Arrhythmic Mitral Valve Prolapse: New Menaces of the Known Disease

Mitral  valve prolapse  (MVP) has  long  been  the subject  of intense  discussions regarding the prognosis and  follow-up tactics.  In most  cases,  this condition has a benign prognosis. However, recent autopsy and follow-up studies have shown risks of developing  sudden cardiac death (SCD) in some subgroups of patients who have this clinical phenomenon. The proposed  literature review uses the population  of patients with MVP with the highest probability  of developing  life-threatening ventricular tachyarrhythmias. Patients with the presence of a complex  of changes, including  bicuspid  MVP, negative T waves in the inferior and lateral leads on a standard  12-lead electrocardiogram (ECG), and a special anatomical  phenomenon called mitral annular  disjunction  (MAD), are at high  risk of developing  ventricular  ectopias  and VSS.  A reflection  of the high  risk of SCD  in such patients  is the increase of ventricular ectopy according to Holter monitoring. The presence of a bicuspid  MVP and the MAD  phenomenon, which is a separation  of the line of attachment  of the posterior mitral leaflet from the basal inferior wall segment  towards  the atrial wall, determines the presence of a special form of MVP,  the so-called  arrhythmogenic MVP.  Hence,  in most cases MVP has a benign  prognosis. However, patients with the aforementioned ar- rhythmic  MVP  signs  must  be given  particular  attention  and  annual  follow-up including  ECG  control,  Holter  monitoring and  echocardiographic examination of the heart to reduce the risk of ventricular tachyarrhythmias and SCD development

SAFETY OF AMIODARONE USAGE IN PATIENTS WITH WOLFF-PARKINSON-WHITE SYNDROME AND ATRIAL FIBRILLATION

Amiodarone is one of the basic antiarrhytmic drugs for atrial fibrillation treatment. However application of amiodarone in patients with atrial fibrillation and Wolff-Parkinson-White syndrome can induce ventricular fibrillation. Amiodarone usage in these patients should be accompanied by readiness for performance of resuscitation. This is confirmed by clinical case presentation

PROGNOSTIC VALUE OF PATHOLOGIC Q-WAVE AND TIME OF ITS APPEARANCE IN PATIENTS WITH MYOCARDIAL INFARCTION: COMPARISON STUDY

Aim. To evaluate short- and long-term prognosis of myocardial infarction (MI) depending on occurrence of pathologic Q-wave on ECG and time of its appearance.Material and methods. 616 patients with initial ST-elevated MI were included into the study — 254 women and 362 men, aged 62.1±11.2. All patients were split up three groups depending on occurrence of pathologic Q-wave on ECG and time of its appearance. First group consisted of 311 patients with early Q-wave (during first 6 hours from onset of MI symptoms). Second group consisted of 120 patients with late Q-wave (from 6 to 24 hours from onset of MI symptoms). Third group consisted of 185 patients with non-Q-wave MI.Results. The hospital lethality in the patients with early Q-wave was significantly higher than this in patients of the second and the third groups. However, we didn’t reveal significant differences between patients with late Q-wave and patients without Q-wave on ECG. The incidences of cardiac death (sudden death and fatal MI), non-fatal MI and hospitalization because of unstable angina was assessed during next two years. During the follow-up period patients of three groups had similar incidences of the non-fatal MI and hospitalization because of unstable angina. However, incidence of cardiac death was significantly higher in early Q-wave group in comparison with non-Q-wave group.Conclusion. Occurrence of pathologic Q-wave on ECG and time of its appearance should be taken into account to assessed short- and long-term prognosis of MI

THE PREVALENCE AND CLINICAL SIGNIFICANCE OF CARDIAC ARRHYTHMIAS

Arrhythmias are one of the most complex, insufficiently studied, and therefore one of the most urgent problems of modern cardiology. A wide spectrum of clinical manifestations of cardiac rhythm disorders (CRDs), their detection both in various diseases and in healthy people, necessitate the study of their prevalence in populations. In the majority of conducted epidemiological studies a single recording of electrocardiogram (ECG) was used. This is the most usable method for examination of large populations but a little informative for detecting arrhythmias. The small frequency of CRDs detected during ECG recording is due to the short duration of its registration. An increase in the duration of ECG recording (ECG recording for 2 minutes, continuous recording of 100 cardiocycles) leads to an increase in arrhythmias frequency. With a wide introduction in the practice of ECG monitoring by Holter as well as the use of individual recorders of electrocardiogram ("handheld ECG recording") data appeared indicating a much higher frequency of CRDs. Data obtained in numerous studies on the prevalence of arrhythmias are very contradictory and depend both on the characteristics of populations and on methodological approaches, which requires further epidemiological studies. At the same time, the main initiating point of such researches is the clinical significance of certain CRDs. However, if the clinical significance of ventricular tachyarrhythmias and atrial fibrillation does not currently cause any doubt, the clinical significance of extrasystoles is highly controversial, despite the high their prevalence, including this in prognostically unfavorable groups of patients. In recent years, the results of a number of studies have been published that allow to think about the adverse effects of both supraventricular and ventricular extrasystoles of the course of certain cardiovascular diseases. Very heterogeneous results of the performed studies, as well as data about the high clinical significance of individual CRDs, make further epidemiological studies in this field extremely urgent

