HBO IN COMPLEX THERAPY OF CARDIOMYOPATHY.

Practical recommendations.

The latest dozens of years attention of clinicists is attracted to cardiac diseases which can be determined as cardiomyopathies (KMP). As WHO interpretes (1969) KMP - the diseases of unclear or unknown etiology with domination of cardiomegaly and cardiac insufficiency including the affection of valves, coronary, lung and system vessels.

Three groups of KMP can be determined: congestion; hypertrophic (including obstructive one) and restructive KMP (this one is usually observed in Asia and deals with development of endomyocardiac fibrosis. Conservative treating is inefficient; prognosis is unconsolidating).

Hypertrophic KMP is characterized with significant hypertrophy of interventricular septa and fresh border of one or both ventricles. The disease is often a hereditary one; prognosis - about 50% sudden death. Treating is commonly a medicinal prophylaxis of arrhythmia and sometimes - of hypotension and hypovolemia. If pressure is high (above 50 mm.) the resection of interventricular septa is recommended.

Congestion KMP - deals with the diffusive affection of myocard and sequent reduction of its squeezing ability. Prognosis - 50% of dead sicks in first two years. Treating - as usual treating of circulatory insufficiency.

Thus the treating of KMP - is prophylaxis and symptomatic therapy ­has insufficient success. New approaches are required.

Thus including of HBO-therapy can be of use, according to data of Efruni et al, 1977; Rodionov et al, 1977; Kolesov et al, 1977, etc. According to them HBO positively influences on heart, improves tolerance for activity, potentiates the influence of glycosides and uretics. Degenerative effects in cardiac muscle are lessening.

Contraindications for the use of HBO.

For today two groups: absolute and conditional contraindications can be outlined. The absolute are: Cavities in organs; epilepsy; claustrophobia; malignant tumor; sensitivity to oxygen. Conditional contraindications are: chronic inflammations of otorhinolaryngologic organs, hypertension of II-III degree.

The preparation to HBO.

The roentgenogram of lung would be done, as well as inspection of otorhinolaryngologist.

Just before the course the instruction on security would be held (oil on skin; static electricity; injurity of ear).

KMP hasn't contraindications for HBO; brarycardia is neutralized by medicines in advance (atropine, metacin, etc.)

Regime and schemes of HBO.

With use of supporting medicines the optimal constants can deviate: amount of procedures - 5 - 15; pressure - 1,2 - 1,7AT; 1-2-3 procedures per day. The ordinary are: 40 minutes once a day with fifteen procedures in sum. The pressure shift would be minimal at the beginning with later improvement (this is a so-called titration method) and control by ventricular rate, electrocardiogram, arterial tension.

The control of efficiency of HBO would be done permanently for feasibility of correction of constants, if required. The indexes of efficiency of HBO are: lessening of dyspnea, pain in heart, headaches, feeling of jollity and freshness.

The use of HBO is desirable against: ventricular extrasystolia; auricle fibrillation and some other diseases. Amidoron and calcium-blocking medicines are desirable; cordoron is incomparable with veropamil.

Clinic criteria of efficiency are lessening of dyspnea, pain in heart, headaches and dizziness. Hypertrophied KMP causes the transgression  of diastolic function of ventricles: transgression of inlet and reduction of systolic response. By means of echocardiography and control of hemodynamics the improvement of cardiac index, enlarging of right division of heart (without change of period of circulation), enlarging of left  division of heart (with reduction of period of circulation), improvement of complaisance of interventricular septa.

Treating of congestion KMP - that is treating of congestion circulatory insufficiency. HBO causes positive isotropic change; lessens dilatation of ventricles and improves the results of therapy without digitalis intoxication. Lessening of pulse pate after HBO successfully compensates the taxicardia caused by vasodilative medicines.

The use of special methods of control (echocardiography, radio nuclides in estimating of hemodynamics) allows to determine the exact changes: lessening of size of left ventricle; improvement of outlet of right ventricle together with the improvement of amplitude of vibration of interventricular septa; but in everyday practice these particularities are unnecessary.

If insufficiency is of III degree or bradycardia is less than 40 per minute, the use of HBO is forbidden without effective support by atropine.

Prophylaxis of complications of HBO.

To avoid barotrauma of lung and tympanic membrane the absence of cavern and otorhinolaryngologic pathology would be checked.

The most difficult is the prophylaxis of sharp and prolonged oxygental intoxication. Its immediate displays are: hardening of respiration; dizziness; vomity and sweatiness. HBO would be interrupted or marginally continued with the lowest constants and careful control.

Chronic intoxication can arrive after 10 and more procedures of HBO. Its displays are anemia and improvement of SOE. The course would be interrupted. If barootitis develops - the course would be temporary interrupted for curing of otitis; continuation compulsory requires the use of ephedrine or naphtizin.

Thus HBO permits to reduce disease and improve the hemodynamics. The 18 months, spent after course make us believe further bettering.

These results permit us to recommend HBO for a broad clinical application for treating of KMP.