Physiotherapy. Physical rehabilitation of patients who have suffered large-focal uncomplicated myocardial infarction in a hospital setting

Diseases of the cardiovascular system are in first place among all causes of mortality in the population. In addition, they cause disability and significantly reduce the quality of life. Therefore, there is a constant search for methods to help patients and reduce the risk of complications. Physiotherapy for heart disease vascular diseases used to slow the progression of cardiosclerosis, improve the regulation of vascular tone and coronary circulation.

An active search is also underway medicines, which would allow slowing down or reversing these processes. Methods are being developed surgical treatment acute coronary pathology and heart failure, which is one of the most frequent complications cardiac ischemia. To date acute conditions, for example, a heart attack is an indication for emergency invasive treatment.

Mechanism of development of angina pectoris

Coronary heart disease (CHD) is a pathological condition that develops due to insufficient blood supply to the myocardium. As a result, heart cells suffer from hypoxia and receive little nutrients. They also accumulate toxic metabolites and metabolic products. Ultimately, this leads to them dying and being replaced by connective tissue.

The main cause of insufficient blood supply to the myocardium is coronary atherosclerosis.

This pathology is a consequence of lipid metabolism disorders. “Harmful” lipoproteins from the blood penetrate into the vascular intima, where they form lipid spots, thereby provoking the migration of leukocytes to these areas and the development of local inflammatory reaction. As a result, the formation occurs atherosclerotic plaque blocking the lumen of the vessel.

It has been established that the following factors increase cardiac risk and the likelihood of atherosclerosis:

• Arterial hypertension.
• Diabetes mellitus, impaired glucose tolerance.
• Obesity or metabolic syndrome.
• Excessive consumption of animal fats.
• Availability bad habits, for example, smoking, alcohol abuse.
• Low physical activity, sedentary image life.
• A large number of stress factors, nervous tension, sleep disorders.

Moreover, the likelihood of diseases of the cardiovascular system (CVS) increases depending on how many factors act on the body simultaneously. In addition to direct treatment, much attention is paid to the prevention of these diseases and popularization healthy image life, because to fight chronic diseases It's hard enough.

Also, blood clots can form near the plaques, which then break off and, moving along with the blood flow, completely clog the small vessels, leading to acute disorder blood flow and severe cardiac ischemia. Part of the myocardium dies, and a heart attack develops. In addition to atherosclerosis, reasons this state may become primary thrombosis or severe spasm coronary arteries.

Management of patients with coronary artery disease

Most often, coronary heart disease occurs in the form of angina. Depending on the frequency of symptoms and factors that provoke attacks, it can be stable or progressive. Patients complain of unpleasant sensations behind the sternum or in the area of ​​the projection of the heart onto the chest wall. Symptoms manifest themselves in the form of pressing, squeezing pain, a burning sensation, and strong pressure.

Possible irradiation to the arm, esophagus and scapula. The most common trigger for these symptoms is physical activity or emotional stress. Sometimes the symptoms of heart failure may prevail in patients, leading to shortness of breath, severe weakness and fatigue when performing physical activity, and in severe cases, even at rest, which greatly limits their home activity.

Such people are indicated for treatment outpatient setting, constant use of maintenance drug therapy, regular visits to the doctor are required. Recommended from time to time hospital treatment, during which physiotherapy may be used. The daily routine of such people is usually half-bed.

In case of myocardial infarction, the patient needs urgent hospitalization, if possible, stenting is performed. The main task of doctors at this stage is to preserve viable myocardium. For the first few days, patients should be on strict bed rest. After this, gradual rehabilitation begins. Physiotherapy after myocardial infarction can only be prescribed by the attending physician and physiotherapist.

Features of modern physiotherapy

Physiotherapeutic science studies the effects of various physical factors on the human body, with their subsequent use to cure diseases. For this purpose, a variety of thermal, air and sun baths, mineral therapy, electric current, magnetic and ultrasonic waves. At the same time, electrophoresis and phonophoresis are combined, as they can improve the effect medicinal substances using physiotherapeutic techniques.

