Роль психоэмоциональных нагрузок в возникновении нарушений ритма сердца

Abstract

Objective: to determine the prevalence of cardiac arrhythmias in the structure of visits to the cardiologist. Materials and methods: within two years a doctor-cardiologist turned 4373 patients. 652 of them had arrhythmia (522 men and 130 women), that was 14.9% of those who applied for medical assistance. There were some patients (545) among 652 participants, who had significant rhythm disturbance according to the Holter ECG, the number of ventricular and supraventricular extrasystoles exceeded the acceptable rate. These patients were divided into 3 groups to assess the frequency of ventricular and supraventricular arrhythmias: Group 1: patients with a primary rhythm disturbance according to the type of ventricular arrhythmia – 96 people (80 men and 16 women). Their average age was 68 years (18–89). Group 2: patients with a primary rhythm disturbance according to the type of supraventricular extrasystole – 343 people (271 men and 72 women). Their average age was 67 years (17–83).Group 3: patients with complex arrhythmias (supraventricular and ventricular premature beats) – 106 patients (94 men and 12 women). Their average age was 65 years (18–87). Compulsory medical examination for the patient included a complete medical examination with the filling of a formalized medical history; laboratory studies (clinical blood analysis, biochemical blood-potassium, sodium, magnesium, chlorine, glucose, lipid spectrum, creatinine, total protein, coagulation profile, thyroid hormones T3, T4, TTG); instrumental examinations (ECG, daily monitoring of Holter ECG, radiography of the chest, echocardiography). 48 patients (8.84 %) had no apparent causes of arrhythmias. These patients were directed to magnetic resonance imaging (MRI) of the heart for the purpose of clarifying the nature of the arrhythmia. Results: the prevalence of cardiac arrhythmias in the structure of visits to the cardiologist was 14.9%. The main etiological factors of arrhythmia were: ischemic heart disease (IHD) and arterial hypertension (AH). In the group with supraventricular arrhythmias, patients with a history of pulmonary embolism, heart failure II–IV FC, permanent cardiac pacing, oncology, thyroid disease (hyperthyroidism), hyperkalemia and hypercholesterolemia as well as exacerbation of diseases of the gastrointestinal tract were much more likely to meet. In the group with combined rhythm disturbances, patients with acquired heart defects and hypercholesterolemia were dominating; and in the group with ventricular arrhythmias, there were more patients with a prosthetic aortic valve. In the group with ventricular arrhythmias, smokers with burdened heredity in CAD were significantly more likely to meet, and in the group with supraventricular arrhythmias, there were significantly more women in the state of early perimenopause. The main provoking factor was a psycho-emotional stress. Conclusions: the identification of the nature of arrhythmias according to traditional methods was difficult in 48 patients (8.84%), MRI of the heart allowed to establish probable cause rhythm disturbances in 32 patients in this category (2/3 of all surveyed). This draws attention to the high frequency of detection of MRI signs of myocarditis (1/3 of the surveyed).