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МЕапиПНСКПЕ НАУКИ
COMORBID ANXIENTY AND DEPRESSIVE DISORDERS AT PATIENTS WITH ISCHEMIC HEART DISEASE WITH RHYTHM DISTURBANCES
Abdumalikova Feruza Bahtiyarovna Botaeva Nodira Oybekovna.
The assistant of chair of internal illnesses on training of general practitioners, the Tashkent medical academy,
Tashkent
ANNOTATION
Learning disorders psycho-emotional sphere is of great practical importance, since the presence and severity of anxiety and depressive disorders can be seen on coronary artery disease complicated by arrhythmias, predict prognosis. Given the urgency of the problem to assess the level of severity of depressive disorders in patients with stable angina, without cardiac rhythm and complicated ventricular arrhythmia (PVCs) or permanent atrial fibrillation (AF), examined 62 men aged 46 to 65 years (middle age 54,6 ± 10,5 years). According to the results of examination of patients with stable angina FCII-III, symptomatic alarming symptoms diagnosed in 31.1%, depression in 48% of patients, and the level of anxiety and depression is more pronounced in patients with class II PVCs by Lown or persistent AF.
ABSTRACT
Learning disorders psycho-emotional sphere is of great practical importance, since the presence and severity of anxiety and depressive disorders can be seen on coronary artery disease complicated by arrhythmias, predict prognosis. Given the urgency of the problem to assess the level of severity of depressive disorders in patients with stable angina, without cardiac rhythm and complicated ventricular arrhythmia (PVCs) or permanent atrial fibrillation (AF), examined 62 men aged 46 to 65 years (middle age 54,6 ± 10,5 years). According to the results of examination of patients with stable angina FC II-III, symptomatic alarming symptoms diagnosed in 31.1%, depression in 48% of patients, and the level of anxiety and depression is more pronounced in patients with class II PVCs by Lown or persistent AF.
Keywords: stable angina, ventricular arrhythmia, atrial fibrillation, anxiety and depressive disorders.
A lot of work in recent years, both domestic and foreign authors suggest the connection of anxiety and depression, followed by demonstrations stable CAD [514]. On the one hand, coronary artery disease can be stressful factor that provokes anxiety and depressive symptoms, on the other hand, anxiety and depression are associated with recurrent, persistent angina, cardiac arrhythmia, high incidence of coronary events [3,10,13]. The adverse impact of cardiac arrhythmias on the psychological state is directly proportional to how the patient feels subjectively painful cardiac arrhythmias. [2].
It should be noted that for the timely psychodiagnosis in somatic practice, in particular for adequate correction of affective disorders both with stable coronary artery disease and arrhythmias in complicated stable angina, it is important to determine the severity of psychogenic reactions in response to a variety of arrhythmias. [1]. The study of these aspects is important to optimize the treatment of patients with coronary artery disease purposeful violation of rhythm and improve their prognosis.
Due to the latter fact, the main purpose of our study is to assess the level of severity of anxiety and depression in patients with stable angina without cardiac arrhythmias and complicated ventricular arrhythmia or persistent atrial fibrillation.
Materials and methods
The study included 62 men aged from 48 to 67 years (middle age 57,6 ± 10,5 years) with a diagnosis of stable angina II-III FC. All of the patients, depending on the absence or presence of PVCs class II by Lown or
persistent AF, were divided into three groups. The first group consisted of 22 patients with stable angina without disturbance the rhythm, the 2nd group consisted of 21 patients was verified PVCs class II by Lown (more than 30 PVCs for 1 hour) and the third group consisted of 19 patients with persistent AF. Arterial hypertension was observed in 65.4% of patients, and heart failure in all patients with stable angina. Exclusion criteria was: a history of stroke, diabetes type I and II, the liver and kidney as well as malignant neoplasms.
Treatment of stable angina included the appointment of standard and antiarrhythmic drugs in patients with paroxysmal and persistent AF.
