Physiotherapeutic treatments for angina pectoris. Physiotherapy in the rehabilitation of patients with ischemic heart disease and after cardiac surgery

Angina pectoris- a disease inherent mainly in middle-aged and older people. Due to the characteristic pain behind the sternum, the pathology is also called angina pectoris, and since the shortage of oxygen-enriched blood in the heart muscle occurs due to problems with the patency of the coronary arteries, there is a third name for angina pectoris - coronary heart disease. The reasons for the depletion of coronary blood flow lie in organic changes due to functional disorders or atherosclerosis.

Most often, angina pectoris occurs as a result of atherosclerosis of the coronary arteries. In the initial stage of the disease, the expansion of the lumen of the arteries is limited, which leads to acute shortage blood supply to the myocardium at times of significant emotional or physical overstrain. Due to severe atherosclerosis, the lumen of the artery narrows by 75%, and the deficit is observed even at moderate stresses.

The decrease in blood supply to the mouths of the coronary arteries occurs due to a number of reasons: swelling atherosclerotic plaque, non-clotting thrombus or other acute narrowing of the lumen of the coronary arteries, pathological reflex influences from the chest and cervical spine in the presence of concomitant diseases, also the esophagus and biliary tract. The reason may be a decrease cardiac output due to venous hypotension or tachyarrhythmia, diastolic or arterial hypertension of medicinal or any other origin. All of the above symptoms can cause an angina attack.

An attack of angina pectoris subsides due to the restoration of normal blood flow to the coronal arteries, after a decrease in the load on the heart muscle (the effect of nitroglycerin, cessation of work). A decrease in the frequency and cessation of attacks occurs after the development of myocardial fibrosis in the ischemic zone, stabilization of the systemic circulation, subsidence of symptoms of concomitant diseases, development of bypass blood supply to the myocardium, coordination of the level of physical activity with the reserve capacity of the coronary bed.

There are several types of angina: first-time, stable (tension), unstable (progressive), variant. The first type is characterized by the manifestation of symptoms for about a month, then either regression or transition to a stable stage should be expected. A feature of exertional angina (stable) is the regular repetition of attacks after emotional or physical stress. This type of angina occurs most often; sometimes its presence signals a developing myocardial infarction.

Unstable (progressive) angina is characterized by unexpected attacks, sometimes even in a calm state, severe chest pain is observed. The danger of the disease is high risk development of myocardial infarction, hospitalization of the patient is often required. Manifested by vascular spasms, symptoms of variant angina occur predominantly at night. This rather rare type of angina pectoris can be tracked by means of an ECG.

When suffering from angina pectoris, the appearance of pain is characterized by the following features: 1. its occurrence is observed in the form of an attack, that is, there is a clear time of appearance and subsidence; 2. subsides or stops altogether 1-3 minutes after taking nitroglycerin; 3. appears under certain circumstances, conditions.

An attack of angina pectoris occurs most often while walking - pain appears when walking with a heavy load or after eating, with a strong headwind or climbing a mountain, also with other significant emotional stress or physical effort. There is a direct connection between the continuation of physical effort and the intensity of pain; if the effort is stopped, the pain subsides or stops within a few minutes. The symptoms listed above are sufficient both to make a diagnosis of an “angina attack” and to limit it from all kinds of pain in the chest and in the heart area, which are not angina.

It is possible to diagnose angina pectoris correctly and promptly only by carefully conducting a medical interview. It should be remembered that often, when experiencing symptoms characteristic of angina pectoris, the patient does not consider it necessary to inform the doctor about them, since they “do not relate to the heart,” or, on the contrary, pays attention to secondary diagnostic sensations supposedly “in the area of ​​the heart.”

Intensity angina pectoris qualified by the so-called FK (functional class). The IFC includes individuals who have manifestations stable angina occur rarely and are caused exclusively by excessive physical exertion. The occurrence of attacks of stable angina pectoris even with minor loads (but not always) sends carriers of such a disease to IIFC, but if attacks occur during everyday (light) loads, such patients have a direct path to III FC. Angina with total absence load or at their minimum level is inherent in patients with IV FC.

Physical Therapies

- vegetative-correcting(transcranial electroanalgesia, electrosonotherapy, transcerebral UHF therapy, diadynamic therapy, Amgaga pulse therapy of the sinocarotid zone and paravertebral zones, galvanization, medicinal electrophoresis ganglion blockers, adrenergic agonists, low-frequency magnetic therapy, franklinization, heliotherapy, thalassotherapy, radon baths);

- cardiotonic(carbonic baths);

- antihypoxic(oxygen barotherapy, normobaric hypoxic therapy, oxygen baths, ozone baths, air baths, red laser therapy, electrophoresis of vitamins C, E);

- hypocoagulating(low-frequency magnetic therapy, iodine-bromine baths, medicinal electrophoresis of anticoagulants and antiplatelet agents, laser irradiation blood);

Metabolic (infrared laser therapy, UHF therapy, electrophoresis of metabolic and vasodilating drugs).

Physiotherapy methods are used differentially depending on the stage and characteristics of the disease.

Physiotherapy in patients with stage I hypertension

Patients with stage I hypertension are prescribed physical factors aimed at eliminating dysfunction autonomic nervous system(VNS) and correction of functional disorders of the central nervous system, since at this stage of the disease it is these disorders that underlie the increase blood pressure(HELL) and cause damage to target organs.

VNS dysfunction in the vast majority of patients manifests itself at this stage as hypersympathicotonia with cardiac hyperfunction and a hyperkinetic type of hemodynamics, i.e. increase in blood pressure in them occurs due to cardiac output.

