MORPHOFUNCTIONAL FEATURES OF VENTRICULAR ARRHYTHMIAS IN PATIENTS WITH POSTINFARCTION CARDIOSCLEROSIS AND ARTERIAL HYPERTENSION, DEPENDING ON THE AFFECTED CORONARY REGION
Alina Mikhaylovna VALEEVA1, Natalya Viktorovna SHLYAKHTINA1,2, Olga Sergeevna VOLODICHEVA3
1Novosibirsk State Universuty
2Meshalkin National Medical Research Center of Minzdrav of Russia
3City Clinical Hospital of Emergency Medical Care N 2
Keywords: желудочковые нарушения ритма, артериальная гипертензия, постинфарктный кардиосклероз, электрокардиография, эхокардиография, коронароангиография, внезапная сердечная смерть, ventricular rhythm disorders, arterial hypertension, post-infarction cardiosclerosis, electrocardiography, echocardiography, coronary angiography, sudden cardiac death, ventricular rhythm disorders, arterial hypertension, post-infarction cardiosclerosis, electrocardiography, echocardiography, coronary angiography, sudden cardiac death
Abstract
Acute and chronic perfusion
disorders, the presence of hypertension are among the main risk factors
for the development of electrical instability of the myocardium, in
particular ventricular arrhythmias (VA), the progressive course of which
increases the risk of sudden cardiac death. Changes in a number of
electro- and echocardiographic indicators are recommended to be
considered as predictors of the development of life-threatening
arrhythmias. Purpose of the study was to study VA features, myocardial
remodeling processed and lipid metabolism in patients with arterial
hypertension (AH) and myocardial infarction, depending on the affected
coronary region. Material and methods. The study involved 50 patients
40-80 years old with post-infarction cardiosclerosis, AH, ventricular
arrhythmias episodes, of which 25 people are patients with
atherosclerotic lesions of left coronary artery (LCA), 25 people are
with the lesions of right coronary artery (RCA). Exclusion criteria:
dilated cardiomyopathy, decompensated valvular defects, arrhythmogenic
dysplasia, idiopathic ventricular tachycardia, myocarditis. Research
methods: echocardiography, coronary angiography, Holter monitor (24-Hour
ECG monitoring), biochemical data. Results and discussion. The tendency
to the presence of more pronounced pathological changes of heart rate
turbulence due to an increase of turbulence slope, dominance of the
sympathetic division of the autonomic nervous system against the
background of a significantly larger number of paired ventricular
extrasystoles have been revealed in the group of patients with
atherosclerotic lesions of LCA. That reflects organic and functional
changes in the myocardium. The absence of significant changes in the
duration and dispersion of the QT interval of the compared groups
confirmed the low informativeness of these criteria in the prediction of
the VA. The significantly lower value of interventricular septum
thickness, left ventricular myocardial mass, and larger size of the
right ventricle (0.15 ms) have been revealed along with the above
mentioned changes in the group due to the slightly different course of
the AH, myocardial remodeling processes. However, more significant
changes in the lipid profile, in particular an increase in the level of
total cholesterol and blood triglycerides have been registered in the
group of patients with PCA. Conclusion. The more pronounced pathological
shift of heart rate turbulence due to the increase of turbulence slope
up to 4.4 ms/RR on the background of more paired ventricular
extrasystoles has been determined in the defeat of the LCA. The
significantly lower value of interventricular septum thickness, left
ventricular myocardial mass, and larger size of the right ventricular
have been observed in the group of patients with atherosclerotic lesions
of the LCA in comparison with group of patients with lesions of the
PCA.
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