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Esahanov Shukhrat Normahmadovich, Scientific Applicant of Samarkand Medical Institute,
Uzbekistan Melieva Manzura Atabaevna, Associate professor, of the Pediatric Department of Samarkand Medical Institute, Uzbekistan Rustamova Gulnoza Rustamovna, Assistant, of the Pediatric Department of Samarkand Medical Institute, Uzbekistan E-mail: [email protected] Mamatkulova Dilrabo Hamidovna, PhD., Assistant, of the Pediatric Department of Samarkand Medical Institute, Uzbekistan Turaeva Nafisa Omonovna, Assistant, of the Pediatric Department of Samarkand Medical Institute, Uzbekistan E-mail: [email protected]
CARDIOVASCULAR CHANGES OF VEGETATIVE DYSTONY SYNDROME IN CHILDREN OF 11-15 YEARS ON THE BACKGROUND OF IODINE DEFICIENCY
Abstract: The features of cardiovascular changes in the syndrome of vegetative dystonia in children aged 11-15 years on the background of iodine deficiency. The study included 65 children with VDS with confirmed iodine deficiency, who made up the I-group and 55 children with VDS of the same age who did not have iodine deficiency symptoms (group II) at the time of observation. It was revealed that the symptoms of vagotonia prevailed in the children of the VDS in both groups, and to a greater extent in patients of the I-group who were characterized by severe clinical manifestations, various and profound changes in ECG and EchoCG, which can be explained by insufficient vegetative response and maintenance, adaptive reactions in such patients.
Keywords: cardiovascular changes, vegetative dysfunction, thyroid gland.
Syndrome of vegetative dystonia has a large specific and mental development of the child's organism, con-gravity in the structure of childhood diseases. Manifes- tributes to the development of vegetative disorders of tations of the syndrome in 33,3% of children persist in generalized nature. Disorders of changes in the cardio-subsequent periods of life, and in 17-20% of cases they vascular system is the most common form of vegetative progress, transforming into diseases such as ischemic dystonia in children and adolescents [3; 6]. According heart disease, hypo- and hypertonic disease, arterioscle- to Yu. F. Antropov [1] vegetative-dystonic cardiovascular rosis of the vessels, cerebrovascular diseases, and aggra- disorders occur relatively late, usually on the background vate their course [2]. of pubertal rearrangement of the organism [1].
The thyroid gland (TG) is one of the most impor- Vegetative dysfunction in VDS can be manifested
tant organs of human internal secretion [4]. Lack of locally in various heart structures - in the myocardium, thyroid hormones significantly slows down the growth which leads to disturbances in the repolarization process,
or in the conductive system of the heart, resulting in disturbances in rhythm and conductivity [4; 7]. Among the signs of cardiac syndrome of VDS in children, the latter occupy a leading place [5]. The chronic tachyarrhythmia and bradyarrhythmia characteristic ofVDS are the cause of early disability and are often associated with a risk of sudden cardiac death [6; 8].
In general, the above data indicate the need to study VDS in children on the background of iodine deficiency in a broader context
Purpose of the research. To study the features of cardiovascular changes in the syndrome of vegetative dystonia in children aged 11-15 years on the background of iodine deficiency.
Material and methods. In order to study the clinical and instrumental indices in children aged 11-15 years with VDS on the background of iodine deficiency, we examined 65 patients with VDS aged 11-15 years with confirmed iodine deficiency, which formed the main group and 55 children with VDS of the same age, who do not have iodine deficiency symptoms at the time of observation (control group).
Results of the research and their discussion. The predominance of vagotonia was indicated by complaints of increased sweating in 33 (50.8%) and 19 (34.5%) (herein and after: in patients of the I and II groups. respectively); chilliness - in 32 (49.2%) and 18 (32.7%); pain in the legs - in 30 (46.2%) and 13 (23.6%); cardialgia -in 38 (58.5%) and 19 (34.5%); nausea - in 33 (50.8%) and 21 (38.2%); vomiting - in 7 (10.8%) and 2 (3.6%); periodical abdominal pain - in 26 (40%) and 17 (30.9%) patients. These patients had such subjective sensations as intolerance to stuffy rooms - in 41 (63.1%) and 22 (40%); a feeling of tightness in the chest and a lack of air - in 34 (52.3%) and 20 (36.4%) patients. Fainting occurred in 12(18.5%) and 5 (9.1%). headaches in 15 (23.1%) and 9 (16.4%). dizziness in 19 (29.2%) and 9 (16.4%) patients. Characteristic signs were: a decrease in physical activity in 41 (63.1%) and 25 (45.5%) and increased drowsiness in 33 (50.8%) and 20 (36.4%) of examined patients.