Electrosleep - using a sedative technique with orbital-mastoid arrangement of electrodes, rectangular frequency impulse current 5-20 Hz, current strength 4-6 mA in amplitude value, procedure duration 30-60 minutes, 3-4 times a week; for a course of 10-20 procedures,

Electrotranquilization using the frontomastoid technique, frequency 1 kHz, pulse duration 0.5 ms, procedure duration 30-45 minutes, daily; There are 10-15 procedures per course. In terms of effectiveness, electrosleep and electrotranquilization are very close to each other.

- mesodiencephalic modulation (MDM) By following technique: electrodes with moistened hydrophilic pads are placed on the patient’s head, observing the polarity - positive (+) electrode - on the forehead, negative (-) - on the back of the head. Select a program that may differ in the pulse shape and current shape. The value of the output current is set individually, until the appearance pleasant feeling at the site of the electrodes. The exposure time is 15-30 minutes, the course is 10-15 procedures.

Low-frequency pulsed electrotherapy on the collar area is widely used in the early stages of hypertension. Use diadynamometry (DDT), sinusoidal currents (SMT) and interference currents with sparing parameters. One electrode is applied to the collar zone or 3-5 cm below it. Frequency 80-130-150 Hz, total time 8-12 minutes, daily or every other day; per course from 7-8 to 10-12 procedures.

All types of low-frequency pulsed electrotherapy are used to influence the sinocarotid region. As a rule, bifurcated point electrodes are used, and the indifferent electrode is placed in the area of ​​the upper cervical vertebrae. When using DDT and SMT, gentle parameters of these currents are used with a procedure duration of no more than 2-3 minutes on each side.

In order to actively influence the autonomic regulation of the borderline sympathetic chain, an effect on the spinal region is used using a longitudinal method from the lower cervical to the upper lumbar region or a general effect according to Vermeule.

With the longitudinal technique, one electrode measuring 20x15 cm is placed in the spine at the CIV-TII level, the second electrode measuring 20x10 cm is placed at lumbar region at the SI-SV level. In this case, it is possible to use sinus-modeled currents, interference and diadynamic currents.

You can apply SMT to the kidney area (2 electrodes with an area of ​​100 cm2 each - on the projection area of ​​each kidney and one electrode with an area of ​​300 cm2 - on the anterior wall of the abdomen); IV type of work, frequency 100 Hz, procedure duration 10-15 minutes; There are 10-12 procedures per course.

Magnetotherapy

Magnetotherapy on the frontal area using the following method: a contact-cylindrical or rectangular inductor is placed on the forehead area, the magnetic induction is 25-30 mT, the duration of the procedure is 10-15 minutes, daily; for a course of 10-15 procedures. It is used if there are contraindications to low-frequency pulse currents.

Impact on the frontal area is also possible using combined magnetic field(alternating and constant magnetic field).

Low-frequency alternating magnetic therapy is often used on the collar area. In this case, one or two inductors are used rectangular shape with magnetic induction from 25 to 35 mT; Duration of the procedure is 15-20 minutes, daily; for a course of 10-12 procedures.

To influence the kidney area, you can use a low-frequency alternating magnetic field (50 Hz). Cylindrical inductors are used, which are placed in contact on the area of ​​projection of the kidneys. The magnetic field induction is 35 mT. Procedures lasting 15-20 minutes are carried out daily; for a course of 10-15 procedures.

Anodic galvanization or galvanic collar according to Shcherbak are effective methods of treatment at this stage of the disease; current density 0.01 mA/cm2, procedure duration 6-16 minutes daily; for a course of 10-12 procedures.

Anodic galvanization is also used to correct kidney function. In this case, two bifurcated electrodes (anodes) with an area of ​​100 cm2 are applied to the area of ​​projection of the kidneys, and a cathode with an area of ​​300 cm2 is placed on epigastric region. The duration of the procedure is 10-20 minutes; There are 12-15 procedures per course.

Medicinal electrophoresis on the collar zone with a duration of exposure of 15-20 minutes using a wide range of medications (Mg2+, Ca2+, K+, papaverine, aminophylline, novocaine, no-spa, platiphylline).

Drug electrophoresis of aminophylline is also possible using the bipolar method, since aminophylline is functional when administered from both the positive and negative poles. One electrode with a gasket moistened with a 2% aminophylline solution is placed on the collar area or 3-5 cm below it.

The second electrode, opposite in charge, is applied in the interscapular region; current strength from 2 to 6-8 mA, taking into account individual sensitivity to electric current, exposure 10-15 minutes, daily or every other day; for a course of 8-12 procedures.

Bioresonance therapy

Bemer therapy: the basic program is carried out on an inductor in the form of a mattress, magnetic induction stages from 5 to 7, from 8 to 20 µT, daily; 10-15 sessions per course. According to individual indications, it is possible to carry out procedures every other day.

In addition to the basic program, a local inductor is assigned individually - an applicator with magnetic induction from 83 to 130 µT. Zones of its influence: frontal and occipital regions, cervical-collar region, thoracic region spine, collar area covering the shoulder joints.

The exposure is 8 minutes with a single exposure, the total exposure with the basic program and local inductor is 16-20 minutes, the change in exposure is strictly individual.

PERT therapy: mattress applicator, mode 4, intensity up to 40 mT.

Low-intensity infrared laser radiation

The impact is carried out at 3 points paravertebral on cervicothoracic region spine CVII-TIV continuous or pulsed laser radiation with a frequency of 1500 Hz with an exposure of 5 minutes. The total duration of exposure should not exceed 15-20 minutes.

Low-intensity infrared pulsed laser radiation can also be applied to the sinocarotid region with a frequency of 80 Hz (without a magnetic attachment) with a duration of exposure of 1-2 minutes on each side, daily; for a course of 8-10 procedures.

Ultrasound treatment of the sinocarotid region using an ultrasound head with an area of ​​1 cm, an impact intensity of 0.05-0.2 W/cm2 using a labile technique in pulsed mode with a pulse duration of 4 ms for 1-2 minutes on each side; for a course of 8-10 procedures.

