Search

For the first time it is established that patients with acute virus myocarditis (AVM) at all stages of severity of clinical course of the disease have changes in indicators of fibrinogens, soluble complexes of monomeric fibrin, products of its degradation, activated plasminogen, time recalcification of blood plasma to blood heparin, fibrinolytic activity of plasma, spontaneous fibrinolysis, time of lysis of euglobulin clot, blood heparin, antithrombin III, platelets. It testifies to suppression of fibrinolysis processes which expressiveness statistically reliably correlates with degree of severity of clinical course of AVM. Application of medicamentous correction is necessary for prevention of the development of disseminated intravascular blood coagulation syndrome.

For the first time, positive influence was shown of a complex blood heparin-antitrombin III on the state of the coagulant and fibrinolytic system of blood in patients with acute virus myocarditis that favours the normalization of clinical and laboratory indicators, improvement of the state of patients and reduction of average bed-day indicator (hospital stay) till 25 and 35 days in accordance with severity of clinical course of the disease and can be recommended as a choice of medicine.

For the first time it is established that changes of parametres of coagulation hemostasis (fibrinogen Fg, soluble complexes of monomeasured fibrin -SCMF, products of fibrin degradation-PFD, 1st and 2nd waves of platelet aggregation), platelet hemostasis (platelets, a range index of platelet contact activation -RIPCA, activated partial platelet time--APPT, a total index thrombophilia TIT, platelet time--PT, prothrombin time (Prv), physiological anticoagulants (blood heparin-BH, antithrombin III--AT III, plasma tolerances to heparin--PTH), and fibrinolysis (lysis time of euglobulin clot--LTEC), enzyme condition of antiradical protection--superoxide scavenger (SOSC) which reduction in concentration leads to increase in concentration of malonic dialdehyde (MD) in erythrocytes (Er), thrombocytes (Tr), blood plasma (BP) in patients with acute virus myocarditis (AVM) of all severity groups and statistically correlate with the degree of severity of clinical course and demands medication correction.

For the first time it was established that changes of fibrinogen parameters, dissolved complexes of monomeric fibrinogen (DCMF), products of fibrinogen degradation (PDEF), first and second waves of platelet aggregation, activated partial platelet time (APPT), range index of contact platelet activation (RICPA), general index of thrombophilia (GIT), platelets, prothrombin time, heparin in blood, plasma tolerance to heparin (PTH), time lysis and euglobulin clot (TLEC), lipid peroxidation, antiradical defence ferment, superoxiddismutase (SOD) in patients with acute virus myocarditis of first, second and third group of severity correlate statistically reliably with grade of severity of clinical course of the disease and require correction with medications.

For the first time it is proved, that patients with an acute virus myocarditis have statistically confirmed authentic reduction in quantity of thrombocytes, extention of parameters of a activated partial thrombin time, reduction in concentration of a heparin-antithrombin III (AT-III) complex against suppressed enzyme of antiradical protection - superoxide dismutase and it has led to activization of a malonic dialdehyde in erythrocytes, thrombocytes and blood serum. In case of the development of an acute virus infection especially caused cardiotrophic strain Consaki, virus CVB 1-CVB 4, thrombocytes, according to P. Nemetchek-Gansler, acquire not pertaining to them ability for phagocytosis of viruses with following reduction in quantity of thrombocytes and increase in aggregation abilities of thrombocytes what influence the state of duration index of contact aggregation of thrombocytes with the tendency to shorten this duration, and also it may develop hypoxia, an ischemia and the subsequent necrosis of cardiomyocytes, that is to an acute virus myocarditis that demands corresponding correction with medications.

The article shows that ISCART statistically correlates with the degree of severity of acute virus myocarditis. The authors proposed for the first time the group of medications and proved that efficiency of these medications correlates with the degree of severity of the disease and has a place to be used by physicians.

The author carried out an analysis of first and second wave of the aggregation of platelets in patients with acute virus myocarditis in connection with the stage of clinical course of the disease and therapy done.

The article is devoted to an urgent problem of the status of fibrinogen in patients with acute viral myocarditis and methods of the treatment. It is proved for the first time that a decrease in the concentration of fibrinogen as an indicator of thrombinemia correlates statistically to a great extent with the degree of severity of the condition in patients with acute viral myocarditis. Convincing, statistically significant data have been obtained on a decline in the concentration of fibrinogen in those patients with acute viral myocarditis placed on a complex therapy, running a mild course of the disease, a mild one presenting with elevated indices for hemostasis, and moderately severe course (diclofenac, heparin, thiotriazoline) as well, in grave condition (prednisolone, heparin, thiotriazoline), that can help in choosing of patient treatment tactics.

The article focuses on the status of a natural anticoagulant antithrombin III in patients with acute viral myocarditis (AVM) and on modes of treatment thereof. It has been proved that there is a statistically significant correlation between a drop in concentration of antithrombin III and degree of severity of AVM. Convincing, statistically significant data have been obtained that antithrombin III gets increased in AVM patients undergoing complex therapy: in those patients running a mild course of the illness, a mild one presenting with elevated indices for homeostasis, a medium gravity course (diclofenac, heparin, thiotriasoline, quick-frozen plasma), and grave course as well (prednizolon, heparin, thiotriasoline, quick-frozen plasma), which fact can be taken account of in choosing a therapeutic regimen.

Twelve percent of patients with a mild clinical course have been shown to be in the mild degree of severity of the clinical course by the clinical picture and state of the ejection fraction but by indices for hemostasis they approach moderately severe degree of the clinical course. Recognition of this fact makes the physician especially responsible for all he ventures in treating patients in the above group to prevent transformation into a more severe degree of the clinical course of acute viral myocarditis.

Disturbances were studied in the system of hemostasis, lipid peroxidation, functional condition of the cardiac muscle in patients with acute mild, moderately severe, and severe viral myocarditis. The studies were made before and after the treatment of patients with basal drug preparations, heparin, antioxidants (thiotriasaline, captopril). Therapeutic benefit from treatment with heparin, thiotriasaline was but insignificant in patients with mild, moderately severe, and severe course of the disease. It was only with the adoption of a complex therapy (basal drug preparations, heparin, thiotriasaline, captopril, diuretics) that patients derived clinical-and-laboratory-instrumental-and-social-and-economic benefit from treatment.

Carried out in this study for the first time was the diagnosis and treatment per groups of degree of severity of the clinical course of infectious myocarditis. According to the classification of the New York Association of Cardiology (1964, 1973), there has been established a clear correlation between the gravity of the process course, hemodialysis and cardiac haemodynamics.

The novelty of the work consists in application of hirudotherapy (leeches) to treat infectious myocarditis, which therapy has been embarked on for the first time in the treatment of this medical condition. Coagulation methods used by the author are modern, the methodical approach is adequate. The role of hirudotherapy versus heparin therapy is shown.

Overall thirty-four patients with infectious myocarditis were studied by 9 coagulation techniques. A major proportion of this patient population displayed stage I blood disseminated intravascular coagulation syndrome. Treatment with coagulants, antiaggregants or nonsteroid antiinflammatory drugs resulted in positive dynamics of indices for coagulative and thrombovascular hemostasis, which observation significantly correlated with clinical improvement.