QTC INTERVAL DURATION CLASS AND DRUG THERAPY OF PATIENCE IN A FIRST YEAR AFTER PACEMAKER IMPLANTATION

49 patients (28 female, 21 male) with implanted DDD/DDDR, VVI/VVIR and CRT pacemakers are investigated. Purpose frequency and dose rate of anticoagulants, antiplatelet agents, direct thrombin inhibitors, cardiac glycosides, amiodarone; ivabradine, diuretics, aldosterone antagonists, beta-adrenergic blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), statins were evaluated before, in acute postoperative period (3–5 days), 6 months and 1 year after pacemaker implantation. Patients were divided into classes 1 (normal QTc (320–440 ms)) – 24 (49 %) patients) and 2 (long QTc (> 440 msec)) – 25 (51 %) patients) of QTc interval duration. To process the data using standard statistical procedures using Microsoft Excel. It was more often prescriptions of new anticoagulants, beta-adrenergic blockers, ARBs, statins to patients in the first year after pacemaker implantation. QTc interval duration lengthening was associated with a greater purpose frequency and doses of amiodarone, diuretics, beta-adrenergic blockers, ACE inhibitors, ARBs and statins. Patients with implanted pacemaker need individualized drug therapy according to QTc interval duration, in particular, enhancing antiischemic, antihypertensive, antiarrhythmic therapy and therapy of chronic heart failure in patients with QTc interval duration lengthening

THE PROPORTION OF PATIENTS WITH HYPERTENSION IN THE GROUPS OF TERMS PROLONGED QTc INTERVALS PER DAY DATA OF AMBULATORY ECG MONITORING IN DEPENDENCE FROM CLINICAL SIGNS

The study of the proportion of patients in 82 patients with hypertension in groups of different periods of prolonged QTc per day was performed based on the data of the AM of the ECG, depending on the clinical signs. Depending on the duration of prolonged QTc per day, the patients were assigned to one of three groups: group 1 – the term extended by day of the interval QTc from 0 to 33.3 %, group 2 – from 33.4 to 66.6 %, group 3 – from 66.6 to 100 %. The proportion of patients with hypertension was determined in the groups of the prolonged QTc interval depending on age, sex, weight of patients, type of circadian heart rate index, stage, degree and prescription of EH, presence of coronary heart disease, FC and stage of CHF and diabetes mellitus. According to the AM ECG, an prolonged QTc interval occurs in each patient with hypertension, with an increase of 0 to 33.3 % per day, it is detected in 76 %, from 33.4 to 66.6 % – in 16 % and with 66.7 to 100 % – in 8 % of patients. The existence of a prolonged QTc interval in each patient indicates that in its analysis it is necessary to base on the data of the AM of the ECG taking into account, except for the elongation and lengthening for a day

INFLUENCE OF THE TOTAL POWER OF THE HEART RATE VARIABILITY SPECTRUM ON THE SPECTRAL PARAMETERS DISTRIBUTION IN PATIENTS WITH ARTERIAL HYPERTENSION IN A PACED BREATHING TEST

To determine the effect of the total power (TP) of the heart rate variability (HRV) spectrum on the distribution of high, low and very low frequency waves, 40 patients with arterial hypertension (AH) at the age of 58 ± 9 years were divided into 5 groups according to the degree of TP decrease in the initial stage of the test: 1st – more than 3000 ms2; 2nd – 3000–2000 ms2; 3rd – 2000-1000 ms2; 4th – 1000–500 ms2; 5th – less than 500 ms2. To assess HRV parameters in each group, 3 stages of the paced breathing test with a double (light and sound) metronome were evaluated; the hardware and software complex «Cardiolab» («HAI-Medica») was used. The distribution of the parameters was estimated taking into account the median, 25 and 75 quartiles. To estimate the differences between the statistical samples, the nonparametric Mann-Whitney U-test was used, as well as the Craskell–Wallis criterion. Statistically significant differences were considered between the data at a value of p < 0.05. It was found that the greater is the degree of TP reduction, the more significant is the autonomic imbalance, as well as the decrease in the influence of paced breathing on the regulation of the heart rhythm; at TP values below 1000 ms2 not only the parasympathetic component decrease is observed, but also the transition from sympathicotonia to the neurohumoral factors prevalence

DINAMICS OF BLOOD PRESSURE AND HEART RATE VARIABILITY PARAMETERS DURING BIOFEEDBACK IN LOOP OF HEART RATE VARIABILITY AND PACED BREATHING IN PATIENTS WITH DIFFICULT-TO-CONTROL ARTERIAL HYPERTENSION ON THE BACKGROUND OF DRUG

60 patients with difficult-to-control arterial hypertension (DTCAH) were examined (average age is 59.0 ± 9.4 years). The changes in blood pressure (BP) and parameters of heart rate variability (HRV) during biofeedback sessions (BFB) in loop of paced breathing (PB) in patients with DTCAH on the background of standard drug therapy were assessed. It has been established that the systematic sessions of BFB in loop of PB in patients with DTCAH allow to increase the total power of the HRV spectrum, VLF and HF, and also improve control of BP. BFB in loop of PB can be recommended as an adjunctive method to the standard drug therapy for patients with DTCAH