Aeroionotherapy

The initial dose is 300 units, maximum - 700 units, daily; There are 10-15 procedures per course.

Aerophytotherapy includes vapor inhalation essential oils vanilla, orange, ylang-ylang, hyssop, lemon, marjoram, juniper, fennel, cypress, geranium, lavender, rosemary. The air flow speed in the treatment room is up to 0.1 m/s, the vapor concentration is 0.4-0.6 mg/m3.

For halotherapy, modes No. 2 and 3 are used. Session duration is 40 minutes, daily; 10-20 sessions per course.

Ozone therapy is prescribed intravenously daily or every other day, 200 ml (concentration 1.2 mg/l); 10 infusions per course.

Physiotherapy in patients with stage II hypertension

The goal of hardware physiotherapy in patients with stage II hypertension is to improve the humoral regulation of blood pressure, primarily to reduce aldosterone levels, normalize water-salt balance and reduce total peripheral vascular resistance(OPSS).

In stage II hypertension, as a rule, the hypokinetic variant of hemodynamics predominates, i.e. the increase in blood pressure is due to an increase in peripheral vascular resistance. For improvement central mechanisms For the humoral regulation of blood pressure, neurotropic methods of pulsed electrotherapy are used, but the impact parameters are different than in stage I hypertension.

The treatment complex includes methods that produce effects similar to beta-blockers: methods of neurotropic pulsed electrotherapy (sedative electrosleep, electrotranquilizer, transcerebral amplipulse therapy or interference therapy), magnetic therapy, electrophoresis of beta-blockers and metabolic drugs (sodium hydroxybutyrol, vitamin E, methionine and etc.).

Methods of neurotropic pulsed electrotherapy:

Electrosleep is used using the orbital or frontomastoid technique with a pulse current frequency of 80-100 Hz for 30 minutes every other day. This technique is usually followed for the first 6 procedures, and subsequent procedures (up to 15) are performed using a sedative technique.

Transcerebral amplipulse therapy. A variable mode is used with a modulation depth of 75%, a frequency of 30 Hz for frontal localization and 100 Hz for orbital localization, procedures for 15 minutes are prescribed daily; There are 10-15 procedures per course.

Amplipulse magnetic therapy with the specified SMT parameters and simultaneous exposure to a low-frequency alternating magnetic field on the occipital region with a magnetic induction of 30 mT, duration of procedures 15 minutes, daily; There are 10-15 procedures per course. In this case, the pronounced hypotensive effect is accompanied by improvement rheological properties blood and correction of cerebral hemodynamics.

Interference currents: frontomastoid or occipital location of electrodes, frequency from 1 to 150-200 Hz before sensation patients with mild vibration, procedure duration 15 minutes, daily; There are 10-15 procedures per course.

Drug electrophoresis on the collar area of ​​medications (Mg2+, Ca2+, K+, papaverine, aminophylline, novocaine, no-spa, platiphylline, aminophylline, apressin, methionine, etc.).

It is preferable to use sinus-modeled currents for electrophoresis.

In the collar region, exposure to other physical factors is also used: various pulsed currents, alternating and pulsed low-frequency magnetic fields, ultrasound in pulsed mode with a pulse duration of 4 ms, exposure intensity of 0.2-0.4 W / cm2 for 3-5 minutes, daily ; for a course of 10-12 procedures. The same ultrasound parameters are used for apressin ultraphonophoresis, for which a 4% apressin ointment is used.

During exacerbation of the disease to prevent the development hypertensive crisis apply sequentially (practically without an interval) apressin ultraphonophoresis and electrosleep using a sedative technique with a reduced (up to 15-20 minutes) duration of the procedure.

The projection area of ​​the kidneys is actively used for exposure to physical factors in the treatment of patients with stage II hypertension. So, diadynamic therapy, amplipulse therapy and other types of low-frequency pulsed electrotherapy are used not according to the transverse method, but paravertebral, so that the kidney parenchyma does not fall into the field of action of the impulse current, since this may cause hematuria.

With the paravertebral technique, current loops capture only the sympathetic renal plexus, which regulates hemodynamics and kidney function, which is accompanied by a pronounced hypotensive effect. The exposure parameters for all types of low-frequency pulsed electrotherapy are the same as for the treatment of patients with stage I hypertension.

Magnetotherapy assigned to the kidney projection area using the same parameters and methodological features, as in stage I of the disease.

In addition, a high-frequency electromagnetic field (13.56 MHz) is used - inductothermia in the kidney area in an oligothermal dosage. Procedures are carried out daily; for a course of 10-12 procedures.

Also appointed ultrahigh frequency electromagnetic field(460 MHz, UHF therapy) to the area of ​​projection of the kidneys; use rectangular emitters 16x35 cm in size, exposure power 30-35 W, procedure duration 10 minutes, daily; for a course of 10-15 procedures.

In addition to electromagnetic fields of high and ultrahigh frequency, ultrasound with an exposure intensity of 0.4-0.6 W / cm2 in continuous or pulsed mode for 3-5 minutes per field, daily can be applied to the projection area of ​​the kidneys; for a course of 10-12 procedures.

To reduce the total peripheral vascular resistance at this stage of the disease, they begin to affect the calf region.

Anode galvanization is used: 2 bifurcated electrodes (anodes) with an area of ​​100 cm2 are each placed on the calf region of both legs, and a cathode with an area of ​​300 cm2 is placed on the lumbar region.

The duration of the procedure is 10-15 minutes, 3-4 times a week; for a course of 12-15 procedures.

