SU976960A1 - Method of differential diagnisis of myocardial infarction - Google Patents

Description

The invention relates to medicine, namely to methods for the differential diagnosis of cardiovascular diseases.

A known method for the diagnosis of myocardial infarction by electrocardiographic studies ij

However, the known method only indicates the presence of myocardial damage and does not allow differentiating its size, since there is a reliable connection between the volume of myocardial necrosis and the amplitude of the Q wave, as well as between the amount of necrosis and the number of ECG leads, which are signs of myocardial infarction, installed .

The most perfect method is the differential diagnosis of small and large-focal myocardial infarction to determine the activity of aspartate aminotransferase in serum. In case of large-focal myocardial infarction, aspartate aminotransferase activity is 4.5–5 times normal values (normally, aspartate aminotransferase in serum ranges from 8 to 40 units) and is observed in 96-98% of patients; in small-focal myocardial infarction, this enzyme activity pred.py norm (23 ,,

However, when using this method, the enzyme activity is preserved only in the first two days of the development of myocardial infarction, dramatically reduces the accuracy and information content of this method, since patients are often hospitalized at 3–4 minutes.

10 day from the development of myocardial infarction, while the determination of enzyme activity in the blood serum requires deficient reagents and appropriate equipment.

15

The purpose of the invention is to improve the accuracy of diagnosis in the early days of the disease.

The goal is achieved by the fact that in the implementation of the method

20 differential diagnosis of myocardial infarction, a patient is intracutaneously injected with a 0.1% zymosan solution in a dose of 0.05-0.15 ml and at the appearance of papule in 20-24 hours

25 at the site of injection of the drug with an area of 12.6-38.4 mm in size, MHOKap-j is diagnosed with a large-focal infarction and, if the area of the papu is 0.8-7.1, a small-focal infarction is diagnosed

Claims (2)

30 myocardium. The method is carried out as follows. A 0.1% solution of zymosan in a dose of 0.05-0.15 ml is administered intracutaneously to a patient, and if papules appear after 20-24 hours at the injection site of an area of 12.6-38.4 MTI, a large-focal myocardial infarction is diagnosed, and when the area of the papule is 0.8-7.1 mm, small-focal myocardial infarction is diagnosed. The size of the papule area is calculated using the TC formula 3.14f D - papule diameter in mm. Example 1 Patient S., 1934 first birth. History of angina pectoris for 1.5 years. The day before hospitalization, the strongest anginal stupor developed, which lasted for 2 On admission to the hospital for ECG, there are signs of transmuscular changes in the anterolateral wall of the left ventricle. ASAT serum 120 units. Intracutaneous tests are carried out with zymosan: 0.05 ml of 0.1% zymosan solution is administered intracutaneously. Black 20-24 hours papule is formed with an area of 12.6 mm. The diagnosis of large focal (transmural) myocardial infarction was made. The course of the disease was complicated by complex heart failure and heart failure, and on the 4th day there was a lethal outcome. Pathological anatomical dissection followed by histological examination confirmed the diagnosis. Example 2. Patient 3., 192 years of birth. For the first time in life with blunt chest pain for 2 days before the r feed. The pain persisted for one hour. Upon admission to the hospital on an ECG, signs of common small-focal changes. The AST activity in serum 32 units. An intracutaneous test with zymosan was carried out: 0.15 ml of a 0.1% aqueous solution of zymosan was injected intracutaneously. After 20-24 hours, a papule with an area of 7.1 mm was formed. Diagnosed with small focal myocardial infarction. Example 3 Patient G., born in 1911, for 2.5 liters before admission of angina to the hospital. The day before the gestation, a long angiosis developed. Upon admission to the hospital for ECG signs of small focal changes in the anterior wall of the left ventricle. The activity of ASAT serum 38 units, which also confirmed the diagnosis of small myocardial infarction. However, when conducting intradermal tests with a zymosan, data on the presence of a large-focal myocardial infarction — the area of the papule — 38.6 M1 is obtained. The patient's condition continued to deteriorate, and despite the intense intensity of the disease, after several days a fatal outcome occurred. In case of anatomic autopsy followed by histological examination, a large-focal (transmural) myocardial infarction was established. Example 4 Patient M., born in 1932. For the first time, pains in the heart appeared on the day of hospitalization. Upon admission to the hospital on an ECG, signs of large-focal (transmural) changes in the anterolateral wall. The activity of serum ASLT 82 units, indicating a large-focal myocardial infarction. The area of the papule after intradermal injection of zymosan is 12.6 mm, which also testified to the large-focal myocardial infarction. Despite the intensive treatment, the patient's condition deteriorated progressively and was fatal. In the case of anatomical anatomy and histological examination, the diagnosis of large-focal myocardial infarction is confirmed. Example 5 Patient I., born in 1922. On the day of hospitalization, an attack of chest pain with typical irradiation for 40 minutes. When entering the ECG, there are pronounced signs of diffuse muscle changes, suspicion of focal changes in the lateral wall of the left ventricle. ASAT serum 103 units, i.e. 2.6 times higher than normal, which testified in favor of large-focal myocardial infarction. However, when conducting an intracutaneous test with zymosan, data are obtained on the presence of a small focal myocardial infarction (papule is absent). With repeated repeated ECG study reveals the development of small-focal changes. Diagnosed with small focal myocardial infarction. EXAMPLE 6. Patient R., born in 1934. On admission, severe anginal pain for 3 hours. On the ECG, there are signs of a complete blockade by the Human branch of the His bundle and impaired coronary circulation in the antero-secondary region. ASAT 27 units , i.e., the serum ASAT activity, nor the ECG data, do not indicate myocardial infarction. When conducting an intradermal test with zymosan, data are obtained on the presence of a small-focal myocardial infarction (papule area 7 mm). With repeated, dynamic study of ECG through. 5 and 8 days reveal the dynamics of small focal changes. Diagnosed with small focal myocardial infarction. The proposed method is applied on 106 patients. It was found that it provides an increase in the accuracy of diagnosis in the first days of the disease up to 82 ± 6%, while when using the known method the accuracy of diagnosis does not exceed 5946%, while the proposed method is simple in execution and in the interpretation of the results obtained. DETAILED DESCRIPTION OF THE INVENTION Method for differential diagnosis of myocardial infarction, which is so that, in order to increase the diagnostic accuracy in the first days of the disease, a 0.1% solution of eimosan is intracutaneously administered to the patient at a dose of 0.05-0.15 ml, and when papules appear, after 20-24 h at the injection site of the preparation with an area of 12.6-38.4 mm, large foci are diagnosed, myocardial infarction, and at papule area 0.8-7 , 1 mm is diagnosed with small focal myocardial infarction. Sources of information taken into account during the examination 1. Cardiologists, 1977, 2, p. 43-49. 2. Fetisova T.F. Biochemical methods in the diagnosis of myocardial infarction. In the book. Myocardial infarction ed. AI-Gritsyuk, Kiev, p. 74-92, 1973 ..