DOUBLE BLOCKADE OF ALDOSTERONE RECEPTORS AS A METHOD OF ELIMINATION NEGATIVE EFFECTS OF NON-STEROIDAL ANTI-INFLAMMATORY DRUGS IN CHRONIC HEART FAILURE

摘要

The article deals with the dynamics of echocardioscopy indices during 1.5 years in a patient who underwent an acute myocardial infarction (MI). Two months after the MI left ventricular (LV) end-diastolic size and LV volume were 61 mm and 190 ml, respectively; LV ejection fraction (EF) was 42%. At the background of maximal possible doses of ramipril, bisoprolol, and selective antagonist of aldosterone receptors eplerenone, and after revascularization, within eight months LV end-diastolic size decreased down to 57 mm, LV volume - to 158 ml, and LVEF increased up to 51%. There was no change of potassium and creatinine blood serum levels. The situation changed dramatically after addition to ongoing therapy because of exacerbation of chronic osteochondrosis of ketoprofen 100, meloxicam 15 and tolperisone (Mydocalm) 450 mg/day. The patient noted an increase in dyspnea during walking, a decrease in exercise tolerance. LVEF fell to 36%, LV size increased up to values registered in 2 months after MI. There were no signs of overt fluid retention (no gain of weight, lower limbs edema, lung congestion on X-ray, hepatomegaly at ultrasound examination). In 4 months after addition to therapy of a loop diuretic torasemide (5 mg) the cardio-hemodynamic parameters almost returned to values prior to administration of anti-inflammatory drugs. Conclusion. Loop diuretic (such as torasemide) can be recommended for elimination of negative consequences of the use of nonsteroidal anti-inflammatory drugs in patients with chronic heart failure.