Using this technique, SMT can also be applied: 2 bifurcated electrodes with an area of ​​100 cm2 each are applied to the calf muscles, an electrode with an area of ​​300 cm2 is applied to the lumbar region; variable mode, modulation depth 50%, frequency 100 Hz, procedure duration 10-15 minutes; for a course of 10-12 procedures.

In addition to sinusoidal currents, other types of low-frequency pulsed currents can be used. To influence this area, you can also use an alternating magnetic field of low frequency (50 Hz). In this case, rectangular inductors are placed with their end surfaces on the skin of the calf area. The magnetic field induction is 25 mT. Procedures lasting 10-20 minutes are carried out daily; for a course of 10-15 procedures.

In addition to ultra-high frequency electromagnetic fields, ultrasound can also be used to influence the calf area with an impact intensity of 0.4-0.6 W/cm in continuous or pulsed mode for 3-5 minutes per field, daily; for a course of 10-12 procedures.

Ultraphonophoresis of apressin using 4% apressin ointment and the above ultrasound parameters is also effective.

Limitations for the use of physical factors in the calf muscle area are chronic thrombophlebitis, severe varicose veins in this area, and lymphedema of the lower extremities.
Aeroionotherapy is prescribed from 200 to 500 units. daily; for a course of 10-15 procedures.

The methods of aerophytotherapy, halotherapy, BLOCK, UFOK, Bemer therapy, PERT therapy, ozone therapy are similar to the methods for patients with stage I hypertension.

L.E. Smirnova, A.A. Kotlyarov, A.A. Aleksandrovsky, A.N. Gribanov, L.V. Vankova

• persistent pain syndrome
• progressive (unstable) angina,
• angina at rest,
• significant increase in blood pressure,
• arrhythmias (frequent group extrasystole, frequent and difficult to eliminate paroxysmal disorders heart rate),
• circulatory failure above the BE stage,
• cardiac asthma.

With this disease of cardio-vascular system balneological techniques are used in treatment, such as medicinal baths(radon, carbon dioxide, iodine-bromine, nitrogen and oxygen). All of these types of baths are prescribed every other day or 4-5 baths per week. The time of one procedure is 5-15 minutes, and full course treatment includes 10-12 baths. In the presence of severe angina, this method of treatment is used in a gentle manner, using two- or four-chamber baths. If angina is stable and there are no contraindications (arrhythmias, etc.), general contrast baths can be prescribed. During the procedure, the patient, under the supervision of a specialist, is immersed in a pool with warm water. fresh water for 3 minutes, after which he goes into a pool with relatively cool water for 1 minute and performs active movements(including exercises from the recommended exercise therapy complex). Optimal are 3 consecutive transitions from one bath to another for each procedure, at the end of which a cool bath is taken. By the middle of the course of treatment, the water temperature is reduced to 26-25 °C.
If the patient has circulatory failure at the PA stage and (or) not very significant heart rhythm disturbances, dry carbon dioxide baths are recommended.
The calming effect is achieved using procedures such as galvanic collar, electrosleep and electrophoresis using solutions of sedatives and analgesics. If the patient has no contraindications identified during the examination, it is possible to combine therapeutic baths with hardware physiotherapy. Thus, in many cardiology departments and clinics, in particular, the influence of various types laser radiation. The choice of method is strictly individual and determined by the degree of detected disorders and the presence of concomitant diseases.

(module direct4)

In case of stable angina pectoris and myocardial infarction, the central nervous system and autonomic nervous system are affected, as well as the neurohumoral regulation of the body through a hardware technique such as electrosleep. Also, patients with the mentioned pathologies are shown galvanotherapy and electrophoresis with various medicines. Procedures are carried out according to general methods of influence. The segmental effect is on the collar area in the region of the heart, on the so-called. Zakharyin-Ged zone and zone of projection of sympathetic ganglia along the posterior surface of the body. These procedures have a mild calming (sedative) and analgesic effect, and are also able to stabilize blood pressure.
For ultra-high-frequency therapy, carried out craniocerebral, devices are used that generate frequencies of 27.12 MHz. The technique is indicated for patients with stable exertional angina, including those who have lipid metabolism disorders. The effect of ultrasound is intermittent; its required intensity is 35 watts. In this case, special capacitor plates with a diameter of 12 cm are used for the procedure. The duration of each procedure should be from 5 to 15 minutes, they are carried out daily, and the full course of treatment includes 25-30 procedures.
In the treatment of patients with stable angina pectoris, even in the presence of extrasystolic and atrial fibrillation, magnetotherapy using low-frequency magnetic fields is often prescribed. Such procedures improve microcirculation, reduce the degree of platelet aggregation (reduce the risk of thrombosis) and cause positive changes in autonomic regulation cardiac activity. The impact on the patient is either in the area of ​​the projection of the lower cervical and upper thoracic vegetative ganglia of the border chain at the level of CV - ThIV from the back of the body, or directly on the chest in the area of ​​the projection of the heart.
Microwave (super high frequency) therapy with a frequency of 460 MHz is also indicated for angina pectoris and after myocardial infarction myocardium (after 15-20 days!), because it accelerates the metabolism in the heart muscle and accelerates the process of myocardial recovery. Also, similarly to magnetotherapy, microwave therapy improves microcirculation by expanding blood vessels.
The expediency of using low-energy laser radiation in coronary heart disease is determined by its positive influence on the rheological properties of blood (fluidity) and hemostasis. In addition, laser radiation can mobilize antioxidant protection at the cellular level and have an analgesic effect. These procedures are indicated for stable angina pectoris, myocardial infarction in the recovery phase, as well as for circulatory failure, but not higher than stage I. Rare extrasystoles, sinus tachycardia and bradycardia, as well as blockade of the legs of the bundle of His are not a contraindication to this type of physiotherapy.

