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7Violations of cardiac rhythm in children
ShanovaO.V., BoychenkoT.E.
Amur State Medical Academy, Blagoveshchensk, Russia
Abstracts: vegetative homeostasis has connection with minor anomalies of the heart and it influences on violations of cardiac rhythm in children.
Key words violations of cardiac rhythm, vegetovascular dystonia, dysplasia of connecting tissue.
Violations of a rhythm can be congenital or acquired and are caused by the cardial, extracardial and combined reasons. In recent years the great attention is given to cardial dysplasias and its interrelation with violations of a rhythm of heart (VRH). About abundance of violations of a rhythm children have no reliable data. Violations of a cardiac rhythm and conduction find in children of all age, including newborns, but their frequency increases in the puberty.
Materials and methods
The complex assessment of VCR and conduction in teens with a dysplasia of connecting tissue (DCT) was the purpose of our work. For this purpose we conducted examination of 112 children at the age of 15-18 years which were in cardiological unit with vegetovascular dystonia. The basic group consisted of 79 children with the diagnosis vegetovascular dystonia, which is accompanied by DCT (it was revealed not less than 4 external phenotypic signs of DCT), there were 49 boys and 30 girls. 48 children were with sympathetic type, 31 - with vagotonic. The control group was composed of 33 children with diagnosis of vegetovascular dystonia without DCT (it was allowed the presence of 1-3 microanomalies in this group of children), from them 17 boys and 16 girls. At 13 children VVD was on synpaticotonic type, at 20 - on vagotonic.
Results and discussion
When carrying out ECG - investigation in rest various violations of a rhythm of heart and conduction were registered at 63,3% of children and teens of a basic group, and at daily monitoring - at 87,3% that is reliable more often than patients have groups of monitoring (63,6%) (p<0,05). The common tendency by comparison of results of an ECG and holter monitoring was expressed in the combined identification of signs of a dysregulation of a cardiac rhythm, thus detectability of deviations at a daily allowance of an ECG monitoring increased. On the average it was the share of one patient of the I group 1,9±0,2, and in II - 1,2±0,2 violations of a rhythm of heart and conduction (p<0,01). Besides, at patients with DCT authentically more often was noted the combination of arrhythmias and conduction violations - (36,7%) (in the II group of 18,2%) (p<0,05).
Results of comparisons of an ECG in the main and control groups are presented in table 1.
In the analysis of function of automatism symptoms of dysfunction of sinus node in the form of a sinus arrhythmia and tachycardia more often revealed at patients with DCT, and a sinus bradycardia at patients without DCT (p>0,05). Violation rhythm topics in the form of pacemarkers of a rhythm on auricles was diagnosed for 13,9% of teens of a basic group, whereas in control group only in 3% of cases (p<0,05). Paroxysmal and not paroxysmal disease, an ectopic atrial rhythm were revealed only at patients of a basic group. At an ECG investigation at teens with dysrhytmia DCT in 7,6% were shown in the form of an extra systole, and at holter monitoring their frequency increased to 16,6%. Thus prevailed supraventricular extrasystoles (18,9%). In group of monitoring also were registered supraventricular extrasystoles, but with authentically smaller frequency - 6,1% (p<0,05). The ventricular extra systole was registered only among teens with DCT (15,2%). The supraventricular parasystole met low frequency in both groups. On the frequency of change of formation cumulative electropotential in a myocardium it was not succeeded to receive reliable intra group distinctions.
Table 1
Change ECG at the surveyed tees with vegetovascular dystonia (in %)
ECG - changes VVD with a DCT VVD without a DCT
Average FCR 77,35±1,74 77,06±2,27
Sinus arrhythmia 29,1 15,2
Sinus tachycardia 10,1 6,1
Sinus bradycardia 13,9 18,2
Migration of the pacemarker 13,9* 3,0
Ectopic atrial rhythm 2,5 -
Paroxysmal supraventricular disease 7,6 -
Not paroxysmal supraventricular disease 6,3 -
Extra systole supraventricular 18,9* 6,1
Extra systole ventricular 15,2 -
Para systole supraventricular 3,8 1,3
Increase in electric activity of a right auricle 3,8 -
Increase in electric activity of a right ventricle 5,1 3,0
Increase in electric activity of a left ventricle 2,5 3,0
Lowvoltage 3,8 3,0
Syndrome of early repolarization of the ventricles 20,3* 6,1
The expressed metabolic changes in a myocardium 27,8 18,2
AB conduction acceleration 21,5 12,1
AB conduction delay 3,8 -
Focal intra ventricular blockade 1,3 -
Incomplete blockade of a right bundle branch block 7,6 3,0
Incomplete blockade of the left-hand bundle branch block 8,9 3,0
AB blockade of the I degree 1,3 -
A sick sinus syndrome 5,1 -
AB dissociation 1,3 -
WPW syndrome 2,5 -
Note: reliability of distinctions when comparing with monitoring on a significance level:* -p<0,05.
