[Arrhythmia in patients with chronic heart insufficiency and type 2 diabetes mellitus].

UNLABELLED: The aim of the work was to study character, frequency and peculiarities of arrhythmia in patients with chronic heart insufficiency (CHI) depending on its etiology and type 2 diabetes mellitus (DM2). MATERIALS AND METHODS: In-depth clinical observation of 197 patients (mean age 61.3 +/- 0.63 yr, 56-61% men) included EchoCG, 6 min walk test, Holter ECG monitoring. Group 1 was comprised of 74 patients with CHI (NYHA FC II), group of 280 patients with HPI an DM2, group 3 of 50 patients with CD2 (ADA criteria, 2011). The groups were matched for sex, age, severity of disease and complications. Exclusion criteria were acute coronary heart disease, CHI and DM2 decompensation, CHI according to BHOK and OCCH National recommendations (2009). RESULTS: 43.2% of the patients showed ventricular arrhythmia (VA) (p < 0.02), 10.8% had ciliary arrhythmia. Combined arrhythmia (ventricular and supraventricular arrhythmias, hemodynamically significant atrial fibrillation and high-grade ventricular arrhythmias) occurred in 41.2% of the patients having CHI+DM2 62.8% of the DM2 patients had supraventricular arrhythmias. CONCLUSION: Hemodynamically and prognostically unfavourable arrhythmias are most frequently diagnosed in the patients with CHI and DM2 due to more pronounced myocardial failure and DM2-associated pathogenetic factors (dysglycemia, cardiac neuropathy, nephropathy).

[Digestive system pathology in patients with chronic obstructive pulmonary disease concurrent with coronary heart disease].

AIM: to study clinical and functional impairments in the digestive system in patients with chronic obstructive pulmonary disease (COPD), including that in the presence of coronary heart disease (CHD). SUBJECTS AND METHODS: Clinical and functional impairments were analyzed in 1104 patients. Of them, 402 patients had COPD (Group 1); 459 had COPD concurrent with angina on exertion (Group 2); 243 had CHD (Group 3). All the patients suffered from cardiovascular diseases. RESULTS: In patients with concomitant pathology, chronic gastritis is a most frequently detectable disease of the digestive system (62.3%), gastroenterological complaints being insignificant. The rate of Helicobacter pylori infection was 68.2% (in Group 2 patients) to 83.7% (in Group 1). A morphological study indicated that in concomitant pathology the number of patients with signs of atrophy increased; at the same time there were microcirculatory disorders in the gastric mucosa. Ulcerative disease was diagnosed in one third of the patients, a gastric ulcerative process being more commonly located in the stomach. Gastroesophageal reflux disease was detected in 206 (51.2%) patients in Group 1, in 267 (58.2%) in Group 2, and in 113 (46.5%) in Group 3. CONCLUSION: By resulting in the mutual burden of the disease, the high rate of concomitant digestive pathology necessitates additional examination and mandatory medical correction in patients with

[Peculiarities of the treatment of obstructive pulmonary disease in patients with combined pathology].

Effects of combined drug therapy were evaluated in 97 patients during a year Group 1 comprised 32 patients with chronic obstructive pulmonary disease (COPD), group 2 (n = 34) included patients with COPD and angina of effort, group 3 (n = 31) patients with CHD. Broncholytic therapy was prescribed in compliance with GOLD (2006) recommendations. Patients in groups 2 and 3 continued to receive antianginal therapy started before the onset of the study. Combined therapy included ACE inhibitor enalapril. Positive effect of inpatient treatment of COPD on lung function was transient and subsided with time. Specifically, forced expiratory volume in the 1st second and forced pulmonary vital capacity decreased below the acceptable physiological bounds. BODE index tended to drop too because exercise tolerance increased while dyspnea index by MMRC decreased despite impaired FEV1 and tendency toward a fall in BMI. Echocardiography revealed diminished size of both ventricles and improved left ventricular systolic function. However, heart remodeling progressed with time. Adequate therapy resulted in the reduction of CHD functional class and produced positive antianginal, antihypertensive, and antiarrhythmic effects. The treatment was well tolerated by the patients. It is concluded that combined therapy of COPD including enalapril improves respiratory symptoms and decreases manifestations of concomitant pathology.

[Urogenital pathology in patients with chronic obstructive lung disease and ischemic heart disease].