Physiotherapy in cardiology is used to influence the autonomic nervous system, CNS and neurohormonal regulation of vascular tone.

Most are used for this available techniques. However, you need to understand that they cannot always be used. For example, angina pectoris of functional class 3-4 is a contraindication to most types of physical therapy. Also, many procedures are prohibited for patients with impaired heart rate and conductivity.

Electrosleep has good effectiveness in treating diseases of the cardiovascular system - during this procedure, differently charged electrodes are applied to the forehead and back of the head. The duration of the first procedures is 20 minutes, they are gradually increased to 40 minutes, 10-12 procedures are performed. An alternative may be the method of transcranial electrical stimulation. These methods help to relax patients, reduce the level of activity of the sympathetic nervous system, and, as a result, normalize blood pressure and reduce the myocardium’s need for oxygen.

Therapy using a variety of baths has a similar effect. Their advantage is that they can be used even in patients with high functional class angina. Typically, the course includes taking 3-5 baths lasting from 5 to 20 minutes over two to three weeks.

Magnetic therapy for myocardial infarction is performed using low-frequency magnetic fields. This allows you to improve microcirculation and relax spasmodic vessels. Together with anticoagulant and antiplatelet therapy, they improve the rheological properties of blood and reduce the risk of recurrent thrombosis. Microwave treatment also has a similar effect. Today, laser techniques are often used to influence the body, which also improve tone. vascular walls and blood flow. Laser radiation enhances the body's antioxidant defense, thereby slowing the progression of atherosclerosis.

It should be remembered that physiotherapy for myocardial infarction should be carried out with caution. It is necessary to take into account the patient’s condition and not prescribe procedures without the recommendation of the attending physician.

Modern cardiology is faced with big amount patients suffering from coronary heart disease or myocardial infarction. Therefore, much attention is paid to the rehabilitation and supportive treatment of such people. Various methods are used for this: constant drug therapy, physiotherapy for ischemic heart disease. Thanks to them, doctors are able to achieve normalization of many indicators of the cardiovascular system, slow down the progression of coronary heart disease and reduce the risk of severe complications.

It is necessary to understand that angina is a chronic disease, which means it cannot be cured completely. However, when the right approach and careful implementation medical recommendations, the patient can protect himself from dangerous consequences and significantly improve the quality of life.

There are currently a number preventive measures, which have a fairly effective effect on coronary insufficiency: 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 underlying cause emergence coronary insufficiency- atherosclerosis. Physiotherapy methods and therapeutic exercises with strictly differentiated use in these early stages deserve a lot of attention. The positive effect of some of them, for example diathermy of the heart region, was once reported by both domestic and foreign authors, to a lesser extent diathermy of the stellate and cervical region sympathetic nodes. Subsequently, however, great caution was shown regarding diathermy due to its sometimes observed negative effect on patients with angina pectoris.

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

However, in the presence of pronounced zones of cutaneous hyperalgesia (Zakharyin-Ged zones), it is advisable to direct the effect 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 is proposed novocaine blockade- novocaine electrophoresis with localization of the active electrode in zones of hyperalgesia (Zakharyin-Ged zones). Taking into account the irritating effect of the negative pole of direct current, the indifferent electrode is removed from the zones of skin hyperalgesia and possible irradiation of anginal pain, placing it on the lower back. This is substantiated, in particular, by 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 anginal pain with such localization of the electrode can even serve as a differential diagnostic sign the presence of atherosclerosis of the coronary arteries. The occurrence of anginal pain when the negative electrode is localized on the left shoulder, from our point of view, can be explained irritating effect negative pole one of the most frequent zones irradiation of angina pain, and therefore we recommend placing the negative electrode on the lower back.

Many authors report favorable results of the effect of novocaine electrophoresis on the Zakharyin-Ged zones.

