EUROMEDICA  Hanover 23-24  Mai 2011	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover

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Microvascular angina is quite rare disease, little-studied processes of endothelial dysfunction are in the base of its pathogenesis, they initiate spasm of small coronary arteries brunches. The treatment options in microvascular angina are still poor developed and insufficiently effective.

The aim of the study is to increase treatment effectiveness of the patients with microvascular angina with using interval normobaric hypoxytherapy (IHT).

Materials and methods. 60 patients with microvascular angina were included in the study if they: had chest pain of several hours duration during exercise, with absence of ischemic ECG changes at rest; had ischemic changes during exercise testing; did not have positive reaction on sublingual nitroglycerine, left heart hypertrophy features and valvular disease on echocardiography, did not have in history myocardial infarction, systolic or diastolic dysfunction, arteriosclerosis coronary arteries obliterans, features of deterioration of segmental myocardial contractility.

We did not include patients with diabetes mellitus, mitral valve prolapse, essential hypertension. Specific characteristics that specify presence of microvascular angina at coronary angiography are: symptom of contrast substance “delay”, presence of “myocardial bridges”, distal arteries sinuation or its contours irregularity. Microvascular angina is diagnosed by complaints on angina pain; absence of coronal arteries changes at coronary angiography; ECG ST segment depression >1 mm at veloergometry. Other patient’s pathologies of cardiovascular system and any severe concomitant disease, diabetes mellirus in particular, were excluded.

The patients were divided in 2 groups. 30 patients of the 1-st group took beta-adrenergic blocking agents and/or calcium channel blockers, trimetazidine, acetylsalicylic acid, hypolipidemic agent, when needed – nitrates. The 2-d group (30 patients) additionally got daily session of normobaric hypoxytherapy for 50-60 min during 30 days (hypoxicator “GIP-10-1000”, Russia). Control group included 30 practically healthy people of the adequate sex and age.

For individual test of hypoxia tolerance and treatment sessions hypoxicator “GIP 10-1000-0”, «Trade Medical» (Russia) and pulseoxymeter B-002, “Bion” (Russia), stopwatch and tonometer were used. Treatment session of IHT was performed in cycle-fractionate mode: breathing with hypoxic gaseous mixture, then breathing with normal gaseous mixture.

During hypoxic adaptation time of breathing with hypoxic gaseous mixture was increased. Number of such cycles during one procedure was 5-10, total time of breathing with reduced content of oxygen in the air was from 20 to 45 min. Optimal oxygen concentration was used for men 11.5%, for women 12%, for eldery patients – 12%.

Hypoxic cycle duration was corrected taking into account individual sensitivity and susceptibility for hypoxia, oxygen saturation, heart rate and arterial pressure. At the moment of hypoxic gaseous mixture inhaling oxygen saturation was from 85 to 80%, that is feature of prosedure adequacy. Duration of on hypoxic period was 3-5 min, pause of normal gaseous mixture respiration - 5 min. Such exposures was repeated 10-12 times during one procedure. Statistical processing of the results was made using package “Statistica 6.0”.

Results. Patients with microvascular angina of the 2-d group who have got IHT treatment had significant exercise tolerance increasing (χ²=7,1, р=0,04) in comparison of the 1-st group, frequency of angina pectoris attacks (χ²=8,7, р=0,008) and necessity of additional nitrates intakes (χ²=4,1, р=0,03) were decreased.

Conclusion. Everyday interval normobaric hypoxytherapy sessions in patients with microvascular angina stimulate exercise tolerance increasing, angina attacks frequency and necessity of additional nitrates intake decreasing.