 789 VNIIPI State Committee for Inventions and Discoveries at the State Committee on Science and Technology of the USSR 113035, Moscow, Zh-35, Raushsk nab. 4/5 Production and publishing plant Patent, Uzhgorod, st. Gagarin, 101 Proofreader A, Obruchar Subscription