A certain level of mental and emotional status was carried out with the help of Hospital Anxiety and Depression Scale - hAdS (AS Zigmond) [12]. Questionnaire related to the subjective, is designed to identify and assess the severity of depression and anxiety in a general medical practice, has high discriminant validity in relation to the two disorders: anxiety and depression. The scale is composed of 14 claims, Serving 2 subscales. In the interpretation of the data is taken into account the total figure for each subscale (A and D), while the values of the area allocated 3: 0-7 points - the norm; 8-10 points - severe subclinical anxiety / depression; 11 points or more - symptomatic anxiety / depression. Benefits of scale are to ease of use and processing, which allows to recommend it for use in the somatic practice of primary revealing anxious depressive syndrome [6, 12].
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Statistical processing of the results was carried out by standard programs of analysis package (set of data analysis tools, "the Microsoft Corporation Exsel-2007") and using indicators of scientific and evidence-based medicine.
Results and Discussion
By analyzing the psycho-emotional state of patients based on the interpretation of the results on a scale of HADS, it was found that the presence of arrhythmias associated with various forms of clinically severe and subclinical anxiety and depressive symptoms. The manifestations of anxiety symptoms were found in 14 patients of the 1st group (63.6%), 15 patients in group 2 (71.4%) and 17 patients (89.4%) Group 3. Depressive disorders were more frequent in groups with PVCs class II by Lown or persistent AF: 17 patients (80.9%) in group 2, and 17 (88.4%), Group 3 (p <0.01) while the same were identified in 15 patients in the first group, which accounted for 68.1%. The absence of anxiety and / or depressive states was observed in 4 patients of the 1st group (18.1%), 2 patients (9.5%) in the 2 nd and 1 patient (5.2%) in the third group, that is, to a less extent in patients with persistent AF.
The importance of anxiety and depression as a predictor of cardiovascular events is more accented character in patients with cardiac arrhythmias. An important aspect is the selection of patients for the presence of clinical and subclinical levels of anxiety and depressive disorders, as often these affective disorders "masked" by somatic and autonomic symptoms, so that in most cases the pathology is not promptly diagnosed and treated. On closer questioning of the patient, using a methodology for assessing the psycho-emotional status, as a rule, it can be detected and the actual anxiety and depressive symptoms [6]. Several clinical studies have indicated that if the sub-clinical manifestations of anxiety-depressive syndrome can be evaluated on specific complaints of the patient, which is a subjective indication, clinical anxiety and depression contribute to the development of certain manifestations, objectively defined and directly affect the medical condition of the patient [11, 15] .
Clinical anxiety levels was detected in 8 (38.1%) patients with stable angina PVCs class II by Lown (average score was 13,2 ± 1,33), in 12 (63.1%) patients with persistent AF, with an average score of 12,9 ± 1,24, which was significantly higher than the 7 patients of the 1st group (32.3%), non-cardiac arrhythmias (12,4 ± 1,23 points) (p <0,01 ). Subclinical option alarm occurred in 13 (61.9%) patients in group 2 (average 9,1 ± 1,15), 7 (36.8%) patients of the 3rd group (average score of 9,21 ± 1 13), which was also significantly more (p <0,001), than in 9 patients (40.9%) of the 1st group (average score 8,5 ± 1,12).
Depression is one of the most studied psychological risk factors. A number of meta-analyzes and systematic reviews show that this affective disorder, even if it does not exceed the severity of subclinical threshold, not only reduce the quality of life of cardiac patients, but also significantly affects their prognosis [4].
The level of clinical depression was observed in 6 (37.5%) of 16 patients without stable angina arrhythmias (mean 12.5 ± 1.24 points), subclinical depression in 10
(62.5%) patients (middle ± 8,1 1.15 points), while in the second group of clinical symptoms of depression were observed in 7 (38.8%) of 18 patients (mean 13.7 ± 1,31ballov) subclinical depression in 11 (61.1%) (on average 9,0 ± 1,15 points). The third group of clinical depression was diagnosed in 11 (64.7%) of 17 patients (average 13,9 ± 1,32 points), subclinical - in 6 (35.3%) patients (average score 9,5 ± 1.13), which was significantly higher than in patients without cardiac arrhythmias (p <0,01).