Results of an ECG of research showed that is reliable more often at children and teens of DCT came to light the syndrome of early repolarization of ventricles (SERV) (p<0,05). In a basic group in 3/4 supervision (75% of cases) it was registered in combination with violations of a cardiac rhythm that allows to consider it as one of risk factors of development of arrhythmia at a syndrome of DCT of heart. Signs of violation of processes of a metabolism at the examined were documented by deformation of terminating part of a ventricular complex - shift of a segment of ST (no more than 2 mm) and changes of the wave of T in 27,8% and 18,2% respectively on groups (p>0,05). The expressed and permanent repolyarizational changes in a myocardium often were the causes of hospitalization of teens for carrying out corrective therapy by cardiometabolites.
Carrying out violations on atrioventricular connection and ventricles were registered in a basic group (36,7%), than in group of monitoring (18,2%) (p <0,05) authentically more often and were more diverse. Essential it is necessary to recognize existence of the combined forms of dysfunction of sinus node which came to light at 8,9% of patients with DCT and were not noted in one case in group of monitoring.
Undoubted interest submitted the analysis of features of an ECG at children and teens of a basic group with a syndrome of DCT of heart depending on character of cardial dysplasias.
The range of changes of an ECG with reliable values was more diverse at patients with chance chords of a left ventricle. So, the analysis of the obtained data showed that the ventricular ekstrasistoliya was registered authentically more often at teens with chance chords of a left ventricle (CCLV) (21,4%) (p<0,05), reliable distinctions in subgroups with various topographical options CCLV us is not received. In comparison of frequency of identification of a syndrome of early
repolarization of ventricles at patients with various echocardiographic characteristics we obtained the following data: the SERV was found out in 28,6% of cases at CCLV that was reliable more often than at a prolapse of atrioventricular valves (PAVV) (6%), a combination of PAVV and CCLV (6,7) and an open oval window (OOW) (9,1%). Besides, incomplete blockade of the left bundle (IBLB) branch block took place at 12,5 teens with a CCLV that is also reliable more often than at a PAVV (2%) (p<0,05). Reliable differences were available in ECG terminating complex characteristics. Violation of processes of repolarization (VPR) met in 60% of cases at a combination a PAVV and CCLV (p<0,01).
Analysis of detection of ECG abnormalities depending on the severity of DCT leads to the conclusion about the growth of dysregulation, dysfunction of synoatrial zone and dysrhytmia which is parallel to the increase of DCT in manifestations.
Correlation between a number of violations of an electrogenesis and dysplastic changes of heart is authentic: with increase of DCT's signs the frequency of identification of signs of a dysregulation of a cardiac rhythm and conduction (R=0,31; p=0,005) increases.
Conclusions
The carried out analysis of data of ECG in the examined teens allows to allocate group of the changes associated with a syndrome of DCT to which it's related migration of pacemarker of a rhythm on auricles, extra systole, a syndrome of an early repolarization of ventricles (SERV), a smoothness and inversion of a segment of ST and the wave of T and incomplete left bundle branch block. The obtained data testifying to close connection of dysplastic changes of heart with various changes of ECG in teens, say that they are threatened on development of these violations.
References
1. Bobkowski W., Siwinska A., Zachwieja J. et al. Electrolyte abnormalities and ventricular arrhythmias in children with mitral valve prolapse // Pol Merkuriusz Lek. — 2001. — V. 11, № 62. — P. 125-128.
2. Wroblewska-Kaluzewska M., Piorecka-Makula A., Tomik A. Arrhythmia and repolarization in children with vegetovascular dystonia // Wiad. Lek. — 2006. — V. 53, № 9-10. — P. 13-517.
Tincture of medicinal plants and oxidative stress in the conditions of cold
influence
SimonovaN.V., DorovskichV.A., ShtarbergM.A., LiO.N., AnokhinaR.A., LashinA.P., KodintsevV.V.
AmurStateMedicalAcademy, Department of Pharmacology, Blagoveshchensk, Russia
Summary. The increase of adaptation capabilities of a person to the damaging effect of cold with the help of pharmacological medicine is important at prophylaxis of different diseases and pathologies development. In experimental conditions the possibility to correct free radical lipid oxidation of rats' organism membranes was studied with the oral introduction of the tincture made of birch, nettle and plantain leaves. It is established that daily cold influence during three hours contributes to the increase of lipid hydroperoxides level, of diene conjugate, of malonic dialdehyde against the decrease of antioxidant system activity in the blood of animals under experiment. The introduction of the tincture to rats in the conditions of cold influence contributes to the reliable decrease in the blood of lipid hydroperoxides by 19%, of diene conjugates - by 13%, malonic dialdehyde - by 18% in comparison with the rats of the control group. So, the application of the mentioned tincture in the conditions of long influence of cold on the organism of animals under experiment leads to the stabilization of the processes of peroxidation against the increase of antioxidant system activity.
