НАРУШЕНИЯ СЕРДЕЧНОГО РИТМА И ПРОВОДИМОСТИ У МУЖЧИН МОЛОЖЕ 50 ЛЕТ С КАРДИОГЕННЫМ ШОКОМ ПРИ ИНФАРКТЕ МИОКАРДА

Abstract

Relevance. Cardiogenic shock remains one of the most common causes of death in myocardial infarction. Aim. To evaluate the features of cardiac rhythm and conduction disturbances in myocardial infarction complicated by cardiogenic shock, as well as their significance for the development of this complication in males under 50 years old to improve prevention and outcomes. Material and methods. The study included males aged 19-49 years old with type I myocardial infarction. The patients were divided into age- comparable groups. The study group consisted of seven patients with cardiogenic shock, the control group - without cardiogenic shock - 223 patients. A comparative analysis of arrhythmias among the variants of the clinical course, complications, as well as their structure in selected groups were performed. The influence of the studied parameters on the risk of cardiogenic shock development in the examined patients was assessed by the method of risk analysis using the Pearson Chi-square test. Results. In the study group, a higher incidence of arrhythmias in the structure of MI complications (85.7%) was revealed than in the control group (24.2%; p=0.003). They were observed in combination with complications of the group of contractile myocardial insufficiency and its mechanical failure (57.1% and 6.3%, respectively; р˂0.0001) and only contractile insufficiency (28.6% and 11.2%; р˂0,0001). In the structure of arrhythmias in the study group, the frequency of observation of atrial fibrillation and flutter (66.7%) prevailed over the control group (4.9%; р˂0.0001), ventricular fibrillation (50.0 and 2.4%, respectively; р˂ 0.0001), supraventricular tachycardias (33.3% and 1.5%; р˂0.0001), supraventricular (33.3% and 8.3%; р=0.03) and polytopic extrasystoles (33.3% and 3 .9%; p=0.0003), ventricular tachycardias (16.7% and 2.0%; p=0.02), complete atrioventricular blockades (16.7% and 2.0%; p=0.02) and asystole (16.7% and 1.5%; p=0.007). The risk of cardiogenic shock development increased with these arrhythmias. Conclusions. The listed types of arrhythmias should be used in the formation of high-risk groups for the cardiogenic shock development in myocardial infarction for monitoring and timely implementation of the necessary treatment. It is also expedient to take them in the prognostic modeling of this complication.