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.
The article is devoted to the issue of great current interest--that of treatment of patients with acute viral myocarditis. Topicality of the subject in touched upon in some detail, positive and negative sides of use of corticosteroids in patients with acute viral myocarditis are outlined. Comparative data are submitted of treatment of patients with acute viral myocarditis running a grave clinical course with heparin, thiotriasoline, complex heparin--thiotriasoline--prednisolone. The presented results of treatment show expediency of administration of corticosteroids leading to a statistically significant decrease in concentration of titres of antiviral antibodies Coxsackie B1-4 viruses, increase in ejection fraction, rises in platelet count in patients with acute viral myocarditis running a grave clinical course.
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.
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.
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.
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.
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.
Acute infectious myocarditis is accompanied by disturbances in the contractile function of the left ventricle, its degree being related to the gravity of the disease course. Improvement in the condition of the left ventricular contractile function correlates both with degree of severity of the illness and methodological approaches to the conducted therapy.
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.