Currently, there are a number of preventive measures that quite effectively affect coronary insufficiency: the regulation of the work and rest regime, if necessary, changing the conditions and nature of work (exemption from night shifts, etc.), an appropriate diet, the use of vasodilators and sedatives, anticoagulants, synthetic sex hormones that affect the main cause of coronary insufficiency - atherosclerosis. The methods of physiotherapy and therapeutic exercises, with their strictly differentiated use in these early stages, deserve great attention. ABOUT positive action some of them, for example, diathermy of the heart region, were reported by both domestic and foreign authors, to a lesser extent, diathermy of the stellate and cervical region sympathetic nodes. In the future, however, with regard to diathermy, great care was shown because of its sometimes negative effect on patients with angina pectoris.

Eufillin electrophoresis is carried out according to the method overall impact Vermel, using a 2% freshly prepared solution of aminophylline (0.6 g of aminophylline per 30 ml of distilled water, aminophylline is injected from the positive pole). Procedures for 10-20 minutes at a current density of 0.03 mA/cm2 are carried out 4-6 times a week, for a course of treatment 12-15 procedures.

However, in the presence of pronounced zones of skin hyperalgesia (Zakharyin-Ged zones), it is advisable to direct the impact of physical factors to block pathological impulses emanating from the ischemic myocardium and chemoreceptors. coronary vessels, to interrupt pathological conditioned reflex connections to improve the activity of the coronary arteries and metabolic processes in the myocardium. For this purpose, one of the options novocaine blockade- novocaine electrophoresis with localization of the active electrode in hyperalgesia zones (Zakharyin-Ged zones). Given the irritating effect of the negative DC pole, the indifferent electrode is taken out of the areas of skin hyperalgesia and possible irradiation of angina pectoris, placing it on the lower back. The justification for this is, in particular, the instructions of N. A. Albov, who observed the occurrence of angina attacks during iodine and magnesium electrophoresis with localization of effects on left shoulder. According to the author, the appearance of angina pectoris pains with such localization of the electrode can even serve as a differential diagnostic sign of the presence of atherosclerosis of the coronary arteries. The occurrence of angina pain when the negative electrode is located on the left shoulder, from our point of view, can be explained by the irritating effect of the negative pole of one of the most private areas irradiation of angina pain, and therefore we recommend placing a negative electrode on the lower back.

The favorable results of novocaine electrophoresis on the Zakharyin-Ged zones are reported by many authors.

It is known that novocaine has a local anesthetic, antihistamine and ganglion blocking action. It is successfully used for angina pectoris in the form of a novocaine blockade of the cardiac plexus area, in the form of a vagosympathetic blockade according to A.V. Vishnevsky, intradermal injections in the zones of Zakharyin-Ged and electrophoresis. Nevertheless, novocaine electrophoresis has its advantages. Firstly, the total effect on the receptor apparatus of the skin of direct current and novocaine matters; secondly, drug ions injected into the skin disrupt the local ionic conjuncture, which is the source of reflexes that, propagating through the nervous system, reach the autonomic ganglia, the reticular formation, and the cerebral cortex; thirdly, novocaine exhibits its pharmacological action at a much lower concentration of the substance, which is very important in view of poor tolerance some patients large doses novocaine, and, finally, direct current reduces the sensitivity of skin receptors in the area of ​​localization of the electrode connected to the anode. All this suggests that novocaine electrophoresis of the Zakharyin-Ged zones will cause a pronounced anesthetic effect.

In this case, one or two electrodes with pads of 100 cm2 each, moistened with freshly prepared 10% aqueous solution novocaine (lower concentrations of novocaine during electrophoresis, according to A.P. Parfenov, do not cause pronounced anesthesia of the skin), are placed in the area of ​​​​hyperalgesia zones (Zakharyin-Ged zones) and connected to the anode of the galvanization apparatus, while the indifferent electrode with a gasket of 200 cm2 dipped in warm tap water, located on the lower back. Procedures for 6-10-15 minutes at a current density of 0.03-0.08 mA/cm2 are carried out daily or every other day, in total from 8 to 20 procedures. During treatment, the localization of the active electrode is changed depending on the speed of disappearance or a significant decrease in hyperalgesia in the affected areas (approximately 3-4 procedures for the same area). Placement of the electrode on the region of the heart should be avoided, as this has sometimes been observed to have a negative effect on the procedure.

If exertional angina develops in patients with deforming spondylosis and secondary radicular syndromes, which, of course, are aggravating provoking factors in the course of the development of coronary disease, it is advisable to use novocaine electrophoresis in a slightly modified technique. In this case, of the two electrodes with pads moistened with a 10% solution of novocaine, one is placed in the area of ​​the hyperalgesia zone, the second - in the interscapular region. Both of these electrodes are connected to positive pole apparatus for galvanization; the third electrode with a pad of 200 cm2 moistened with warm tap water is placed in the lumbar region and connected to the negative pole of the galvanizing apparatus. Procedures at a current density of 0.03-0.08 mA/cm2 for 10-15 minutes are carried out daily or every other day, in total 10-15 procedures.

After the disappearance of angina attacks and zones of hyperalgesia, procedures are carried out only on the spine area for 20 minutes.

There are indications in the literature about the effectiveness of dionin electrophoresis in the area of ​​the reflexogenic cardiac zone Zakharyin-Ged in chronic coronary insufficiency. At the same time, in most patients, pain in the region of the heart disappeared, the rhythm of cardiac activity returned to normal, sleep improved, and general weakness disappeared. Dionin electrophoresis was performed as follows: a positive electrode with a pad moistened with a 0.1% solution of dionine was placed along the left midclavicular line in the region of the IV-V ribs, an indifferent electrode was placed in the cervicothoracic spine (C7-D5); the procedures were carried out daily for 20 minutes at a current density of up to 0.08 mA/cm2, a total of 5-6 procedures.

