ФАКТОРЫ, АССОЦИИРОВАННЫЕ С ПОЗДНИМ ОБРАЩЕНИЕМ ЗА МЕДИЦИНСКОЙ ПОМОЩЬЮ ПРИ ИНФАРКТЕ МИОКАРДА

Purpose. To assess factors associated with pre-hospital delay in seeking medical care in patients with myocardial infarction.Materials and Methods: 51 patients with myocardial infarction, included in the original single-center research trial, were surveyed to assess the differences in the time intervals from the onset of symptoms to the decision to seek medical care, as well as the factors, associated with delay in calling emergency medical service.Results. We found that the majority of patients (> 70%) with myocardial infarction, admitted to the Kemerovo Regional Clinical Cardiology Dispensary, applied for medical care within 6 hours from the onset of symptoms. However, there was a group of patients with increased pre-hospital delay time. Patient delay may affect the effectiveness of treatment for acute coronary syndrome. These patients were commonly of younger age and males, with higher education working in the urban areas. Information campaigns targeted at this group of patients should be launched to raise their awareness and highlight the crucial role of prompt and timely calling EMS after the onset of myocardial infarction.Conclusion. It seems to be a rationale to launch informational campaigns targeting this group of patients (young working men living in large industrial cities) to highlight the importance of early and prompt seeking of medical care after the onset of MI symptoms. Цель исследования. Оценка факторов, связанных с поздним обращением пациентов за медицинской помощью при инфаркте миокарда.Материалы и методы. В оригинальном одноцентровом исследовании на основании анКэттирования 51 пациента с инфарктом миокарда оценены различия временных характеристик обращения за медицинской помощью при развитии заболевания, а также факторы, вероятно связанные с поздним вызовом неотложной помощи.Результаты. Выяснено, что большинство пациентов (>70%) с инфарктом миокарда, поступившие в Кемеровский областной клинический кардиологический диспансер, обращаются за медицинской помощью до 6 часов от начала заболевания. Однако сохраняется группа пациентов, которые «затягивают» время до обращения за помощью, что может значимо влиять на эффективность лечения острого коронарного синдрома. Эти пациенты чаще мужского пола, более молодого возраста, с высшим образованием, работающие в городе.Выводы. среди молодых работающих пациентов мужского пола, проживающих в крупных промышленных центрах, необходимо проводить больший объем разъяснительных информационных мероприятий, направленных на повышение знаний о значимости раннего обращения за медицинской помощью при появлении признаков инфаркта миокарда.

CHANGES OF CARDIOVASCULAR STABILITY IN CORONARY PATIENTS AND HEALTHY CONTROLS OVER AN INDIVIDUAL YEAR

To determine the influence of an individual year cycle (IYC) lasting from one birthday to another, on the clinical, laboratory and physiological values, we have studies case histories of 330 men with acute coronary pathology and also examined 146 men with Coronary Heart Disease admitted for CABG. 35 almost healthy young men were also examined during a year in different seasons.We have found out that the number of patients developing MI in the XII month of the IYC, was reliably higher that the value for IV-VI months and almost twice as high as the number for the VI month. The severity of MI developing in the XII and I months of the IYC surpassed such in MI developing in other periods of the IYC. In the IV trimester of the IYC (X-XII months) the patients showed a relatively low number of T-cells, the highest cortisol concentration in the saliva, in the III and IV months – T-supressors; in the IV trimester coronary patients showed much less thyroxin, tri-iodothyronin and cortisol than in the I trimester. Blood values in the II trimester of the IYC were consistent with a better prognosis.Healthy young men showed stressed adaptation mechanisms in the IV trimester of the IYC: increased personal alertness (the index of regulatory systems stressing was calculated from a mathematical analysis of heart rate), higher incidence of hypertension, decreased ability to work and immunity. The values in the II trimester were more favorable.The data enable us to draw a conclusion about the universal nature of IYC changes of adaptive parameters of cardiovascular and endocrine systems, which is crucial for preventive cardiology