SIGNIFICANCE OF SYSTOLIC AND DIASTOLIC BLOOD PRESSURE DAILY PROFILE TYPES IN CLINICAL EVALUATION OF HYPERTENSIVE PATIENTS

The characteristics of the arterial hypertension (AH) clinical signs according to the types of diastolic blood pressure (DPB) daily profile in comparison with systolic blood pressure (SBP) daily profile types in 82 patients (33 men and 49 women), mean aged 56 ± 11 years, were studied. Statistical analysis was performed on a PC using the «Microsoft Office Excel 2010» and «STATISTICA» programs. It was found that DPB is as important as SPB hemodynamic parameter in patients with AH, and violation of its circadian rhythm leads to AH potentiating. To higher risk of DBP pathological daily profile types prone females, patients with a short history and the initial stages of AH. Evaluation of DBP daily profile carries additional information about the course of the disease and should be performed in all patients with AH

OUTCOMES OF ARTERIAL HYPERTENSION IN PATIENTS WITH DIFFERENT TYPES OF SYSTOLIC BLOOD PRESSURE ORTHOSTATIC REACTIONS

Peculiarities of currency and outcomes in arterial hypertension (AH) patients with hypotensive, isotensive and hypertensive orthostatic reactions (OR) of systolic arterial blood pressure (SBP) were studied in the follow up of 113 AH patients, age 64,73 ± 6,42 years (44 males and 69 females). According to the SBP in orthostatic test patients were divided into 3 groups: group 1 – hypotensive OR, group 2 – isotensive OR and group 3 – hypertensive OR. AH grades and stages frequencies, HF functional class after 4 years of treatment, and the severity and frequency of adverse cardiovascular events and outcomes were identified. Data was processed by the variation statistics methods. It was found that the less severe currency of AH is seen in hypertensive type, more severe in hypotensive type, and the most severe in isotensive type of SBP orthostatic reactions. In general quantity of adverse events and outcomes is more frequently seen in isotensive type of SBP OR – 46 %, is less frequently seen in hypertensive type – 18 %. In AH patients it is necessary to pay special attention not only to the BP control, but also to the optimization of SBP orthostatic reactions

CLINICAL CHARACTERISTICS OF THE TYPES OF DAILY BLOOD PRESSURE PROFILES IN PATIENTS WITH ARTERIAL HYPERTENSION DEPENDING ON THE SELECTED ABPM INDEX

The frequency characteristics of the clinical signs of arterial hypertension (AH) according to the daily profile type of systolic (SBP), diastolic (DBP) and pulse (PP) blood pressure were studied. The data showed a significant difference in the frequency of occurrence of AH clinical signs, depending on the type of daily profile of SBP, DBP, and PP. It was concluded that in patients with AH determination only SBP daily profile of is not enough, it's necessary to take into account the types of DBP and PP daily profiles also

CHANGING OF THE DOSE COEFFICIENT OF THE MAJOR GROUPS OF DRUGS FOR PATIENTS WITH IMPLANTED PACEMAKERS, DEPENDING ON THE STAGE OF HYPERTENSION

We observed 131 patients (70 men and 61 women) aged 69,5 ± 11,6 at the annual stage of drug therapy after implantation of pacemakers in the DDD / DDDR modes, VVI / VVIR and CRT-P / CRT-D. Patients were divided into 2 groups – I and II stage of AH. . In each group, the dose rate was defined in major groups of cardiac drugs at every stage of research. The results showed that the dose coefficient of the major groups of cardiac drugs in patients with pacemaker and AH was determined by the stage of AH, what is more AH stage III required higher doses of diuretics and anti-arrhythmic drugs than AH stage II during the hole period of observation. Patients with implanted pacemaker and AH require more careful titration of the major groups of cardiac drugs, taking into account the stage of AH

DYNAMIC CHANGES IN SPECTRAL HEART RATE VARIABILITY PARAMETERS IN PACED BREATHING TEST IN PATIENT WITH UNCONTROLLED ARTERIAL HYPERTENSION AND POLYMORBIDITY

A clinical case of a patient with uncontrolled hypertension and polymorbidity. The paced breathing test was made, was found prevalence of low frequency influences at the initial stage and its intensification at the resting stage, growth of the total power of heart rate variability spectrum (TP) with respiratory modulation. The course of the disease worsened the appearance of new-onset atrial fibrillation (registered paroxysm on Holter monitoring); the general deterioration of the patient’s state reflected HRV changes on sinus rhythm tracing - significantly reduced TP growth in response to paced breathing, an increase in LF/HF (ratio of low frequency to high frequency waves), as well as switching to the neurohormonal level of heart rate regulation at the resting stage. After the treatment the growth of TP in response to the test has increased and LF/HF level has decreased

CLINICAL CASE OF GENERAL SOMATIC COMPLAINTS IN 47 Y.O. FEMALE

A clinical case of general somatic complaints in 47 y.o. female, presenting for several years has described. Patient F., presents with uncertain complaints of general character – tiredness, general weakness, loss of energy. During the biennium was examined and treated by gynecologist, endocrinologist, cardiologist, gastroenterologist with no benefit. Anamnesis vita is significant for uterine fibroid. After thorough interviewing was found that patient was done ECG, EchoCG, gastroscopy, thyroid tests but no CBC, urinalysis, general biochemical panel during this two years. The CBC results were stunning and gave answers to all questions