It is known that novocaine has local anesthetic, antihistamine and ganglion-blocking effects. It is successfully used for angina pectoris in the form of novocaine blockade of the cardiac plexus area, in the form of vagosympathetic blockade according to A. V. Vishnevsky, intradermal injections in the Zakharyin-Ged and electrophoresis zones. Still, novocaine electrophoresis has its advantages. Firstly, the total effect of direct current and novocaine on the skin receptor apparatus is important; secondly, medicinal ions introduced into the skin disrupt the local ionic conjuncture, which is the source of reflexes that, spreading through the nervous system, reach the autonomic ganglia, reticular formation and cerebral cortex; thirdly, novocaine shows its pharmachologic effect at a significantly lower concentration of the substance, which is very important due to poor tolerance some patients take large doses of 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 gives reason to assume that novocaine electrophoresis of the Zakharyin-Ged zones will cause a pronounced anesthetic effect.

In this case, one or two electrodes with pads with an area of ​​100 cm2 each, moistened with a freshly prepared 10% aqueous solution of 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 ​​zones of hyperalgesia (Zakharyin's zone - Geda) and connect them to the anode of the galvanization apparatus, the indifferent electrode with a gasket with an area of ​​200 cm2, moistened with warm tap water, placed on the lower back. Procedures of 6-10-15 minutes at a current density of 0.03-0.08 mA/cm2 are carried out daily or every other day, for a total of 8 to 20 procedures. During the treatment, the localization of the active electrode is changed depending on the speed of disappearance or significant reduction of hyperalgesia in the affected areas (approximately 3-4 procedures for the same area). Placement of the electrode on the heart area should be avoided, as negative effects of the procedure have sometimes been observed.

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

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

There are indications in the literature about the effectiveness of dionine electrophoresis of the Zakharyin-Ged reflexogenic cardiac zone in chronic coronary insufficiency. At the same time, in most patients, pain in the heart area disappeared, the rhythm of cardiac activity normalized, sleep improved, and the general weakness. Dionine electrophoresis was carried out as follows: a positive electrode with a pad moistened with a 0.1% dionine solution was placed along the left midclavicular line in the region of the IV-V rib, an indifferent electrode was placed in the cervicothoracic spine (C7-D5); 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 ganglerone electrophoresis (0.25% ganglerone solution) of the sinocarotid zone for coronary insufficiency with symptoms of angina pectoris. He believes that under the influence of ganglerone 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 the calf muscles when walking, paresthesia in the feet and legs, etc.), it is more advisable to use complex physical therapy: aminophylline-electrophoresis according to the method of general influence in alternation with foot hydrogen sulfide baths (two-chamber baths) with a hydrogen sulfide concentration of 50-100-150 mg/l, temperature 36-37°, for 10-15 minutes, a total of 12 baths. Influenced hydrogen sulfide baths skin capillaries and small vessels of the legs dilate, and therefore tissue hypoxia decreases and, as a result, pain in the calf muscles decreases or disappears when walking. With this complex treatment, not only angina pain and headaches decrease or stop, but weakness and pain in the legs when walking decreases.

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

For angina pectoris in patients with hypertension, it is advisable to use complex treatment, including physical factors and antihypertensive drugs (reserpine, serpazil, etc.). Since when hypertension There is a tendency to spasms of not only coronary, but also cerebral vessels; it is most advisable to use aminophylline electrophoresis using the above method.

If there is a tendency to tachycardia, instead of aminophylline electrophoresis, platiphylline electrophoresis (0.01-0.03 g per procedure) is indicated according to the general effect method. If there are zones of skin hyperalgesia, novocaine electrophoresis is indicated for the Zakharyin-Ged zones, alternating with aminophylline or platyphylline electrophoresis. For improvement cerebral circulation appropriate in medical complex include massage of the collar area.

There are instructions about beneficial influence 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 during 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 of the pain syndrome and positive dynamics of the electrocardiogram.

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

If patients have spondylosis deformans cervicothoracic region spine without 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 increased temporal pressure, to enhance the effect of aminophylline electrophoresis on cerebral circulation and cortical neurodynamics, massage of the collar zone, which is also alternated with electrophoresis, is advisable. At the same time, temporal pressure decreases.

