Теreshchenko N. Іncreasing the effectiveness of rehabilitation measures in the early postinfarction period by means of physical training against the background of the use of modern methods of treatment of acute myocardial infarction

The research is based on the data obtained when treating and examining 91 patients with acute myocardial infarction and in their follow-up within 4, 6 and 12 months. All patients were men with primary, mainly Q-myocardial infarction. They all underwent emergent coronary angiography with stenting of the infarct-related coronary artery in the first hours of myocardial infarction onset. The dissertation draws on general clinical studies, along with instrumental (coronary angiography, echocardiography, bicycle ergometry) and laboratory (determination of lipid metabolism) methods. According to modern protocols and recommendations, the patients received intensive statin therapy, antiplatelet drugs, proton pump inhibitors; angiotensin-converting inhibitors and beta-adrenergic blockers were administered in individually selected doses, depending on hemodynamic effects. Medications with other groups of pharmaceuticals were prescribed according to the indications. The patients were divided into two groups depending on the volume of the physical component of cardiac rehabilitation.The 1st group consisted of 47 patients who were included in the program of physical rehabilitation. They participated in training on a bicycle ergometer three times a week under medical control in addition to distance walking and therapeutic physical complexes that depended on the presentations/manifestations of myocardial infarction. The course comprised 30 sessions. The regimen of training was calculated individually. It was based on the data of the tests with physical load. The training level did not exceed 75% of the threshold power. After a half-course of training, a control test on a bicycle ergometer was performed. In case of the adequate response and increased tolerability to physical activity, the level of the training regimen was increased at the next stage. The 2nd group consisted of 44 patients whose physical rehabilitation was limited to distance walking and physical exercises. The patients of the 2nd group were examined within the same time frame as the 1st group. Modern treatment modalities of acute coronary syndrome and myocardial infarction with the use of high-tech interventions and antiatherosclerotic and antiplatelet medication contributed to reaching the physical activity in the majority of patients, which corresponds to the level of light physical labor at the stage of inpatient treatment. When analyzing the results of loading testing during one-year follow-up, it was discovered that hemodynamic indices in both groups did not differ, neither before the loading test. In the group of physical training, the tolerance to physical activity increased significantly with the improvement of the index "the ratio of the dual product to the performed work", which characterizes the hemodynamic value of the unit of performed work. The positive changes were significant even at completing the half-course of physical training, with further improvement in working capacity. During these periods the threshold power increased in the control group. During the one-year period, against the background of physical training, gradual decreases were observed in the end diastolic and systiolic volumes and their indicesin the 1st group. This was accompanied by an increase in the ejection fraction immediately after the physical training. The achieved level of ejection fraction remained unchanged during further observation. In the 2nd group the false volatility of volumetric indices was sufficient for a slight but significant increase in the ejection fraction in comparison with the first survey. The number of patients with kinetic disorders decreased 3-4 times in the 1st group. The analysis of the data showed that in patients with acute myocardial infarction the violation of the quantitative indices of lipid metabolism occurs against the background of the intensification of processes of free radical oxidation of lipids with a decrease in the activity of enzymes in the system of antioxidant protection. It was accompanied by the high level of myeloperoxidase with decreased activity of the рaraoxonase-1. Only 12 months later in the 1st group there was an intersection observed with a decrease in the activity of myeloperoxidase and increased рaraoxonase-1