Ишемическая болезнь сердца-Ischemic heart disease

При лечении больных ИБС особенно важно учитывать его психологическое состояние. С психодинамической точки зрения для больных ИБС типична форма поведения руководителя. Как правило, карьера таких больных представляет собой цепочку взлетов и падений. Они добиваются успехов благодаря целеустремлённости, полной самоотдачи, стремления доминировать и демонстрировать собственное превосходство. Однако из-за невозможности контролировать свои гиперактивность, сверхувлеченность и желание самопожертвования, их планы часто терпят крушения. Оказавшись в отделении интенсивной терапии и будучи изолированным, больной находится в условиях, способствующих нагнетанию страхов и опасений. Многие больные, перенесшие острый инфаркт миокарда, закрываются в себе, избегая общения, стараются скрыть возникающие затруднения и жалобы. В данной ситуации необходима профессиональная поддержка врача, который должен установить контакт, проявить эмоциональные реакции больного и оказать терапевтическую помощь. На развитие ИБС также существенное влияние оказывают различные психические факторы. Особенно их влияние значимо в комплексе с соматическими факторами риска. Немаловажное значение и глубокое психотерапевтическое влияние имеет обсуждение правильного образа жизни в лечебных группах, что значительно способствует стремлению больных бросить курить, контролировать массу тела и рационально распределят физические нагрузки. Таким образом, лечение ИБС заключается как в медикаментозной терапии, так и в исключении факторов риска. Ишемическую болезнь сердца успешно лечат в тандеме «врач-психолог» в Центре лечения психосоматических заболеваний ApertaVia в Чехии. Многолетний опыт работы и уникальная методика лечения пациентов доказывают эффективность лечения ИБС , как психосоматического заболевания.

The discussion of the side-effects of treatments in this section should not be seen as alarmist propaganda. It is important that this point be appreciated because, unfortunately, such techniques are used in some types of sales drives. The purpose of describing these effects in the following discussion is that they have a very important role in medicine. Discussion of; any therapy without including the side-effects involved is completely invalid. There is another reason. This is that one of the parameters which must be used in comparing the value of any therapy with any other is that of the side-effects. p r instance, if two treatments are equal in their effectiveness for treating a particular condition but one of them exhibited undesirable side effects, then the one which did not would obviously be a better treatment, even though it was, overall, no more effective.

As this book will be connected primarily with rheumatoid and osteoarthritis it will be appropriate to reserve the discussion mainly to these two conditions.

Salicylate therapy

Starting with rheumatoid arthritis, it is probably true to say that the most universally preferred therapy by practicing clinicians is salycilate therapy. Put into simpler terms this usually means aspirin, although other forms of the compound are used. An example of another form is sodium salicylate.

Aspirin is the name given to a compound known chemically as acetyl salicylic acid which is now produced by synthetic means. It did, however, originate in the bark of trees, and before methods for synthesizing it were devised, extracts from the bark of the willow tree were, used in the treatment of rheumatic diseases.

Using acetyl salicylic acid as an example of salicylate therapy, it will be convenient to refer to it in the name of aspirin. There are some variations in effect of the various salicylates but this discussion will be of too general a nature to consider these.

Generally speaking, aspirin shows three beneficial effects: it is an anti-inflammatory, anti-pyretic and an analgaesic agent. It is almost certainly the drug in widest use in the treatment of rheumatoid arthritis and has been used in this way since the beginning of this century. With its anti-inflammatory and analgaesic action it eases pain in two ways. One is by direct pain-relieving action on the central nervous system; the other is by reducing inflammation and thus relieving the pain created at the inflammatory site. It is possible that the anti-pyretic (heat or temperature lowering property) may only be applicable in fever conditions. The effects of salicylate therapy tend to be felt quickly, bringing rapid relief. The duration of relief, however, may not be more than a few hours, thus necessitating repeat doses at frequent intervals.

Side-effects of salicylates

Taking a brief look now at the negative side of this particular therapy (the side-effects) it will be found that regular consumption of salicylates, even in small doses, may induce gastric problems. The most common and the most serious problem is gastric hemorrhage and ulceration. A lot of research has been carried out on this topic and it is believed that factors other than the straight consumption of salicylate can influence the degree of severity of this type of damage) For instance it would be fairly obvious to most people that the taking of aspirin on an empty stomach would be more likely to cause gastric upset and damage than if taken ink conjunction with a meal. However, the degree to which stress, such as tiredness, emotion, or perhaps exposure to adverse climatic conditions, may have an adverse effect is not known. The fact that stress conditions, in conjunction with aspirin, can lead to a marked increase in the severity of gastric damage compared with aspirin alone has been demonstrated in laboratory tests on animals.

If large doses of salicylates are being consumed, then in addition to bleeding and ulceration, effects such as nausea, dizziness, kidney problems and partial deafness can occur.

It must be remembered that people differ considerably in their reactions and responses to pain and to drugs, etc. Thus, there is no hard and fast rule as to the effect that a particular person might anticipate from a given amount of drug. As will already have been realized, apart from many external factors, it also depends very much on the individual and the situation involved.

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