Table 1.- Cardiac changes in subjects
The predominance of sympathicotonia was manifested by cold extremities in 17 (26.2%) and 12 (21.8%); chilling like hyperkinesis - in 17 (26.2%) and 8 (14.5%); palpitations - in 14 (21.5%) and 12 (21.8%) patients. For patients with a predominant influence of the sympathetic nervous system. headaches were also common - in 10 (15.4%) and 12 (21.8%); mood variability - in 13 (20%) and 14 (25.5%); absentmindness and fast distraction - in 14 (21.5%) and 12 (21.8%): poor sleep - in 15 (23.1%) and 15 (23.1%) patients.
As can be seen from the characteristics of these complaints among the patients ofboth groups, the vagotonics prevailed, and this was manifested more significantly in the main group.
A large number of changes we have identified from the cardiovascular system. Thus, the widening of the heart borders to the left was noted in 5 (7.7%) of the patients of the main and 3 (5.5%) of the control group. The muting of tones was heard in 55 (84.6%) and 37 (67.3%), on the contrary, loud tones - in 5 (7.7%) and 7 (12.7%) patients. A common symptom is systolic murmur of a functional nature at the apex and at the Botkin point in 45 (69.2%) and 34 (61.8%) of the examined patients. The revealed auscultatory disturbances of a rhythm were noted in the majority of patients of the basic group. In this case, tachycardia was observed in 20 (30.8%), and bradycardia in 30 (46.2%). In the control group, these arrhythmias were detected somewhat less frequently, respectively: 16 (29.1%) and 14 (25.5%). Arterial pressure, as was to be expected in patients with SVD, was unstable, and in both groups there was a tendency to hypotension: 29 (44.6%) and 20 (36.4%). The tendency to increase of blood pressure was observed in 8 (12.3%) of the patients in the main and in 12 (21.8%) - in the control group.
In general, a detailed study of complaints and data from objective research showed that in children with VDS in both groups, the symptoms of vagotonia predominate, and in a greater degree in patients of the main group. All our patients underwent an ECG study. The data of this study are given in (Table 1).
with SVD according to standard ECG
№ ECG changes I group II group
1 2 3 4
1. Sinus tachycardia 21 (32.3%) 16 (29.1%)
2. Sinus bradycardia 27 (41.5%) 17 (30.9%)
1 2 3 4
3. Sinus arrhythmia 61 (93.8%) 40 (72.7%)
4. Migration of the pacemaker 9 (13.8%) 2 (3.6%)
5. Syndrome of weakness of the sinus node 4 (6.2%) -
6. Supraventricular extrasystole 3 (4.6%) 2 (3.6%)
7. Ventricular extrasystole 6 (9.2%) 5 (9.1%)
8. Paroxysmal tachycardia 1 (1.5%) 2 (3.6%)
9. Atrioventricular blockade of the I degree 2 (3.1%) 2 (3.6%)
10. Intra-atrial blockade 3 (4.6%) -
11. Blockade of the right crus His bundle 9 (13.8%) 4 (7.3%)
12. Blockade of the left crus of His bundle 3 (4.6%) 1 (1.8%)
13. Syndrome of premature ventricular excitability 1 (1.5%) 2 (3.6%)
14. WPW- syndrome 2 (3.1%) -
Changing the rhythm of the heart is the most labile and easily recorded reaction of the body in response to any effect, therefore ECG changes were observed by us in all patients. Disturbance of the function of automatism in the form of sinus tachy-, bradycardia, and arrhythmia occurred in the majority of patients in both groups. However, there were some differences. Thus, in patients of the main group, sinus tachycardia was observed more rarely and - bradycardia more often. Sinus arrhythmia is probably characteristic of patients with VDS, but it was also more often revealed in patients of the main group. Such changes as migration of the pacemaker were 2 times more often on the electrocardiogram of patients of the I-st group, we did not register the syndrome of weakness of the sinus node at all in the control group.