L. I. Fisher used gangleron electrophoresis (0.25% gangleron solution) of the carotid sinus zone in coronary insufficiency with angina pectoris. He believes that under the influence of gangleron electrophoresis, coronary circulation improves and myocardial hypoxia decreases.

With more widespread atherosclerosis, when, along with attacks of angina pectoris and clinical signs cerebrosclerosis, there are signs of atherosclerosis of the arteries of the legs (weakness in the legs, pain in calf muscles when walking, paresthesia in the feet and legs, etc.), it is more advisable to use complex physical therapy: eufillin-electrophoresis according to the method of general exposure in alternation with foot hydrogen sulfide baths (two-chamber baths) with a hydrogen sulfide concentration of 50-100-150 mg / l, temperatures 36-37°, 10-15 minutes each, 12 baths in total. Influenced hydrogen sulfide baths skin capillaries and small vessels legs expand, and therefore tissue hypoxia decreases and, as a result, pain in the calf muscles decreases or disappears when walking. With such a complex treatment, not only angina pectoris and headaches decrease or stop, but weakness and pain in the legs when walking decreases.

However, with atherosclerotic angina pectoris occurring against the background of hypotension, methods such as eufillin electrophoresis and hydrogen sulfide foot baths, can sometimes cause both during the procedure and after it, dizziness, a feeling of "emptiness" in the head, obviously associated with some decrease in blood pressure. Such patients are shown electrophoresis of nicotinic acid, which in small doses does not reduce blood pressure, but at the same time causes expansion of the coronary vessels. In this case, one electrode with a pad of 300 cm2 moistened with 1% nicotinic acid solution is placed in the lumbosacral region and connected to the cathode of the galvanization apparatus, the second with a pad of the same area moistened with warm tap water (in the presence of deforming spondylosis-10 % solution of novocaine), placed in the interscapular region and connected to the anode of the apparatus for galvanization. Procedures for 10-15 minutes are carried out every other day at a current density of 0.03 mA/cm2, a total of 12 procedures. Patients easily tolerate electrophoresis of nicotinic acid; at the same time, angina pectoris pains decrease or stop.

In angina pectoris in patients with hypertension, it is advisable to use complex treatment, which includes physical factors and antihypertensive drugs(reserpine, serpasil, etc.). Since in hypertension there is a tendency to spasm not only of the coronary, but also of the cerebral vessels, it is most advisable to use eufillin electrophoresis according to the above method.

With a tendency to tachycardia, instead of eufillin electrophoresis, platifillin electrophoresis (0.01-0.03 g per procedure) is indicated according to the method of general exposure. If there are zones of skin hyperalgesia, novocaine electrophoresis is shown on the Zakharyin-Ged zones in alternation with eufillin or platifillin electrophoresis. For improvement cerebral circulation it is advisable to include massage of the collar zone in the treatment complex.

There are indications of the beneficial effect of potassium and magnesium electrophoresis (1.5% solution of their salts), which is carried out for 12 days. Its use is based on the fact that with angina pectoris in the heart muscle, the intracellular concentration of potassium and magnesium salts decreases. As a result of treatment, the content of these salts in the blood serum increases, accompanied by a weakening or disappearance pain syndrome and positive electrocardiogram dynamics.

With angina, oxygen therapy is widely used, especially in patients with cerebrocardial atherosclerosis. Its favorable effect is due not only to the disappearance of hypoxemia, but also to its beneficial effect on the nervous, cardiovascular, respiratory and other body systems.

If patients have deforming spondylosis of the cervicothoracic spine without a pronounced radicular syndrome to improve blood circulation in the area of ​​the intervertebral discs and the spine itself, massage of the back muscles is performed alternately with electrophoresis of drugs.

For angina pectoris in patients with hypertension, traumatic cerebropathy and cerebrosclerosis, accompanied by an increase in temporal pressure, to enhance the effect of eufillin electrophoresis on cerebral circulation and cortical neurodynamics, it is advisable to massage the collar zone, which is also alternated with electrophoresis. In this case, the temporal pressure decreases.

With angina pectoris in obese patients, to reduce body weight, eufillin electrophoresis (in stationary conditions) is carried out against the background of unloading days(once in 5 days milk, curd-kefir, meat, fruit day), and if available chronic diseases gastrointestinal tract (chronic gastritis, colitis, intestinal dyskinesia, etc.), as well as liver and gallbladder electrophoresis, it is advisable to carry out against the background of an appropriate diet in combination with drinking mineral waters (Essentuki No. 17, No. 4, Borjomi).

To enhance the function external respiration and increased blood flow to the right heart, as well as to improve cortico-visceral connections, eufillin-electrophoresis is performed against the background of therapeutic exercises for the cardiovascular complex with an emphasis on breathing exercise.

With severe angina pectoris, referral of patients to balneotherapeutic resorts is impractical. Such patients are shown spa treatment, mainly in local cardiological sanatoriums, as well as in climatic resorts, mainly in the seaside northwestern regions of the Baltic states.

In case of atherosclerotic cardiosclerosis without severe attacks of angina pectoris and without a history of myocardial infarction, with symptoms of circulatory failure not higher than degree I, a referral to the resorts of the Southern Coast of Crimea and Odessa is indicated.

Contraindications for the treatment of angina pectoris atherosclerotic nature by physical factors:

1) aneurysm of the heart after suffering

Apparatus physiotherapy in the rehabilitation of patients with coronary heart disease

The use of methods of hardware physiotherapy in patients ischemic disease hearts (ischemic heart disease), angina pectoris is mainly aimed at normalizing the central mechanisms of blood circulation regulation with a concomitant increase in myocardial oxygen consumption, contractility myocardial and exercise tolerance, as well as a decrease in total peripheral vascular resistance and normalization of autonomic reactions.

