Особливості ремоделювання лівого шлуночка у пацієнтів з гіпертонічною хворобою при розвитку гострого інфаркту міокарда

Abstract

The purpose of the study was to determine the peculiarity of left ventricular remodeling among patients with hypertension developing acute myocardial infarction. Material and methods. The results of the study are based on the data of a comprehensive examination of 477 patients with coronary artery disease: 280 patients with STEMI (ST-segment elevation myocardial infarction), 91 patients with NSTEMI (non ST-segment elevation myocardial infarction) and the control group consisted of 76 patients with exertional angina (II and III functional class for 38 people). The examination of patients was carried out in the period from 2015 to January 2018 on the basis of the Regional Medical Center for Cardiovascular Diseases of the Zaporozhye Regional Council. All patients (n=477) were comparable in age, social status and gender. The proportion of patients with hypertension was comparable between the groups and amounted to 255 (91.1%) patients with STEMI, 86 (94.5%) with NSTEMI, and 71 (93.4%) patients with stable coronary artery disease. Results and discussion. The development of left ventricular hypertrophy is a long-term process in hypertensive patients. At first, there is a change in the geometry of the left ventricle, since during systole the ventricle tends to take a spherical shape. Further, dilatation of cavities, hypertrophy and an increase in the mass of the left ventricular myocardium, replacement of the myocardium with fibrous tissue develop. Whereas in patients with acute myocardial infarction, due to acute myocardial ischemia, thickening of the myocardial wall is associated with interstitial edema occurs rather quickly. These important factors make it difficult to compare different studies and to reliably identify patients with true left ventricular hypertrophy. Therefore, left ventricular myocardium mass index should be determined as early as possible in patients with hypertension after the development of acute myocardial infarction, in order to interpret the obtained data. Сonclusion. Ischemic heart disease is often associated with essential hypertension, more than 90% of patients with acute myocardial infarction developed essential hypertension. It was determined that eccentric and concentric left ventricular hypertrophy prevailed among those examined on the first day of hospitalization and was due to the presence of hypertension