Abstract
As a rule, heart damage in patients with sarcoidosis of respiratory organs (SOD) is not diagnosed in time, so a very important and urgent task is to identify common heart rhythm and conduction disorders.The aim of the studywas to investigate the main clinical manifestations of sarcoidosis in SOD, depending on the peculiarities of the disease course and to compare the frequency and severity of pulmonary and extrapulmonary manifestations of sarcoidosis, including myocardial lesions and electrocardiographic (ECG) signs of heart rhythm disorders.Methods. In the period 2006– 2016, the pilot open prospective uncontrolled study conducted at the Pulmonology Department of the Regional State Autonomous Healthcare Institution "Tomsk Regional Clinical Hospital" included patients (n = 84) aged 20–67 years with the diagnosis of SOD. Patients were divided into 2 clinical groups: the 1st comprised 45 (53.5%) patients with a favorable course of sarcoidosis, the second one included 39 (46.4%) patients with an unfavorable course of the disease. A full range of studies was carried out, including the analysis of medical history and clinical and epidemiological data, instrumental methods (including ECG and Holter ECG monitoring (HM), pathomorphological study of lung biopsy samples.Results. According to the data of frequency analysis of occurrence of pulmonary and extrapulmonary clinical manifestations in ODS, it was shown that the leading clinical manifestations, most frequently occurring in patients of both groups, included asthenia syndrome (72.6%), bronchial syndrome (66.7%) and fever syndrome (33%). In 33% of cases, clinical manifestations of myocardial damage were detected. In 41 (51.2%) patients in both groups, changes on ECG were recorded at rest. Regardless of the course of the disease, in 23.5% of patients of both clinical groups, according to the results of the HM ECG, rhythm and conduction disturbances were found – a combination of ventricular arrhythmias and conduction disorders (ventricular extrasystole and right His bundle branch block of various degrees) and a combination of supraventricular arrhythmias and conduction disturbances (supraventricular extrasystole and right His bundle branch block of various degrees).Conclusion. Thus, regardless of the severity of the disease course, SOD patients are concerned about complaints from both respiratory system and extrapulmonary manifestations, including cardiac complaints, as well as heart rhythm and conduction disorders (according to the results of ECG and HM ECG), the frequency of which, according to the comparative analysis, has not significantly changed in both clinical groups, which indicates the non-specific character of clinical manifestations.
Highlights
Сведения об эпидемиологии саркоидоза разнообразны; наиболее часто заболевание встречается в государствах с развитой системой здравоохранения, расположенных на севере Европы
In 33% of cases, clinical manifestations of myocardial damage were detected
Клиническая симптоматика у обследованных оказалась достаточно многообразной – у 19 (22,6 %) пациентов наблюдалось острое течение заболевания, у 65 (77,4 %) – подострое и хроническое, у 1⁄3 – скрытое, выявленное лишь при проведении рентгенологического обследования во время профилактического осмотра или случайно, когда пациент обратился в поликлинику с другими жалобами
Summary
Поражение сердца у больных саркоидозом органов дыхания (СОД) своевременно не диагностируется, поэтому весьма важной и актуальной задачей является обнаружение часто встречающихся нарушений сердечного ритма и проводимости. Целью исследования явились изучение основных клинических проявлений при СОД в зависимости от особенностей течения заболевания и сравнительная оценка частоты и тяжести легочных и внелегочных проявлений саркоидоза, включая поражения миокарда и электрокардиографические (ЭКГ) признаки нарушений сердечного ритма. Независимо от течения заболевания, у 23,5 % больных обеих клинических групп по результатам ХМ ЭКГ обнаружены нарушения ритма и проводимости – сочетание желудочковых аритмий и нарушений проводимости (желудочковая экстрасистолия и блокада правой ножки пучка Гиса разной степени) и сочетание наджелудочковых аритмий и нарушений проводимости (суправентрикулярная экстрасистолия и блокада правой ножки пучка Гиса разной степени). Независимо от тяжести течения заболевания, больных СОД беспокоят жалобы как со стороны дыхательной системы, так и внелегочные проявления, включая кардиальные, а также нарушения ритма сердца и проводимости (по результатам ЭКГ и ХМ ЭКГ), частота встречаемости которых, по результатам сравнительного анализа, в обеих клинических группах достоверно не изменялась, что свидетельствует о неспецифичности клинических проявлений.
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