Physiotherapy in patients with coronary artery disease should be used only in combination with drug therapy And a wide range non-drug methods treatment (therapeutic Physical Culture, balneotherapy, methods of psychological correction).

Patients with coronary heart disease with angina pectoris I and II functional class physiotherapy is prescribed to eliminate the effects of hypersympathicotonia, increase adaptation to physical activity. Preference is given to such methods as electrosleep using a sedative technique, magnetic and laser therapy, and drug electrophoresis.

Position of the patient: lying on his back or sitting in a comfortable chair; impact zones: shoulder joints(mostly right), fifth intercostal space, sternum area (central zone or at the level of the upper third of the sternum). The waveguide is placed in contact or with a gap of 1-2 cm. Exposure from 10-15 to 20-30 minutes, daily; for a course of 10-20 procedures.

In aeroionotherapy, regimens similar to those used in patients with hypertension are used.

Aerophytotherapy includes inhalation of vapors of essential oils of orange, lavender, rose, mint, lemon balm, hyssop, anise, geranium, ylang-ylang, marjoram.

With PERT therapy use mode No. 3, intensity up to 20 μT, exposure time s gradual increase 10 to 20 minutes, daily; for a course of 10-15 procedures.

With Bemer therapy prescribe steps 3-5 or program P2 (intensity 10-15 μT), duration of the procedure 12 minutes, daily; for a course of 10-15 procedures.

With BLOCK, ozone therapy, UBI, the regimens are the same as in patients with hypertension. With halotherapy, only mode No. 2 is used.

In IHD patients with functional class III angina, physiotherapy is prescribed to activate microcirculation processes in the coronary bed, improve the rheological properties of blood, reduce myocardial hypoxia and increase the degree of organic adaptive mechanisms.

One of the methods of neurotropic pulsed electrotherapy is used (electrosleep using a sedative technique, electrotranquilization, transcerebral amplipulse or interference therapy), magnetotherapy, electrophoresis of β-blockers and metabolic drugs (sodium oxybutyrol, vitamin E, methionine, etc.).

To reduce the total peripheral vascular resistance and enhance the propulsive ability of the myocardium, the effect of physical factors on the calf region is used. Almost all physical factors used in stage II hypertension can be used in patients of this category. Apressin ultraphonophoresis is especially effective.

In the presence of concomitant diseases of the spine, applications of peloids of indifferent temperatures on the cervicothoracic or lumbar, which reduces the frequency pain attacks, and also, according to HM, reduces the number of episodes of "silent", or painless, ischemia, reduces the frequency of cardiac arrhythmias.

In patients with coronary artery disease who have undergone myocardial infarction(THEM), physical factors begin to be more widely used in the second phase of rehabilitation - in the early post-hospital recovery period (convalescence phase - 3-6 to 8-16 weeks). The main task of rehabilitation during this period is to increase coronary and myocardial reserves, economize the work of the heart, prevent the development late complications MI, chronic heart failure, optimization of scar formation in the infarction zone.

17-23 days after the onset of acute MI, patients can be prescribed:

- electrosleep by sedative technique: orbital mastoid arrangement of electrodes, frequency of rectangular pulsed current 5-20 Hz, current strength - 4-6 mA in amplitude value, procedure duration 30-60 minutes, 3-4 times a week; for a course of 10-20 procedures. The rationale for prescribing electrosleep to such patients is the presence of following effects: sedative, analgesic, hemodynamic (close to the effects of β-blockers, but without vagus nerve activation, which allows the method to be used in concomitant broncho-obstructive conditions), metabolic, manifested in improved lipid and catecholamine metabolism.

Autonomic correction under the influence of electrosleep in the form of a decrease in the manifestations of hypersympathicotonia with a decrease in myocardial oxygen demand makes the electrosleep method especially indicated in this period of rehabilitation;

- central electroanalgesia gives effects close to those of electrosleep, and is carried out with the fronto-mastoid arrangement of electrodes, with a pulse frequency of 800 to 1000 Hz at a current strength of 1.5 mA (average value). The duration of the procedure is 30-45 minutes, daily; 10-15 procedures per course;

- medicinal electrophoresis is carried out using various techniques (impact on the collar region, on the region of the heart, etc.). Typically, a current density of 0.05 mA/cm2 is used with a duration of procedures of 15-20 minutes; for a course of 6-12 procedures. With the help of galvanic or pulsed current, the necessary medicinal substances: vasodilating, ganglion blocking, analgesic, anticoagulant, neurotropic, affecting metabolic processes, antioxidants (papaverine, no-shpa, eufillin, obzidan, heparin, sodium oxybutyrate, panangin, vitamin E, etc.).

Sometimes two can be injected from different poles at the same time medicines. As an example of the introduction of two different substances, one can cite transcardial electrophoresis of potassium and magnesium or lithium with simultaneous electrophoresis of heparin and hexonium on the collar region or paravertebral on the thoracic spine.

- low frequency magnetic field used in two ways. The first is to influence the projection area of ​​the lower cervical and upper thoracic vegetative ganglia of the border chain (at the level of CV-TIV, the second - to the area of ​​the projection of the heart along the anterior surface of the chest. The inductor is placed in contact in the corresponding zone, the direction of the lines of force is vertical, the magnetic field induction is 25 mT, procedure duration 10-15 minutes, daily; course 10-15 procedures.

To achieve a good vegetative-corrective effect, it is recommended to use a low-frequency magnetic field (impact on the thoracic spine paravertebral or on the collar region) with an induction of 15-20 mT at an exposure of 10-15 minutes, daily or every other day, depending on individual tolerance; course 8-15 procedures.

- laser therapy for the rehabilitation of patients survivors of myocardial infarction, is used using a variety of techniques. BLOCK is prescribed according to the standard method. Currently, non-invasive transcutaneous effects of infrared pulsed laser radiation (0.89 μm) are widely used.