Thus, 23.3% of patients with the presence of PVCs class II by Lown and 28.4% of patients with persistent AF is amplified level of clinical anxiety by 8.3%, depressed by 9.7% compared with patients non-cardiac arrhythmias, which is consistent with the opinion of other authors, points to the fact that the presence of anxiety and depression is an unfavorable prognostic factor in terms of CHD patients [4, 5, 6]. In the present study indicated that patients with stable angina II-III FC at 67.6% of the patients there are anxious and depressive disorders 78.4%, and a significant contribution to making available the clinical symptoms of AF, resulting in the disruption of mental activity, characterized neurotic behaviors, high internal stress, which in turn leads to a decrease in quality of patients’ life.
Conclusions
In patients with stable angina II-III FC clinically significant anxiety symptoms diagnosed in 29.8%, from 46.5% of depressive patients. The level of anxiety and depression is more pronounced in patients with cardiac arrhythmias, with subclinical levels of anxiety and depression prevailed in the presence of patients with stable angina ventricular arrhythmia Lown class II, while clinical data level of affective disorders prevailed in the permanent form of atrial fibrillation. Determining the level of severity of comorbid psychogenic reactions in response to heart rhythm disturbances and their influence on the course and prognosis of CHD data makes it possible to take into account the results of the development programs for the rehabilitation of patients, in particular for adequate correction of psycho-emotional disorders in cardiovascular disease.
Bibliography
1. Gadaev AG, Nurillaeva NM New prevention technologies in coronary heart disease in primary care at the present stage. Tashkent, 2011, pp 37-48.
2. Kurbanov RD, Khodzhaev AI, Salimov NR Diagnosis and treatment of neurotic rastrojstv in cardiology practice. Tashkent, 2001.S.52.
3. Krylov AA, Krylov GS Arrhythmias and cardiac conduction abnormalities from the standpoint of psychosomatic medicine and psychotherapy // Clinical Medicine. - 2001. - № 2. - S.47-49.
4. Boris Mikhailov The problem of depression in somatic practice //
Intern. honey. Zh. - 2003 - T. 9, № 3. - S. 22-27.
5. Mosolov SN, Kalinin VV Some regularities of formation,
comorbidity and pharmacotherapy for anxiety and phobic disorders.
Anxiety and obsessions / Ed. AB Smulevich. - M., 1998. - S. 217-228.
Евразийский Союз Ученых (ЕСУ) # 9 (18), 2015 I МЕДИЦИНСКИЕ НАУКИ
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6. Nurillaeva NM and Soave. The diagnosis of anxiety-depression in coronary heart disease. Tashkent, 2011, pp 3-12.
7. Poghosova GV Recognition of the importance of mental and emotional stress as cardiovascular risk factor of the first order // Cardiology. - 2007.- №2. - S. 65-72.
8. Smulevich AB Depression at somatic and psychiatric diseases: M .: Medical News Agency. - M. -2003. - S. 131-136.
9. Hamer ME, Blumenthal JA, McCarthy EA, et. al. Quality-of-life assessment in patients with paroxiysmal atrial fi brillation or paroxysmal supraventricular tachycardia. // Am J Cardiol. - 1994. - Vol.74. - P. 82629.
10. Opolski G., Torbicki A., Kosior DA. et. al. Rate control vs. rhythm control in patients with nonvalvular persistent atrial fi brillations: the results of the Polish How to Treat Chronic Atrial Fibrillation (HOT CAFE) Study // Chest. - 2004. - Vol. 126. - P. 476-86.
11. Carney R.M., Rich M.W., te Velde A. et al. Major depressive disorder in coronaryartery disease. Am. J. Cardiol. 1987; 60: 1273-1275.