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

To enhance function external respiration and increasing blood flow to the right heart, as well as to improve cortico-visceral connections, aminophylline electrophoresis is carried out against the background therapeutic exercises on the cardiovascular complex with an emphasis on breathing exercises.

With severe angina, referring patients to balneotherapeutic resorts is inappropriate. It is indicated for such patients sanatorium treatment, mainly in local cardiological sanatoriums, as well as in climatic resorts, mainly in the coastal north-western regions of the Baltic states.

In case of atherosclerotic cardiosclerosis without severe attacks of angina pectoris and without a history of myocardial infarction and symptoms of circulatory failure no higher than stage 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) cardiac aneurysm after undergoing

Physiotherapy for cardiovascular diseases may be aimed at eliminating or weakening neurotic state, reduction of high blood pressure, dilation of blood vessels in relevant organs or areas of the body, metabolism (in order to obtain favorable changes in the metabolism of lipoids and lipoproteins).

Most physiotherapeutic methods provide therapeutic effect by influencing the nervous system; Moreover, one can even believe that many of the physiotherapeutic procedures act rather on the psyche (the psychotherapeutic component of physiotherapy is often dominant).

Hence it is clear that a variety of physiotherapy for cardiovascular diseases, based, it would seem, on completely different physical and technical principles, help to more or less the same extent; they are usually effective only in a certain group of patients and equally ineffective in another group; both groups usually differ not in the nature of the cardiovascular disease, but in the state of the higher parts of the nervous system of the patients. This includes procedures such as bath treatment (essentially any chemical composition), electric shock(it doesn’t matter in what form). Of course, what has been said applies only to more or less delicate, careful influences; with an “overdose” of these effects, a deterioration in the condition of patients is usually observed, and again without a direct connection with the type of physiotherapeutic methods. The above should not be taken as a derogation of practical value similar treatment; it undoubtedly helps, but mainly because it affects mental functions. Perhaps, in this case, the effect on higher nervous activity is also achieved reflex influences, coming from skin receptors to the central nervous system. The reflex principle probably forms an important basis of physiotherapy for cardiovascular diseases. It cannot be denied, however, that the effect can be achieved not only by improving the state of higher nervous activity (i.e. weakening), but also by the influence of physiotherapeutic procedures on vascular tone, on the lumen of small arteries and arterioles. The vasodilating effect of physiotherapeutic agents is proclaimed by almost all specialists; idea about action physical methods on “vascular tone” is predominant in this branch of medicine.

The direct vasodilatory effect of physiotherapy in cardiovascular diseases is most convincing when used in patients suffering from ischemia lower limbs. First of all, in this case pathological condition Heat works well. Warming the feet in every possible way is absolutely necessary for such patients. They wear woolen stockings, regularly take hot foot baths, and cover their feet with heating pads (caution is required, since burns easily occur if the sensitivity of the limbs is weakened). Mud or paraffin applications in the form of a long course can undoubtedly improve blood circulation in the limb affected by atherosclerosis due to the expansion vascular bed; to a certain extent we can talk about an increase in this collateral circulation(although new vascular pathways are not formed - only the function of existing ones improves). Heat treatment carried out at the corresponding resorts. The action of some methods of electrotherapy, including diathermy, as well as ultra-high frequency (UHF) current, is based on the same principle.
In other localizations of atherosclerosis, physiotherapy does not have a clear vasodilator effect (at least there is no evidence in favor of it). So, when on the basis coronary atherosclerosis Various methods of electrotherapy were repeatedly used, with the goal of obtaining an analgesic and vasodilating effect.