We present one of the methods.

Irradiation is carried out by a pulsed low-intensity laser emitter of the infarction range with a frequency of 80 Hz (without a magnetic nozzle) contacting the points: point 1 - the second intercostal space at the point of attachment of the rib to the sternum, point 2 - the fourth intercostal space along the midclavicular line, point 3 - the sixth intercostal space along the anterior axillary line , point 4 - at the corner of the left shoulder blade. The exposure time is from 1 to 3-4 minutes with a total duration of not more than 15 minutes, daily; for a course of 10-15 procedures.

Physiotherapy after cardiac surgery

For the rehabilitation of patients with coronary artery disease after surgical correction ( coronary artery bypass grafting, sympathotonia, etc.), you can apply the methods of apparatus physiotherapy already 8-10 days after the operation.

The tasks of hardware physiotherapy at this stage:

1) removal of pain syndrome of angina pectoris, which persists in some patients;
2) relief of pain in chest associated with surgical intervention;
3) increase in coronary, myocardial and aerobic reserves,
4) elimination autonomic dysfunction, the phenomena of hypersympathicotonia, to increase the oxygen supply of the myocardium.

Electrosleep is prescribed by a sedative method: orbital mastoid arrangement of electrodes, frequency of rectangular pulsed current 5-20 Hz, average amplitude value of current 4-6 mA, procedure duration 30-60 minutes, 3-4 times a week; for a course of 10-20 procedures.

Central electroanalgesia can be used according to the fronto-mastoid technique with a pulse frequency of 800 to 1000 Hz at a current strength of 1.5 mA (average amplitude value). The duration of the procedure is 30-45 minutes, daily; a course of 10-15 procedures.

Anode galvanization the collar zone or the galvanic collar according to Shcherbak is used to eliminate autonomic dysfunction and reduce hyperreactivity; current density 0.01 mA/cm2, procedure duration 8-10 minutes, daily; course 10 procedures.

electrophoresis Novocaine is used by the transcardiac method to relieve long-term chest pain caused by tissue trauma during surgery, placing the anode in the area of ​​greatest pain, and the indifferent cathode at the angle of the left shoulder blade; current density 0.05-0.1 mA/cm2, procedure duration 10-15 minutes, daily; a course of 10-12 procedures.

SMT electrophoresis Inderal according to the general method, according to Vermel and paravertebral to the cervicothoracic spine (at the level of CIV-TVI) is used to improve the autonomic supply of cardiac activity, reduce the effects of hypersympathicotonia and improve myocardial oxygenation, as well as to prevent the development of heart failure.

SMT parameters: rectified mode, duration of half-cycles 2:4, type of operation III-IV, modulation depth 50%, frequency 100 Hz, 7 minutes for each type of operation at a current strength of 5-10 mA in amplitude daily; for a course of 10 procedures. Anaprilin is injected from the anode.

The advantage of this method is the ability to obtain a β-adrenergic blocking effect with small doses of the drug without a pronounced negative inotropic effect (decrease in cardiac output), which makes possible application it in patients with hypokinetic type of hemodynamics with initially reduced cardiac output.

This technique is preferable to prescribe with concomitant arterial hypertension and uncomplicated cardiac arrhythmias. Contraindications are II degree AV blockade and complex arrhythmias (frequent group polytopic extrasystoles, paroxysmal arrhythmias occurring more than twice a week, tachysystolic form of atrial fibrillation, etc.).

Low frequency magnetotherapy used to actively influence the autonomic nervous system to eliminate the effects of hypersympathicotonia and correct hemorheological disorders in early post-hospital (8 days after myocardial revascularization) rehabilitation.

This method of apparatus therapy is used according to the paravertebral technique, on the projection area of ​​the lower cervical and upper thoracic vegetative ganglia of the border chain (at the level of CVI-TII segments. Two rectangular inductors are placed paravertebral in contact (through clothing) in the corresponding zone, the direction of the lines of force is vertical multidirectional, magnetic field induction 25 mT, procedure duration 10-15 min, daily; course 10-15 procedures.

Low-frequency magnetotherapy can be prescribed to patients for whom other methods of physiotherapy are contraindicated, as well as in more severe patients. The only contraindication is individual intolerance exposure to a magnetic field (extremely rare).

laser therapy used to increase metabolic processes in the myocardium and improve its oxygen supply, as well as to enhance regenerative processes in the myocardium and damaged tissues, increasing adaptation to physical activity using various transcutaneous methodological approaches.

Method of ultratonotherapy used to relieve pain after surgery, as well as to form a soft elastic scar and prevent the development of chondritis and perichondritis.

The method is based on the use of high-frequency (22 kHz) alternating sinusoidal current. Due to direct action current of supratonal frequency, capillaries and arterioles expand, local temperature slightly increases, blood and lymph circulation improves.

All this has a positive effect on metabolism, improves skin trophism, enhances repair processes. Improving microcirculation, reducing vasospasm and reducing sensitivity nerve endings determine the pronounced analgesic effect of this method.

Apply therapeutic ointments: lidase, dimexide, heparin ointment, pantovegin; contratubex, heparoid; exposure from 5 to 15 minutes, daily, possibly every other day with a short (5-7 procedures) duration of the course of treatment; for a course of 10-20 procedures - according to individual indications.

At postoperative complications(mediastinitis, pleurisy, pneumonia, suppuration of the postoperative wound) it is possible to use extracorporeal ultraviolet irradiation blood or BLOCK according to the standard method. Ozone therapy is also used.

Perform intravenous infusions ozonated physiological saline 400 ml with an ozone concentration of 2 mg/l daily; course up to 10 procedures.

L.E. Smirnova, A.A. Kotlyarov, A.A. Aleksandrovsky, A.N. Gribanov, L.V. Vankova