Hypertensive disease is one of the urgent problems in the modern cardiology. It is known that a huge variety of comorbid states influence the development of hypertensive disease, i. e. neurogenic hyperventilating syndrome. It is the sign and the marker of suprasegmental vegetative structures disorders that destabilize homeostasis, initiate the development of specific pathological processes, which are the base of somatization of hyperventilating disorders, including heart disorders. It led to research of structural and functional characteristics of the ventricles with the help of echocardiology among hypertensive patients with neurogenic hyperventilating syndrome. Ventricular dilation of cavities, mostly of the right one without thickening of the walls, was found in the patients with stage 1 hypertension disease (43.59 %). Dilation of the ventricular cavities was also revealed in hypertensive patients with stage 2 hypertension disease in 37.88% of cases. The next variations of remodeling were registered: concentric – in 10.61% of cases; concentric hypertrophy – in 22.73%; asymmetric hypertrophy – in 12.12%; eccentric remodeling and eccentric hypertrophy of the left ventricle – in 4.55% and 9.09% of patients, respectively. Thickening of the right ventricle wall was observed in 13.64% of patients. In the control group of patients without hypertonic syndrome, the signs of concentric and asymmetric hypertrophy were noticed in 10% of patients, eccentric – in 20%; extension of the left ventricle – in 20%. The assessment of the condition of transmitral and tricuspid flows revealed a significant increase in the number of cases, disorders, relaxation of the heart ventricles among hypertensive patients with neurogenic hyperventilating syndrome. It can be a sign of specific role of permanent hyperventilation in ventricle remodeling and mandatory systematic echocardiological control of these patients.
Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Ivano-Frankivsk National Medical University Topicality. Atrial fibrillation (AF) is the most common chronic heart rhythm disorder, occurring in 1-2% of people in the general population. Stable coronary heart disease, hypertension, heart failure, obesity are risk factors for AF progression. Psycho-emotional stress, anxiety and depression can also cause AF. Goal. To investigate the dynamics of the effectiveness of treatment of psychoemotional status in patients with persistent AF. Materials and methods. We examined 62 patients with a permanent form of AF, treated in the cardiology department. Patients were divided into groups: group 1a - (n = 16), received basic therapy; 1b group - (n = 16), patients who in combination treatment received mebicar; Group 1b - (n = 15) patients who received carvedilol in addition to standard therapy; Group 1g (n = 15) consisted of patients receiving combination therapy with carvedilol and mebicar. In order to study the psychological state of patients with AF, L. Reeder"s scale of psychosocial stress, perceived stress-10, hospital scale of anxiety and depression (HADS) were used. Results. The dynamics of the scale of perceived stress-10 in patients with a permanent form of AF in the dynamics of treatment showed a decrease in stress resistance after 2 weeks and a month and a half of treatment (p1 <0,001; p2 <0,001) (p1 - the significance of the difference compared to before and after p2 - the significance of the difference between the values compared with the value after 1.5 months of treatment (p <0,05) During treatment, the proportion of people with high and medium stress decreased by 31,43% in the group of standard treatment, and 39,95% in the group of patients where mebicar was used. It should be noted that in the same group before treatment was dominated by high levels of stress, and the average level was much less common. The share of high stress levels decreased from 53,34 to 6,66%. In this group of patients, the reduction in the score of stress was 17,78%. The level of stress in patients taking carvedilol decreased by 25,89%, and in the group where mebicar was used by 13,68%. Under the influence of standard therapy, the level of stress decreased by 13%, but this figure was not significant, despite the fact that in this group the number of patients decreased from high to medium stress. In the treatment of patients with anxiolytic drug should be noted a significant reduction in psychosocial stress (p1-2 <0,001). It was found that against the background of psychopharmacotherapy in patients with AF there was a reduction from clinical to subclinical levels of anxiety and depression. It should be noted that the course of therapy with carvedilol adversely affected the course of anxiety and depression. Conclusion. According to our study, psychometric parameters improved significantly against the background of comprehensive treatment in all groups of patients.
Violation of the heart rhythm is widespread at present. Anxiety-depressive symptoms and a tendency to chronic stress leads to the depletion of the body, which contributes to arrhythmia. The aim of the study is to assess the severity of clinical and hemodynamic indices by using anxiolytic drug mebicar. Materials and methods. Assessment of psycho-emotional status was studied using the psychosocial scale of stress by L. Reader, PSS-10 PHQ-15 and questionnaire identification of social factors that can affect health. Determination of cortisol level in serum was carried out by immunoassay (ELISA) on the ER-500 Microplate Reader. The concentration of N-terminal fragment of the brain natriuretic peptide precursor (NTproBNP) in serum was determined by ELISA using a Biosan PST-60HL shaker. Results. The results of the survey showed a direct dependence of the manifestation of atrial fibrillation (AF) on the level of psychoemotional stress. We found that in group 1b (standard treatment+mebicar) there were complaints of increased excitability (p<0.001), (p-reliability difference of indices before and after treatment), fatigue (p<0.001), deterioration of memory (p<0.01), appetite loss (p<0.05), sleep disturbance (p<0.001), signs of severe sweating (p<0.001), indicating the appearance of astheno-vegetative syndrome. The reduction of manifestations of high stress (p<0.01) in patients of group 1b (standard treatment+mebicar) was noted. A similar pattern was detected in the severity of anxiety in men (p<0.01). Conclusions. Application in the complex therapy of patients with stable coronary heart disease (SIHD) in conjunction with AF anxiolytics of the benzodiazepine series (mebicar) has allowed stopping anxiety-depressive disorders. Analyzing the level of cortisol, we observed its increase depending on the degree of anxiety and depression; NT-proBNT metrics are respectively.
The objective is to investigate the influence of stress on the clinical and pathogenetic peculiarities of the course of stable coronary heart disease (SIHD) in conjunction with atrial fibrillation (AF). Materials and methods. The analysis of psychodiagnostic tests, labolatory and instrumental research methods in patients with and without AF has been performed. Patients were divided into three groups: group 1 – patients with stable ischemic heart disease (SIHD) with a constant form of AF (15 patients were examined), group 2 – patients with SIHD with paroxysmal form of AF (16 patients were examined), group 3 – patients with SIHD without AF (15 patients were examined). Results. According to the analysis of the data obtained, low level of stress was found in 6 (37.50%) patients with a permanent form of AF, whereas in patients without AF, it was observed in 1 (6.67%) person (p1<0.05) (p1 – the reliability of the differences in indicators relative to patients without AF). Moderate somatic disorder in women with paroxysmal AF was significantly higher than in the group of patients with a constant form of AF (p2<0.05) (p2 – the reliability of the differences in the indicators relative to patients with a constant form of AF). It is confirmed in patients with AF there are signs of the average stress level on the perceived stress level-10 (p2<0.05). Among the social factors that may have an impact on health are the influence of the media, the use of alcohol by relatives, the threat of unemployment for relatives and friends. These indicators were most often found in the group of patients with AF rather than without it (p2<0.05). Changes of ECG and echocardiographic parameters in all groups of patients were revealed. Conclusion. The association of stress with stable ischemic heart disease combined with atrial fibrillation has shown that stress disorders are associated with an increased risk of atrial fibrillation and may worsen their course and predict the risk of developing paroxysm. The dependence between the severity of clinical manifestations, psychodiagnostic tests, laboratory methods, ECG and echocardiographic parameters of the heart on the course of atrial fibrillation is proved.
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