It cannot be denied that for neurotic pain in the heart area, physiotherapy for cardiovascular diseases, namely electrotherapy (in former time d'Arsonval currents, Vermeule galvanization, and currently Shcherbak's collar or Bourguignon's method were used especially willingly) is often useful, and sometimes “relieves” pain for a more or less long period. At angina pectoris of atherosclerotic nature, these methods of treatment, of course, do not give even a partial effect, despite the fact that the nervous and even mental component plays a significant role in the pathogenesis of atherosclerotic angina pectoris. Obviously, the source of pain - myocardial ischemia - does not undergo any change as a result of the use of these methods, therefore, no significant improvement occurs coronary circulation. No matter how deeply electricity “warms”, it obviously (in this form and form) is not able to have a “vasodilator” effect in relation to the coronary bed. And even if these methods of physiotherapy for cardiovascular diseases have a beneficial effect on mental sphere, on autonomic system, stenosis and ischemia remain the driving spring of the pain “viscerosensory” reflex. At the same time, it must be borne in mind that the passion for physiotherapy for angina pectoris has repeatedly led to disastrous results: repeated physiotherapeutic stress, like any nervous and physical stress, has caused a deterioration in the condition of patients.

cardiovascular diseases

Physiotherapy for cardiovascular diseases aimed at restoration functional state heart, improvement of coronary circulation and myocardial contractility, its excitability and automaticity; improving the functions of auxiliary (extracardiac) circulatory mechanisms by reducing increased tone peripheral arteries and veins, general peripheral vascular resistance, which allows increasing the propulsive work of the heart with more economical consumption of oxygen; improvement of blood microcirculation and its function in transporting oxygen; improving the functions of the central and autonomic nervous system, neuroendocrine and immune processes underlying a number of cardiovascular diseases. Physiotherapy methods are used for coronary disease heart, hypertension, neurocirculatory dystonia, myocardial cardiosclerosis, etc.

Cardiac ischemia. F.'s use has been most studied in stable angina tension, post-infarction cardiosclerosis, atherosclerotic cardiosclerosis (with the so-called painless form), as well as rehabilitation treatment patients with myocardial infarction, patients who have undergone surgery coronary artery bypass surgery and resection of cardiac aneurysm.

Contraindications: progressive (unstable) angina pectoris, circulatory failure above stage IIB, cardiac asthma, prognostically unfavorable heart rhythm disturbances (frequent group extrasystoles, frequent difficult-to-control paroxysmal disorders heart rate), aneurysm of the heart and blood vessels.

The choice of F. method is determined by the degree functional impairment cardiovascular system, the state of the nervous and neurohumoral systems of blood circulation regulation, as well as the nature concomitant diseases. With stable angina pectoris, myocardial infarction, incl. post-infarction cardiosclerosis, and after coronary artery bypass surgery and aneurysm resection at all stages of rehabilitation, starting from the 15-20th day of the disease or operation, as well as in patients with a predominance of excitation processes, hypersympathicotonia, extrasystolic arrhythmia, concomitant hypertension of stages I and II, diabetes mellitus(mild and moderate forms) effects on the central and autonomic nervous system and neurohumoral regulation carried out using electrosleep (Electrosleep) . The same patients are treated with galvanotherapy (Galvanotherapy) or Electrophoresis (medicinal) according to the methods of general influence, segmental - in the zone of projection of the sympathetic ganglia (Th I - L I) along the posterior surface of the body, in the Zakharyin-Ged zones, in the collar region and in the heart region. The procedures have a mild sedative and analgesic effect and normalize blood pressure. For electrophoresis, vasodilators, painkillers and other agents are used.

Ultrahigh frequency therapy (Ultrahigh frequency therapy) (with a frequency of 2712 MHz) are used craniocerebrally for stable angina pectoris of functional classes I and II, incl. with lipid metabolism disorders. Treatment is carried out using the Thermopulse-700 device in intermittent mode, intensity 35 W using capacitor plates with a diameter of 12 cm; daily procedures, lasting 5-15 min for the course 25-30.