Approximately the same disturbances of excitability were observed, these were, in the first place, extrasystoles, which, in general, were infrequent in both groups. Attention is drawn to the more frequent occurrence of conduction disorders in patients with iodine deficiency. Thus, in the main group, compared with the control group we noted signs of an incomplete blockade of the right crus of the his bundle and the branches of the left leg 2 times more often. Although disturbances of intra - atrial conduction were revealed in both groups, clear signs ofintracirculatory blockade - only in the I-st group. Finally, more often in children with VDS, iodine deficiency was accompanied by metabolic changes in the ventricular myocardium (in the form of a high, pointed T wave), increased electric systole (QT interval), supraventricular crest syndrome.
Summarizing the results of the ECG study, we can conclude that there are various changes in the electrocardiogram of patients with VDS in children. In patients of the I-st group, ECG features can be considered as more frequent discovery of respiratory arrhythmia, bradycardia, various blockades and other abnormalities, which are predominantly determined by vagotonic influences.
All patients with VDS underwent an EchoCG study. We revealed a significant (P < 0.05) increase in Dd in patients of both groups, but in the main group this index exceeded not only the parameters of healthy children, but also the control group indices (P < 0.001). In the main group, we noted a significant excess ofAc as well (P < 0.05) (Table 2). The increase in the diastolic and systolic dimensions of the left ventricle, most likely, can be explained by a decrease in the tone ofthe myocardium, which under conditions of overload could lead to dilatation of its cavity. We did not notice significant differences between such indicators of the main and control groups with healthy children, as thickness of posterior wall of left ventricle, diameter of the right ventricle (P > 0.1).
Particular attention was paid to the state of systolic function of the left ventricle. Systolic function of the left ventricle was evaluated according to the following indices: Vs, Vd, Impact volume (IV), Fractional index (FI). Evaluation of these indicators in the main and control groups showed that their mean values also did not differ significantly from the standards. However, in-depth analysis within each of the groups revealed heterogeneity of values in dependence not only on the type of VDS, but also on the severity of its manifestations. Thus, in
the control group, in 12 (21.8%) patients with sympathicotonic type of VDS, the mean values of Vs, Vd, IV, and FI were significantly (P < 0.05) higher than those of healthy patients, the other patients of this group did not differ from these ones (P > 0.1). In the main group, the situation was even more complicated. We also noted a significant (P <0.05) high values of Vs, Vd, IV, FI in 10 (15.4%) patients with sympathicotonia, and in 15 (23.1%) with vagotonia accompanied by distinct bradycardia. Strengthening of the pumping function under
vagotonia can be regarded as a compensatory reaction, in the implementation of which bradycardia plays a role, contributing to an increase in the time of diastolic filling [33]. In 10 (15.4%) patients of the primary and 10 (18.2%) children of the control group with sympathicotonia, hyperkinesia of the left ventricular wall was noted. In 12 (18,5%) patients of the main group with vagotonia, with thyroid function deficiency, and in 2 (3.6%) examined patients from a control group with a similar vegetative status, hypokinesia of the walls was revealed.
Table 2.- Echocardiography dimensions of the heart in healthy children and those in with VDS (M ± m)
EchoCG indices Healthy children n = 25 The I group n = 65 The II group n = 55
Diastolic diameter mm 40.4 ± 0.51 42.3 ± 0.56 * 39.0 ± 0.45* **
Systolic diameter mm 26.1 ± 0.53 23.8 ± 0.55 25.0 ± 0.49
Thickness of posterior wall of left ventricle mm 7.0 ± 0.35 6.3 ± 0.29 7.2 ± 0.32
Diameter of the right ventricle mm 10.3 ± 0.30 9.5 ± 0.43 9.6 ± 0.37
*- Reliability of indices of the main group. (P < 0.05). **-
Summarizing the results of the EchoCG survey, it can be concluded that the changes in echocardiography are more dependent on the initial type of vegetative status and the degree of its severity and are due to the adaptation of CCC in conditions ofvegetative dysregulation.
Conclusions.Thus, the study of clinical and instrumental indices in children aged 11-15 with VDS showed
Reliability of indices of the control group(P < 0.001)
the advantage of the vagotonic type of the initial vegetative tone in both groups. The difference in VDS in children on the iodine deficiency can be considered as more severe clinical manifestations, various and profound changes in ECG and EchoCG, which can be explained by insufficient vegetative response and maintenance, as a result of the disturbance of adaptive reactions in such patients.
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