The objective of this study was to elucidate the incidence and clinical features of renal dysfunction and urogenital system disorders in 956 patients with chronic obstructive lung disease (COLD) and/or coronary heart disease (CHD). COLD was diagnosed in 346 patients (group 1), COLD and CHD in 402 (group 2), CHD in 211 (group 3). The methods included X-ray studies (survey and excretory urography), functional diagnostics (ECG, Doppler cardiography, assessment of external respiration, abdominal, renal, and bladder ultrasound, measurements of residual urine, transrectal and transabdominal examination of prostate). The glomerular filtration rate was estimated using Cockcrofft-Gault and MDRD formulas and Rerberg- Tareev method, renal hemodynamics by duplex scanning of renal arteries. Inflammatory urogenital diseases were most frequently diagnosed in group 2 (chronic cystitis 83.8%, chronic pyelonephritis 73.9%). Diabetic nephropathy common in this group (25.4%) was related to the high prevalence of diabetes mellitus in these patients (37.8%) compared with 26.3 and 29.9% in groups 1 and 3 respectively. Ischemic renal disease occurred in every tenth patient of group 2 or much more frequently than in groups 1 and 3. This suggests additive COLD and CHD effect on the atherosclerotic process. The combination of these diseases was responsible for a large fraction of patients with chronic renal insufficiency in group 2 (45%). It is concluded that concomitant urogenital pathology in patients with COLD results in mutual aggravation of the clinical course of the two diseases and requires additional examination and obligatory medicamentous correction.

[Heart rhythm disturbances in patients with chronic obstructive pulmonary disease in aggregate with coronary heart disease].

The purpose of the research was to study kinds, frequencies and features of heart rhythm disturbances (HRD) in patients with chronic obstructive pulmonary disease (COPD) subject to degree of severity, including presence of coronary heart disease (CHD). 1189 of patients with registered HRD were examined. 315 of them had COPD (group 1), 531--combination of COPD and CHD (group 2), 343 were CHD patients (group 3). The extent of examinations included electrocardiogram (ECG), Halter monitoring (HM), bicycle ergometry (BEM), external respiration function estimation. Supraventricular HRD were registered statistically more frequently in group 1: according to ECG data in rest - in 37.2% patients, by BEM results--in 18.8%, by HM--in 50%. Combined (supraventricular and ventricular) HRD were registered most frequently in group 2: 41.2 24.4, and 45.5% respectively. Ventricular HRD dominated in group 3: 47.6, 29.3 and 48.6% respectively. The results of the study indicate that supraventricular HRDprevaile in patients with COPD, combined HRD - in patients with COPD and CHD. Ventricular HRD, which most informatively reflect changes in intracardiac geometry and left ventricle hemodynamics, dominate in CHD patients. The optimization of therapy correction consists in early diagnostics of HRD subject to features of cardiorespiratory system functional state.

[Arterial hypertension in patients with chronic obstructive pulmonary disease in combination with coronary artery disease].

AIM: To study clinicofunctional features of arterial hypertension (AH) in patients with chronic obstructive pulmonary disease (COPD) including COPD patients with coronary artery disease (CAD); 24-h profile of blood pressure (BP) and changes in intracardiac hemodynamics; to compare the disturbances detected. MATERIAL AND METHODS: 1256 patients were divided into 3 groups, 395 AH patients with COPD entered group 1; 509 AH patients with COPD and CAD, angina of effort--group 2, 352 AH patients with CAD--group 3. RESULTS: Most patients with comorbid diseases have 24-h BP profile of non dipper and night picker types in the presence of high heart rate explained by COPD effect on AH course. Lower BP in group 2 patients results from progressive maladaptive heart remodeling, attenuation of the systolic function, increasing number of patients with a restrictive type of transmitral blood flow. CONCLUSION: COPD patients with AH have more severe and frequent changes in target organs, poor prognosis as these diseases aggravate each other.

[Nosocomial respiratory infections in patients with bronchial asthma]. / Vnutribol'nichnye respiratornye infektsii u bol'nykh bronkhial'noi astmoi.

AIM: To study incidence and causes of nosocomial respiratory infection (NRI) and its influence on clinical manifestations of bronchial asthma (BA). MATERIAL AND METHODS: 5212 inpatients of the pulmonary department were examined from 1994 to 2000. RESULTS: NRI was found in 41 of 912 patients with BA (4.5%) compared to 57 of 1287 patients with pneumonia (4.4%) and 72 of 1793 patients with chronic bronchitis (4%). In BA patients NRI was represented by acute respiratory viral infection (ARVI) in 39 cases and by nosocomial pneumonia (NP) of candidiasis genesis in 3 cases. ARVI occurred more frequently in winter (37%), less frequently in spring (23%), autumn (23%) and summer (17%). During outbreaks, ARVI affected 11.7% BA patients, but out of outbreaks only 1.5%. ARVI occurred twice more frequently in patients with atopic and severe BA, 3.5 times more frequently in using inhalatory glucocorticoids in the course of treatment, and much more often in case of using these systematically. Mycoplasmic pneumonia was detected in 1/4 of ARVI patients. CONCLUSION: NRI was detected in 4.5% patients with BA. NRI was represented by ARVI (4.4%) and by nosocomial pneumonia (0.3%). Mycoplasmic pneumonia was detected in 1/4 of BA patients with ARVI. ARVI, especially associated with mycoplasmic infection, aggravates the course of BA.