Low-frequency magnetic field (see Magnetotherapy) causes restructuring autonomic regulation heart in the form of a decrease in sympathetic tone, decreased platelet aggregation and improved microcirculation, while not significantly affecting central hemodynamics. This allows it to be used in the treatment of patients with stable angina, incl. with extrasystolic and atrial fibrillation(rare and easily relieved paroxysms, permanent form with circulatory failure not higher than stage I), patients with myocardial infarction of classes I, II and III of clinical severity, starting from the 15-20th day of the disease. In this case, they act either on the projection area of ​​the lower cervical and upper thoracic autonomic ganglia of the border chain at the level of the CV-Th IV vertebrae on the side of the back, or on the projection area of ​​the heart.

Ultrahigh frequency therapy (460 MHz) when exposed to the heart area, causes dilation of the microvasculature in the myocardium, reducing platelet aggregation, which improves myocardial metabolism and accelerates reparative processes in it. Procedures are prescribed for stable angina pectoris, myocardial infarction, starting from the 15-20th day of illness. They act either on the area of ​​projection of the sympathetic ganglia C V -Th IV on the posterior surface of the body, or on the area of ​​projection of the heart along the anterior surface of the chest.

At the core clinical effect low energy laser radiation(see Lasers) in coronary heart disease there are positive changes in hemostasis and rheological properties blood, microcirculation and mobilization antioxidant protection cells; Its analgesic effect is also important. Procedures are prescribed for stable angina pectoris, myocardial infarction in the convalescence phase, starting from the 15-20th day of the disease, in the absence of heart rhythm disturbances and circulatory failure not higher than stage I. The presence of rare extrasystoles, sinus tachycardia and bradycardia, and bundle branch block is not a contraindication.

Balneotherapeutic procedures cause vasodilation, increase blood flow speed, and improve microcirculation. For stable angina of functional classes I and II, incl. with post-infarction cardiosclerosis, as well as after coronary artery bypass surgery after 6-8 months. with circulatory failure not higher than stage I and in the absence severe violations For cardiac rhythm treatment, general carbon dioxide, hydrogen sulfide, radon, sodium chloride and other types of minerals, as well as nitrogen and oxygen baths, are used. All types of baths are used every other day or 4-5 baths per week from the second half of the treatment course with a duration of 10-12 min; 10-12 baths per course.

In case of stable angina pectoris of functional class III, myocardial infarction in the convalescence phase and after coronary artery bypass surgery of class I and II severity, balneotherapy is carried out in the form of 2- or 4-chamber baths; For stage IIA circulatory failure and mild cardiac arrhythmias, dry carbon dioxide baths are used.

Hydrotherapy is used in the form of contrast baths (Baths) , underwater shower-massage and others healing showers. Water procedures reduce sympathetic influences autonomic nervous system, reduce oxygen consumption for heart function, eliminate coronary-metabolic imbalance, which increases coronary and myocardial reserves, the threshold of tolerance to physical and cold stress, and improves vascular reactivity.

In case of stable angina pectoris, post-infarction cardiosclerosis of functional classes I and II with circulatory failure not higher than stage I and without heart rhythm disturbances, general contrast baths are prescribed: the patient is immersed in a pool with warm (38°) water. fresh water by 3 min, then he goes into a pool with cool water (28°) for 1 min while doing active movements. Three transitions to the procedure are recommended, which ends with a cool bath (by the middle of the course the temperature is reduced to 26-25°). A total of 12-15 baths per course, 4-5 baths per week. For post-infarction cardiosclerosis and after coronary artery bypass surgery (starting from the 30-35th day), foot contrast baths are used (with a temperature of 38 and 28°, from the second half of the course - 40 and 20°): a total of 12-15 baths per course.

Balneotherapy and hydrotherapy are used to treat patients with a painless form of coronary heart disease, cardiosclerosis, which can manifest as heart failure and heart rhythm disturbances. When choosing the type of treatment and method of its implementation crucial has a determination of the degree of impairment of the functional state of the cardiovascular system based on physical exercise tests, as well as the nature of heart rhythm disturbances.

