Analysis of heart rate variability in elderly patients with unstable angina pectoris and negative psychology / 中国综合临床

ABSTRACT

Objective To study the heart rate variability and arrhythmia characteristics in the elderly patients with unstable angina and negative psychology and to observe the changes before and after treatment. Methods Eighty patients aged ≥ 65 years with unstable angina were recruited in the study, and divided into two groups according to the determination of Hospital Anxiety and Depression Scale 36 patients in the negative psychology group( NP group) and 44 in the non-negative psychology group ( non-NP group). All patients were monitored by Holter. Results The SDNN, SDANN, SDNNidex, rMSSD and PNN50 in the NP group were (86.8 ±14.1 ) ms, (78.1 ± 11.2 ) ms, (22.9 ± 4.5 ) ms, ( 6.3 ± 1.2 ) % and (40.3 ± 16.4) ms, respectively, which were significantly decreased compared to that in the non-NP group [ ( 138.9 ± 37.1 ) ms, ( 123.3 ± 32.5 ) ms, (25.7 ±12.3)ms,(9.2 ±5.3)% and (47.8 ± 10.7)ms,respectively] (t =4.20,2.52,2.32,2.28 and 2.20,Ps ＜0.05)The prevalence of ventricular arrhythmia, sinus tachycardia, ischemic ST-T changes and heart rate variability (HRV) (55.56%, 13.89%, 33. 33% and 52. 78%, respectively) significantly increased in the NP group,compared to those in the non-NP group(9.09% ,2.27% ,6.82%, 18.18% ,respectively) ( χ2 = 16.89,4.18,4.33 and 4.99, respectively, Ps ＜ 0.05 ). After treatment with Prozac ( fluoxetine hydrochloride scientific name), SDNN,SDANN,rMSSD,PNN50,SDNNindex significantly increased from (84.7 ± 34.0) ms, (79.2 ± 39.6) ms, (23.4 ±7.5)ms,(5.1 ±2.1)% and (38.1 ± 11.8)ms to (102. 1 ±29.6)ms,(94.2 ±26.7)ms,(35.6 ± 10.2)ms,(9.9 ± 7.5 ) % and (63.3 ± 13.8 ) ms ( t = 3.60,2.43,2.34,2.26 and 2.30, P ＜ 0.05 ). After treatment,ventricular arrhythmia,sinus tachycardia,ischemic ST-T changes and HRV significantly decreased compared to that before treatment in the NP group (χ2 = 5.58,4.33,4.24 and 4.06 ,P ＜ 0. 05 ). Conclusions In patients of coronary heart disease with unstable angina and negative psychologically , HRV decreased , and they are prone to ventricular arrhythmias,sinus tachycardia and ischemic ST-T changes. Treatment with Prozac could decrease arrhythmia and improve cardiac ischemia arrhythmias, sinus tachycardia and ischemic ST-T changes. Treatment with Prozac could decrease arrhythmia and improve cardiac ischemia.