HBO IN TREATING OF PAROXYSMAL AND EXTRASISTOLOGIC DISORDERS OF PULSE IF ISHEMIAC SICKS.

Practical recommendations.

Successful treating and prevention of cardiac arrhythmia results in reduction of lethality, caused by cardiac fibrillation, ishemiac disease; lessens the invalidity of patients.

The agents against arrhythmia are quickly developing last time, but the problem isn't solved  yet. This is because of many factors of arrhythmia; individual absence of response on many medicines; individual contraindication of many medicines, in particular absolute contraindication for sicks with the deficiency of circulation.

As hypoxy causes the pulse violation, HBO would be used for solving that problem. HBO was used against paroxysms of cardiac fibrillation and extrasystolic arrhythmia caused by ishemia. The efficiency of treating was different, this may be because of absence of exact indications or contraindications for the application of that method.

Practical recommendations that are represented here deal with the application of HBO for treating of ishemia with paroxysms of cardiac fibrillations; paroxysms of supra ventricular tachycardia; extra systolic pulse disorder; combination of pulse arrhythmia with defects of atrioventricular and intercardial conductivity in myocard, cardiac arrhythmia caused by WPW and CLC.

Experiment on 106 ishemiac sicks shows, that only HBO causes antiarythmic effect. Application of complex therapy including HBO improves the treating effect; lessens the negative influence of beta-blockators on myocard. This is the result of observation of two groups of sicks.

The period of antiarythmic effect of HBO (half-year on average) happened to be proportional to the time of the recovery of pulse arrhythmia. Indications and contraindications were worked out on the application of HBO with disordered pulse and the conductivity process in myocard.

Reasons for use of HBO for patients with ishemia added by disorder of pulse and conductivity.

Compulsity of HBO for sicks with cardiac arrhythmia and ishemia is caused by essential role of hypoxy in production of arrhythmia and feasibility of HBO in hypoxia therapy.

The basic recommendations of the application of HBO in therapy of ishemia were completely developed in the document, worked out in the All-Union Center of HBO VNIIK and EH of Minzdrav together with clinic of the 4-th Division of Minzdrav (1978).

Here we observe the specifications of the application of HBO in therapy of different forms of cardiac arrhythmia in combination with transgressions of conductivity in myocard. The influence on electrocardiogram; central hemodynamics, external breath, gaseous composition and acid-alkaline balance of blood in different vessels, activity of simpatico-adrenal system is also taken into account.

Hypoxia that is the result of ishemia of myocard together with transgressions of central hemodynamics and ventilation after cardiac and lung deficiency can cause cardiac arrhythmia.

The electrocardiographic, hemodynamic and ventilational investigations have adopted that statement. Well determined shifts were observed for sicks - that is the proof of ishemia, hypoxia and

dystrophy in myocard. Damages of hyper- and hypo-kinetic circulation were investigated in central hemodynamics by means of integral reography; and of external respiration by means of spyrography. These sicks also had  a hyperventilational phenomenon of lessening of loading the probes, and wave-type violation of respiration, expiratoral delays and inlet breathes. Only for several patients the de compensation of cardiac activity was observed; the majority had latent forms of deficiency of circulation. Aerial composition of blood was unchanged because of hyper function of external respiration. Only in time of paroxysms the changes have been observed - that testifies the de compensated hypoxia (lessening of capillary pO2, metabolic acidos, enlarging of hyperventilational phenomenon).

Hypoxia can cause changes in cells of myocard; stimulates the ectopical activity; violates conductivity of cardiac muscle - all that was observed in practice. For the majority of patients regular supraventicular, politipic, group and volley extrasystols were observed; for third part - paroxysms of cardiac fibrillations and supraventicular tachycardia; for 30 sicks - all mentioned above together with violation of atrioventricular conductivity, intercardial conductivity, paroxysmal violations caused by WPW and CLC; some patients - constant fibrillational arrhythmia.

Activation of simpatico-adrenal system plays a special role in excitation of paroxysmal arrhythmia - the majority of patients had a high level of cachetolamines (adrenaline, noradrenalin) in blood. But the influence of HBO on that isn't studied yet.

HBO can improve the medicinal influence of cardiac glycosides and beta-blocators, causing the reduction of its everyday dose (as some authors say). When studying the electrocardiograms and hemodynamics we could see that effect only on some part of the  patients. But HBO really managed to reduce inotropical effect of beta-blockators on myocard. That made it possible to use  these medicines for patients with reduced cardiac outlet.

We suppose HBO to influence on activity of hyperbaric oxygen. Thus HBO can change hemodynamic constants: lessen the loading of myocard when hyperkinetical blood circulation; improve cardiac outlet of patient with hypokinetical type of hemodynamics - that can be the result of the improvement of myocard and lessening of ishemiac dystrophy.

Lessening of hypoxia can cause the reduction of hyper function of external respiration and improvement of functional probes. Constant aerial composition prolongs the activity of cardiac and respiratory systems to normal status. Reduction of hypoxia causes the diminishment of respiratoric and cardiac arrhythmia. After HBO the activity of simpatico-adrenal system lessens.

Thanks to this 75% of patients can feel the diminishment or reduction of extrasystols. High extrasystols, that can cause cardiac fibrillation, disappear completely. Often the fibrillational arrhythmia changes to normoarythmia; sometimes the sinus rhythm is being recovered. Inter cardiac blockades are diminishing. These are the  results of both simple HBO-therapy and HBO with antiarrythmic therapy.

HBO is also acting in advance (for approximately half a year): it lessens the hypoxia, improves the state of myocard, reduces activity of simpatico-adrenal system.