Hypertonic disease. When choosing a F. method, one should take into account not only the stage of the disease, but also the type of hemodynamic disorders (hyperkinetic or hypokinetic). In the hyperkinetic variant, electrosleep, central electroanalgesia, galvanotherapy and medicinal electrophoresis, low-frequency magnetic field, microwave therapy, negatively charged electroaerosols are used to reduce the increased sympathetic activity of the hypothalamic centers.

In the treatment of patients with hypertension stages I and II without frequent vascular crises, significant disturbances in heart rhythm and circulatory failure not higher than stage I, balneotherapy is widely used: carbon dioxide, radon, hydrogen sulfide, sodium chloride, iodide-bromine, arsenic-containing, as well as nitrogen baths. The temperature of all baths is 35-36°, except for sodium chloride baths (35-34°). Baths are taken every other day, 4-5 baths per week, 10-12 baths per course.

Patients with stage IIB hypertension in combination with coronary heart disease, as well as with circulatory failure not higher than stage IIA, use 2- and 4-chamber baths or dry carbon dioxide baths (temperature 28°, duration 15-20 min, 10-12 baths per course).

For hypertension stages I and II without signs of coronary and heart failure, heart rhythm disturbances, hydrotherapy is used: pine, pearl, oxygen baths, wet wraps and therapeutic showers, incl. underwater shower-massage, as well as sauna treatments.

Cardiopsychoneurosis. In order to influence arterial hyper- and hypotension, cardialgia, and abnormal heart rhythm, electrosleep is used, medicinal electrophoresis (bromine, anaprilin) ​​is performed using the general effect method or the collar method; for the hypotensive type, caffeine-bromo-electrophoresis is used: for severe asthenic syndrome- galvanic anode collar according to Shcherbak. For the cardiac type of the disease with severe cardialgia, novocaine electrophoresis using a segmental technique, darsonvalization of the heart area, ultraviolet irradiation in an erythemal dose, or massage of the heart area are prescribed.

Carbon dioxide, sodium chloride, iodide-bromine baths are prescribed for the hypotensive type of disease and severe asthenic syndrome; radon, nitrogen baths - for hypertensive, cardiac, incl. arrhythmic, symptom complexes and a pronounced predominance of the process of hypersympathicotonia, insomnia; hydrogen sulfide baths- for hypertensive and cardiac types with relatively balanced nervous processes and without signs of hypersympathicotonia and cardiac arrhythmias.

Hydrotherapy in the form of therapeutic showers (rain, circular, Scottish, underwater shower-massage), dry and wet wraps, contrast, pearl, pine baths used for all types of disease. In case of heart rhythm disturbances, a pronounced predominance of excitation processes, do not use circular and Scottish soul, as well as contrast baths.

Myocardial cardiosclerosis(consequences of rheumatic and infectious-allergic myocarditis) in patients with circulatory failure not higher than stage I, cardialgia, incl. with mild cardiac arrhythmias, is an indication for balneotherapy in the form of general carbon dioxide, radon, sodium chloride and iodine-bromine baths, and in the absence of cardiac arrhythmias - hydrogen sulfide baths. In patients with severe mitral stenosis or after commissurotomy, preference should be given to carbon dioxide baths. Such patients are treated with inhalation of aerosols or electroaerosols; to improve immunogenesis and in order to prevent exacerbations, inductothermy is performed on the adrenal gland area (at the level of Th X -L IV).

Treatment using mechanical influences. An independent section of F. is balneology. Each of them includes a number of therapeutic methods based on the use of one or another physical factor. Largest number methods combine electrotherapy (methods using an electric field, constant, alternating, continuous and intermittent electric currents, alternating magnetic fields, electromagnetic fields). Light therapy includes methods that use light energy, incl. ultraviolet and infrared radiation. Water and balneotherapy methods are based on the use of fresh water (in the form of showers, baths and other water procedures), as well as natural and artificially prepared mineral waters. Thermal treatment includes methods based on the use of heat transferred to the body by heated paraffin, ozokerite, therapeutic mud, sand, steam, dry air, etc. Mechanical treatment includes ultrasound therapy, vibration therapy, massage, manual therapy.