THE PREVALENCE AND CLINICAL SIGNIFICANCE OF CARDIAC ARRHYTHMIAS

Arrhythmias are one of the most complex, insufficiently studied, and therefore one of the most urgent problems of modern cardiology. A wide spectrum of clinical manifestations of cardiac rhythm disorders (CRDs), their detection both in various diseases and in healthy people, necessitate the study of their prevalence in populations. In the majority of conducted epidemiological studies a single recording of electrocardiogram (ECG) was used. This is the most usable method for examination of large populations but a little informative for detecting arrhythmias. The small frequency of CRDs detected during ECG recording is due to the short duration of its registration. An increase in the duration of ECG recording (ECG recording for 2 minutes, continuous recording of 100 cardiocycles) leads to an increase in arrhythmias frequency. With a wide introduction in the practice of ECG monitoring by Holter as well as the use of individual recorders of electrocardiogram ("handheld ECG recording") data appeared indicating a much higher frequency of CRDs. Data obtained in numerous studies on the prevalence of arrhythmias are very contradictory and depend both on the characteristics of populations and on methodological approaches, which requires further epidemiological studies. At the same time, the main initiating point of such researches is the clinical significance of certain CRDs. However, if the clinical significance of ventricular tachyarrhythmias and atrial fibrillation does not currently cause any doubt, the clinical significance of extrasystoles is highly controversial, despite the high their prevalence, including this in prognostically unfavorable groups of patients. In recent years, the results of a number of studies have been published that allow to think about the adverse effects of both supraventricular and ventricular extrasystoles of the course of certain cardiovascular diseases. Very heterogeneous results of the performed studies, as well as data about the high clinical significance of individual CRDs, make further epidemiological studies in this field extremely urgent

LEFT ATRIAL FUNCTION: MODERN ASSESSMENT METHODS AND CLINICAL SIGNIFICANCE

Assessment of the left atrial (LA) function is important aspect of comprehensive cardiovascular system estimation. Many cardiac diseases make an impact to LA work either by direct affect on myocardium or hemodynamic condition changing. It is considered, LA and left ventricle diastolic pressure is interrelated, thus without mitral valve disease LA expanding is a sign of LV filling pressure augmentation. Examination of LA size and function by analysis of atrial reservoir, conduit, and booster pump can predict cardiovascular outcomes in patients with cardiomyopathy, ischemic heart disease and valvular heart disease. The last two decades gave new technologies to accurate and comprehensive LA mechanics estimation, in the first place related to tissue Doppler imaging. Atrial strain and strain rate obtained using two-dimensional speckle-tracking echocardiography have proved to be feasible and reproducible techniques to evaluate LA mechanics.In physiological settings, LA is a highly expandable chamber with relatively low pressures. However in the presence of acute and chronic injury, LA wall stretches. LA stretching is a hallmark of structure changing with myocardial fibrosis and has influence on LA strain and strain rate. LA strain estimation could be useful in the prediction of sinus rhythm restoration and maintenance after cardioversion and catheter ablation. Low values of global longitudinal LA strain indicate irreversible LA remodeling and are related to the atrial fibrillation progression from paroxysmal to permanent forms. The most interesting in these circumstances is the potential contribution of echocardiography to thromboembolic risk stratification in atrial fibrillation and invasive procedures such as atrial ablation. Therefore, at present, the main task is to understand the ways of clinical application of data  obtained during the LA study

DIAGNOSTICS AND TREATMENT OF MITRAL VALVE PROLAPSE

The mitral valve prolapse (MVP) is one of the most inconsistent diagnose. In the most cases patients with MVP have the good long-term prognosis, and therapy is aimed at reduction in psychovegetative dysfunction. Careful follow-up and timely cardiosurgical correction should be performed, if necessary, in patients with classical MPV. The choice method in these cases is the mitral valve plasty