6 research outputs found
A Case of Successful Medical Treatment of Ventricular Tachycardia in a Patient With Ischemic Heart Disease and Heart Failure
The pathogenetic mechanisms of arrhythmias, including high-grade ventricular arrhythmias (including non-sustained ventricular tachycardia), in patients with coronary heart disease may be different. Therefore, the characteristics of ventricular arrhythmias must be considered based on the totality of data, taking into account all the available features. The importance of a personalized approach to the management of a patient with coronary heart disease who had extensive myocardial infarction 18.5 years ago, followed by mammary coronary artery bypass grafting, aneurysmectomy and the development of heart failure with a low ejection fraction, in whom ventricular arrhythmias occurred against the background of a stable course of coronary disease , but after emotional stress, is reflected in this work. An extended examination, as well as a detailed study of the nature of ventricular arrhythmias, made it possible to determine the main provoking factor and select an individualized pathogenetic treatment with a good antiarrhythmic result that persists for several years of observation. Conducting mental tests and psychological questioning can be recommended for patients with coronary heart disease and chronic heart failure as an additional examination to assess the contribution of the psycho-emotional factor to arrhythmogenesis after excluding the ischemic and sympathetic nature of ventricular ectopia. It is incorrect to consider that all ventricular arrhythmias in patients with coronary heart disease are ischemic in nature, and in some clinical situations this statement is even erroneous
Choice of ventricular arrhythmia therapy in coronary artery disease
Aim. To study trigger factors of ventricular arrhythmias (VA) in patients with stable coronary artery disease (CAD) and evaluate the effectiveness of individualized treatment.Material and methods. The study included 155 patients with CAD aged 36 to 83 years (61,5±9,8 years); 73,5% were men with frequent single and coupled ventricular ectopic complexes (VEC) and the left ventricle ejection fraction (LVEF) of 56,4±8,5%. Exclusion criteria were class IV angina, acute coronary syndrome, LV aneurysm, LVEF ≤45%. Treatment and examination of patients was carried out according to the algorithm we proposed in 2017 for managing patients with CAD and high-grade VA.Results. Depending on association between ventricular ectopy and transient myocardial ischemia (TMI) during an exercise tolerance test, patients were divided into 2 groups. Group I included 84 patients (54,2%) with ischemic VA. According to noninvasive topical diagnostics, the arrhythmogenic focus in all patients with ischemic VA was located in the left ventricle. Group II consisted of 71 (45,8%) patients with nonischemic VA, and two subgroups were distinguished depending on presence/absence of TMI: 2A and 2B. During the exercise test, several types of VA were identified.Myocardial revascularization (MR) was indicated in 84,5% of cases in both groups. Six months after MR in group I, the antiarrhythmic effect (AAE) was observed in 55 (77,5%) patients. In group IIA, AAE was significantly lower at 61,7% (p=0,048). We also revealed anxiety in 15 patients of group II. Anxiolytic therapy showed AAE in 75% of group IIA patients and in 63,6% of group IIB patients. Nine patients of group II were referred to radiofrequency ablation of VA with a positive effect of 55,5%. Antiarrhythmic drugs (amiodarone, sotalol) were taken by 5 people of group I.Conclusion. The search for trigger factors and their elimination provides a high AAE for VA therapy in patients with CAD
SEARCH OF THE STRESS INDUSED VENTRICULAR TACHICARDIA REASONS — THE METABOLIC THERAPY OPPORTUNITIES
A clinical case of a 56-year-old man is presented in which only ventricular tachycardia without clinical and ECG criteria of myocardial ischemia is recorded on the exercise test. The ventricular tachycardia was the only reason for stopping the test. This clinical case demonstrates all the difficulties in determining the genesis of ventricular arrhythmias induced by exercise. The purpose of the work was to show all the difficulties in determining the genesis of exercise-induced ventricular arrhythmia. The literature references related to the exercise-induced ventricular arrhythmia differentiation is rather poor. It is only known that if a patient develops and progresses ventricular arrhythmia, a tredmill test is considered questionable. Exerciseinduced ventricular arrhythmias especially ventricular tachycardia, are the most dangerous. Therefore, additional diagnostic methods were used to reveal the main disease as the background of ventricular tachycardia. Results of pharmacological test with nitroglycerine were the indication of the ischemic origin of ventricular tachycardia. Coronary angiography did not reveal coronary artery stenoses. Positron emission tomography revealed coronary microcirculation disturbance after which a decision about metabolic therapy with Mexicor was made. The correct choice of the drug (Mеxisor) was confirmed by the results of control studies — improvement of metabolism and antiarrhythmic effect. The article concludes that the choice of the treatment exercise-induced ventricular arrhythmia in patients with stable coronary artery disease should be individual and pathogenetic
ANTIARRHYTHMIC ACTION OF CARDIOCYTOPROTECTORS IN TREATMENT OF ISCHEMIC HEART DISEASE WITH VENTRICULAR ARRHYTHMIAS
It is known that ventricular dysrhythmias in patients with ischemic heart diasease can be of various origin. Hence selection of antiarrhythmic tactics in such patients should be individual and pathogenetically proved.Aim. To check antiarrhythmic abilities of metabolic therapy for ischemic heart disease combined with variety of ventricular arrhythmias of III-IV grades (by Myerburg RJ).Material and methods. for 42 patients with ventricular arrhythmias of high grade and stable ischemic heart disease with saved ejection fraction of the left ventricle, before and after treatment were done the following: Holter monitoring, treadmill test, and as indicated — coronary arteriography, radionuclide methods of perfusion assessment and metabolism of myocardium, non-invasive topical diagnostics. To individually selected antianginal and antihypertension therapy for all patients was added ethylmethylhydroxypyridine succinate (es) in daily dosage 300 mg, for 2 months.Results. During the study, according to relationship of ventricular arrhythmia with transient ischemia, patients were selected to 2 groups. In the 1 group, with ischemic arrhythmias, in 2 months after start of es, there was significant antiarrhythmic effect: number of single ventricular premature beats decreased by 55%, couplets — by 90%, and episodes of non-sustained ventricular tachicardia — by 100%. At control positrone-emisson tomography in the areas of myocardial ischemia there was significant increase of 11C-buthirate sodium excretion, which witness on the increase of efficacy of energetic metabolism in zones of hypoxia. In the II group, with non-ischemic ventricular arrhythmias — antiarrhythmic effect was not achieved. Conclusion. es should be regarded as pathogenetic chain in complex antiarrhythmic treatment of ventricular arrhythmias in patients with stable ischemic heart disease
Ventricular Tachycardia Induced by Exercise Test as a Predictor of Coronary Artery Disease Development
A long-term clinical observation of the patient with ventricular tachycardia induced by exercise test but without myocardial ischemia and coronary artery atherosclerosis based on the results of angiography in the debut of the disease is described. However, arrhythmia reproducibility during stress tests, positive drug tests with nitroglycerin and beta-blocker, results of cardiac positron emission tomography with fatty acids revealed the ischemic genesis of arrhythmias, which was indirectly confirmed by a positive antiarrhythmic effect of the therapy with a metabolic drug (treatment with a beta-blocker was impossible because there was a sinus block). Coronary angiography was performed again after 7 years during the recurrence of ventricular arrhythmia with unstable angina. Stenosis of the left anterior descending artery was revealed. The antiarrhythmic effect of myocardial revascularization was continuously positive. Therefore, ventricular tachycardia induced by exercise test in patients with risk factors even in the absence of clinical and electrocardiographic criteria for myocardial ischemia could be an early debut of coronary artery disease