In the past, mainly general and regional physiotherapeutic procedures were used with the influence of physical factors in large doses. As a result, similar general reactions of the body arose, and physical methods treatments were classified as so-called nonspecific. Currently, due to targeted effects on certain organs and systems and the use of pulsed modes, significantly lower doses of physical factors are used. This made it possible to significantly reduce contraindications and expand the indications for the use of physical methods of treatment.

Indications for F.'s use are based on the fact that physiotherapeutic procedures improve peripheral, regional and central blood circulation, have an analgesic effect, improve tissue trophism, normalize neurohumoral regulation and impaired immune processes. F. is usually contraindicated in febrile conditions, exacerbation inflammatory processes, exhaustion of the body, infectious diseases in acute stage, active tuberculosis process, malignant neoplasms and suspicion of their presence, systemic diseases blood, tendency to bleeding and bleeding, cardiovascular diseases with circulatory failure above stage II, aneurysm of the aorta and large vessels, diseases of the central nervous system. with intense excitement.

Therapeutic and preventive use of physical factors is carried out in physiotherapy rooms and departments of hospitals, clinics and other treatment and preventive institutions, and, if necessary, in hospital wards and at home. Physiotherapeutic rooms (departments) are organized in hospitals with at least 50 beds and clinics with at least 10 doctors on staff. Preventive measures are carried out in children's groups, in production, in rest homes, and sanatoriums. Physiotherapeutic departments of large hospitals and clinics are headed by physiotherapists who have undergone special training. Nursing staff are allowed to carry out physiotherapeutic procedures only after specialization.

Physiotherapy for cardiovascular diseases aimed at restoring the functional state of the heart, improving coronary circulation and myocardial contractility, its excitability and automaticity; improving the functions of auxiliary (extracardiac) circulatory mechanisms by reducing the increased tone of peripheral arteries and veins, general peripheral vascular resistance, which allows increasing the propulsive work of the heart with more economical consumption of oxygen; improvement of blood microcirculation and its function in transporting oxygen; improving the functions of the central and autonomic nervous system, neuroendocrine and immune processes underlying a number of cardiovascular diseases. Physiotherapy methods are used for coronary heart disease, hypertension, neurocirculatory dystonia, ischemic cardiosclerosis, etc.

Cardiac ischemia. F.'s use has been most studied in stable angina pectoris, post-infarction cardiosclerosis, atherosclerotic cardiosclerosis (in the so-called painless form), as well as in the rehabilitation treatment of patients with myocardial infarction, patients who have undergone coronary artery bypass surgery and resection of a cardiac aneurysm.

Contraindications: progressive (unstable), blood circulation above stage IIB, cardiac, prognostically unfavorable cardiac arrhythmias (frequent group, frequent difficult-to-control paroxysmal cardiac arrhythmias), heart and blood vessels.

The choice of F. method is determined by the degree of functional impairment of the cardiovascular system, the state of the nervous and neurohumoral systems of blood circulation regulation, as well as the nature of concomitant diseases. With stable angina pectoris, myocardial infarction, incl. post-infarction cardiosclerosis, and after coronary artery bypass surgery and aneurysm resection at all stages of rehabilitation, starting from the 15-20th day of the disease or operation, as well as in patients with a predominance of excitation processes, hypersympathicotonia, extrasystolic arrhythmia, concomitant hypertension stages I and II, diabetes diabetes (mild and moderate forms), the effect on the central and autonomic nervous system and neurohumoral regulation is carried out using electrosleep. The same patients use galvanotherapy or electrophoresis (medicinal) according to the methods of general influence, segmental - in the zone of projection of the sympathetic ganglia (Th I -L I) along the posterior surface of the body, on the Zakharyin-Ged zones, on the collar region and on the heart region. The procedures have a mild sedative and analgesic effect and normalize blood pressure. For electrophoresis, vasodilators, painkillers and other agents are used.