КЛИНИКО-ФУНКЦИОНАЛЬНЫЕ ОСОБЕННОСТИ СОСТОЯНИЯ СЕРДЦА У ПАЦИЕНТОВ СТАБИЛЬНОЙ СТЕНОКАРДИЕЙ С СОПУТСТВУЮЩЕЙ БРОНХИАЛЬНОЙ АСТМОЙ

Abstract

Objective: to analyze the frequency of the combination of coronary heart disease (CHD) and bronchial asthma (BA) in clinical practice and to identify the features of the clinical course of stable angina in concomitant BA of varying severity. Materials and methods. CHD patients with BA were divided into 3 groups depending on the severity of the BA course: Group 1 – CHD with mild persistent BA (38 patients), Group 2 – CHD with moderate persistent BA (52 patients), Group 3 – CHD with severe BA (21 patients). All patients underwent a general clinical examination, as well as daily ECG monitoring and echodopplercardiography (ECHODPCG). Results. The patients of the CHD/mild BA group manifested significant differences from the patients of CHD/moderate BA group (p<0.001) and from the CHD/severe BA group (p<0.001) in the level of systolic blood pressure (BP) and diastolic blood pressure, which increased with increasing BA severity. According to the ECHODPCG data, there were significant differences between the study groups concerning both the right and left parts of the heart. The data of 24-hour ECG monitoring confirm that the more severe the BA, the more pronounced the ischemic changes in the myocardium are, which suggests a more severe course of CHD. The number of supraventricular extrasystoles and ventricular extrasystoles in the patients with CHD with BA increases significantly with increasing severity of BA. The analysis of the lipid spectrum revealed that hypercholesterolemia increases with the progression of BA. Conclusion. The results of the study show that with an increase in the BA severity in the patients with a combination of BA and CHD there occur more pronounced changes in hemodynamics related to an increase in the level of systolic and diastolic blood pressure. Mutual aggravation and progression in the combination of bronchial asthma and arterial hypertension is based on the commonality of some links of pathogenesis. This can lead to the progression of heart failure and the early development of cardiorespiratory complications. The data indicate that the progression of BA severity is associated with acceleration of the heart rate, as well as with an increase in the frequency of detection of supraventricular and ventricular extrasystoles, and major myocardial remodeling affecting both the left and the right parts of the heart. This allows us to conclude that chronic inflammation in BA activates the renin-angiotensin-aldosterone and sympathoadrenal systems, which leads to the development of atherosclerosis and an increase in the severity of CHD.