The contraindications for HBO are: braricardia; fibrillational briarythmia; artrioventricular blockades.  Thus HBO is effective in treating of paroxysmal and extrasistolic violations of pulse, caused by ishemia. HBO reduces ishemia and hypoxia of myocard; positively

changes central hemodynamics and external respiration, reduces the activity of simpatico-adrenal system.

Applications of HBO for patients with ishemiac violations of cardiac rhythm.

1. Early politropic, group and volley extrasistoles of high gradations (B.Lown).

2. Regular super ventricular extrasistoles (bi-tri-quadriheminal ones in particular).

3. Paroxysms of blinking of heart and of supraventicular tachycardia.

4. Combination of paroxysmal and extrasistolic arrhythmia with cardiac blockades.

5. Medicinally-resistant paroxysms of cardiac fibrillations and extrasystolic violations of pulse index.

6. Extrasystolic arrhythmia, paroxysmal and extrasystolic fibrillations of heart combined with reduced cardiac outlet.

All these contraindications would be taken into account (together with common contraindications) when HBO-therapy is proposed.

Contraindications for HBO.

1. Caverns in lung;

2. epilepsy;

3. strong hypertension;

4. otorhinolaryngologic diseases;

5. claustrophobia;

6. improved sensitivity to oxygen.

 

Specific contraindications:

1. Combination of bradicardia (less than 50 per minute) with paroxysmal and extrasystolic arrhythmia.

2. Combination of paroxysmal and extrasystolic arrhythmia with atrioventricular blockades.

3. Permanent normo- and bradisistolical fibrillations of heart.

Besides all of this HBO isn't effective  when paroxysms of cardio fibrillations are accompanied by WPW or CLC phenomena; when ishemia and hypertension cause arrhythmia; when arrhythmia has a chronic character.

Practical recommendation for use of HBO for treating of arrhythmia and its prophylaxis.

The common dispanserisation would precede HBO. This is done in order to find out the reasons and form arrhythmia. The roentgen of lung is compulsory to avoid complications.

The procedures are held in chambers "Oka-MT" and "BL-3".

A preceding consultation with HBO-stuff is needed to exclude sicks with contraindications.

A peculiarity of cardiac diseases is that the patient would never been exited; sequentially an improved attention and care are needed.

The security of operating with barochamber demands to forbid all the creams, metallic accessories and any dress except the cotton one.

Patient and hardware would be electrically neutral.

3% solution of ephedrine would be put into ears to avoid the probability of pain.

0,1% solution of atropine is desirable  for patients with ectopic arrhythmia and weak (above 50 per minute) bradicardia; validol and nitroglycerin - if remissions of stenocardia can take place.

The HBO-therapy gives the complete healing effect if the violations of pulse had appeared just recently (less than half a year) and they aren't accompanied with the violations of hemodynamics and complicated disorder of pulse.

Combination of HBO with medicinal therapy can be applied if the preceding medicinal therapy was useless for 2-6 weeks. The medicines to be applied in combination with HBO are: potassium containing compounds; sedatives and tranquilisators; beta-blocators; glucose-novocain mix; hinidine; cardiac glycosides; des-urinal, hypotensive, vascular medicines, vitamins, etc.

HBO can lessen the required dose of medicine; sometimes HBO can permit the application of former rejected medicines (for example: after mix: beta-blocators+HBO the reduced cardiac outlet is surely improving because of lessening its toxic influence on myocard).

An individual approach is required for HBO-therapy: the age; existence of additional diseases would be taken into account.

The first procedure would be more brief - that is done to determine the individual response to oxygen; its influence on the work of cardiosystem.

The first results can appear no earlier than 6 - 8-th procedure.

Each procedure would be supported by electrocardiogram control of pulse and conductivity. This would be done each 2 minutes during compression and decompression and each 5 minutes during the saturation.

The regime of procedure would be selected individually; the average values are: pressure shift - 0,2-0,6AT; time of compression and decompression - 5 - 15 minutes; the saturation - 40 - 60 min. The course would include 8-12 procedures.

If no negative influence of HBO is investigated, the pressure shift can be improved to 0,6AT; if antiarrythmic effect appears (diminishing of extrasystoles; probability of transform of blinking tachyometry to normoatrythmia) - the graduate improvement of pressure up to 0,6AT is possible.

We recommend the pressure shift of 0,2-0,4AT for the prevention of pulse violations, that certainly can't be supported with the oxygental intoxication.

When paroxysms are present, HBO-therapy uses 0,6-1,0AT pressure to avoid hypoxia.

The course would include  2-3 procedures after the normalization of pulse for strengthening of healing effect. As far as this usually appears after 5-8 procedures, the whole course would include 8-11 ones (anyhow that  wouldn't be less than 8).

If no recreation is observed after 10 procedures, the course is recommended to be stopped.

We have persued above 1000 procedures for 106 patients. The majority of sicks didn't suffer from HBO; 6 patients had pain in heart sometimes (it was reduced with nitroglycerine); no negative changes could be seen at electrocardiogram that time.

HBO was interrupted for 10 patients: this was because of pain in ears; development of bradicardia; prolongation of PQ-period; claustrophobia, accompanied by frequent extrasystoles.

Thus HBO can be applied for the treating of ishemia, accompanied by extrasystolic arrhythmia, with paroxysmal cardiac fibrillations and supra ventricular tachycardia and their combinations with internal blockades.

professor                        A.Golikov,

professor                        Yu.Isakov,

doctor                        N.Tretyakova