12. Zigmond A.S., Snaith R.P. The Hospital Anxiety and Depression scale // Acta Psychiatr Scand. -1983. - Vol 67. - P. 361-370.
13. Ford D.E., Mead L.A., Chang P.P. et al. Depression is a risk factor for coronary
artery disease in men: the precursors study. Arch. Intern. Med. 1998; 158:
1422-1426.
14. Hemingway H., Marmot M. Evidence based cardiology: psychosocial factors
in the aetiology and prognosis of coronary heart disease: systematic review
of prospective cohort studies. BMJ 1999; 318: 1460-1467.
15. Jiang W., Babyak M., Krantz D.S. et al. Mental stress induced myocardial
ischemia and cardiac events. JAMA 1996; 21: 5156.
ДИНАМИКА УРОВНЯ ОБЩЕГО ХОЛЕСТЕРИНА В ЗАВИСИМОСТИ ОТ ВИДА БРОНХОЛЁГОЧНОЙ ПАТОЛОГИИ И ТЯЖЕСТИ ПАТОЛОГИЧЕСКОГО
ПРОЦЕССА
Алексейчик Дмитрий Сергеевич
аспирант кафедры инфекционных болезней Белорусского государственного медицинского университета,
г. Минск, Республика Беларусь Доценко Марина Леонидовна
д.м.н., профессор кафедры инфекционных болезней Белорусского государственного медицинского
университета, г. Минск, Республика Беларусь
АННОТАЦИЯ:
Цель: определить уровень общего холестерина у пациентов с различными заболеваниями бронхолёгочной системы: внебольничная пневмония, ХОБЛ, бронхиальная астма.
Методы: был проведён анализ 303 стационарных карт пациентов с внебольничной пневмонией, 73 стационарных карт пациентов с бронхиальной астмой, 50 стационарных карт пациентов с ХОБЛ, находившихся на лечении в пульмонологических отделениях 10 ГКБ в период с 01.01.15 по 30.08.15 года.
Выводы: у пациентов с внебольничной пневмонией наблюдалось статистически значимое снижение уровня общего холестерина во время заболевания 4,51 ммоль/л (25% -3,91, 75%-5,49; IQR- 1,58) против 5,90 ммоль/л (25%-4,77, 75%-6,72; IQR-1,95) (p<0,0001) у пациентов с ХОБЛ и 6,25 (25%-5,79, 75%-6,79; IQR-1,00) (p< 0,0001) у пациентов с бронхиальной астмой. У пациентов с ВБП шанс развития тяжёлой пневмонии при наличии сопутствующей гипохолестеринемии возрастает в 43,71 (95% CI 5,254-363,73; P < 0,0005). Гипохолестеринемия может использоваться как прогностический показатель тяжести течения заболевания с бактериальной патологией.
ABSTRACT
Aim: to investigate the total cholesterol level in patients with community-acquired pneumonia, chronic obstructive pulmonary disease (COPD), asthma.
Methods: 303 hospitalized patients with community-acquired pneumonia, 73 hospitalized patients with asthma, 50 hospitalized patients with COPD were retrospectively enrolled to the study.
Results and conclusion: ^olesterol level in patients with CAP (4.51 mmol/L (25% -3,91, 75%-5,49; IQR- 1,58) appeared to be lower than those in patients with COPD (5.90 mmol/L (25%-4,77, 75%-6,72; IQR-1,95) (p<0,0001) and asthma 6,25 mmol/L (25%-5,79, 75%-6,79; IQR-1,00) (p<0,0001). Hypocholesterolemia was associated with a 43,71fold increased risk of severe CAP (95% CI 5,254-363,73, p<0,0005). Hypocholesterolemia can be used as a marker of severity of CAP.
Ключевые слова: внебольничная пневмония, ХОБЛ, бронхиальная астма, общий холестерин,
гипохолестеринемия.
Key words: community-acquired pneumonia, COPD, asthma, total cholesterol level, hypocholesterolemia
