ANTIARRHYTHMIC UPSTREAM THERAPY OF EXTRASYSTOLIC ARRHYTHMIA IN PREGNANT WOMEN WITH STIGMAS OF CONNECTIVE TISSUE DYSPLASIA
DOI:
https://doi.org/10.11603/24116-4944.2021.1.12353Keywords:
pregnancy, undifferentiated connective tissue dysplasia, mitral valve prolapse, extrasystole, systolic-diastolic dysfunction, arginine, carnitineAbstract
The aim of the study – to reduce the incidence of obstetric complications associated with cardiovascular disorders in women with UCTD by including in the protocol treatment program carnitine-arginine complex.
Materials and Methods. There were examined 58 pregnant women with diagnosed 2–8 separate signs of UCTD, including mitral valve prolapse (MVP) with and without frequent extrasystoles, and 14 pregnant women of control group. Metabolic support by intravenous infusion of 4.2 g of L-arginine and 2.0 g of L-carnitine once per day by 5 days was used for prenatal care of pregnant women with UCTD for prevention of obstetric complications.
Results and Discussion. There are violations of morpho-functional parameters of the heart with the development of moderate systolic-diastolic myocardial dysfunction and endothelial microvascular dysfunction in pregnant women with MVP and extrasystolic arrhythmia on the background of UCTD in the initial state. They were significantly more often diagnosed with miscarriage, late preeclampsia, placental dysfunction, birth defects, birth trauma, postpartum hemorrhage and more. Echostructural abnormalities of the heart acted as predictors of arrhythmias, that associated with more pronounced disorders of intracardiac hemodynamics. There was a significant reduction in the incidence of arrhythmias in the group of patients with MVP and frequent ventricular or mixed extrasystoles – by 90.6 % and 77.8 %, respectively under the influence of complex drug treatment with the inclusion of L-arginine and L-carnitine. In the group of pregnant women with supraventricular arrhythmias, the antiarrhythmic effect was observed in only 37.5 % of patients, which justified the additional use of nebivolol hydrochloride at a dose of 2.5 mg/day. At the same time, such a comprehensive treatment in pregnant women with MVP and arrhythmia on the background of UCTD contributed to the restoration of the studied indicators of endothelial function of microvessels.
Conclusion. In pregnant women with MVP and extrasystolic arrhythmia on the background of UCTD in the initial state there are violations of morpho-functional parameters of the heart with the development of moderate systolic-diastolic myocardial dysfunction and endothelial microvascular dysfunction, which are triggers of complicated pregnancy and childbirth. The inclusion of L-arginine and L-carnitine led to a significant improvement in the parameters of central cardiohemodynamics and restoration of endothelial function of microvessels, that accompanied by a significant reduction in the incidence of extrasystolic arrhythmia and pregnancy complications.
References
Vdovychenko, Yu.P., Ishchak, O.M., Behosh, B.M., & Ivasenko, T.V. (2013). Vplyv dysplazii spoluchnoi tkanyny ta varykoznoi khvoroby nyzhnikh kintsivok u vahitnykh na vynyknennia perynatalnykh ta akusherskykh uskladnen [Influence connective tissue dysplasia and varicose veins of lower extremities disease in prenatal in appearance perinatal and obstetric complications]. Aktualni pytannia pediatrii, akusherstva ta hinekolohii – Actual Problems of Pediatrics, Obstetrics and Gynecology, 2, 79-82 [in Ukrainian].
Gazazyan, M.G. (2017). Osobennosti techeniya beremennosti i rodov u patsiyentok s displaziyey soyedinitelnoy tkani [Features of the course of pregnancy and childbirth in patients with connective tissue dysplasia]. Akusherstvo i ginekologiya – Obstetrics and Gynecology, 1, 121-126 [in Russian].
Faiz, S.A., Al-Meshari, A.A., & Sporrong, B.G. (2016). Pregnancy and valvular heart disease. Saudi Med. J., 24 (10), 1098-1101.
Jana, N., Vasishta, K., & Khunnu, B. (2017). Pregnancy in association with mitral valve prolapse. Asia Oceania J. Obstet. Gynaecol., 19 (1), 61-65.
Tang, L.C., Chan, S.Y., & Wong, V.C. (2015). Pregnancy in patients with mitral valve prolapse Int. J. Gynaecol. Obstet., 23 (3), 217-221.
Nazarenko, L.H. (2010). Dysplaziia spoluchnoi tkanyny: rol v patolohii liudyny i problemakh hestatsiinoho periodu (ohliad) [Connective tissue dysplasia: a role in human pathology and problems of the gestational period (review)]. Zhinochyi likar – Female Doctor, 1, 42-48 [in Ukrainian].
Kucharczyk-Petryka, E., Mamcarz, A., & Braksator, W. (2016). Mitral valve prolapse at pregnancy: is it a real clinical problem? Pol. Arch. Med. Wewn., 114 (5), 1084-1088.
Artal, R., Greenspoon, J.S., & Rutherford, S. (2016). Transient ischemic attack: a complication of mitral valve prolapse in pregnancy. Obstet. Gynecol., 71 (6), 1028-1030.
Shved, M.I., & Pelo, M. (2018). Vplyv kardioprotektornoi metabolichnoi terapii na vynyknennia porushen rytmu ta providnosti u khvorykh na infarkt miokarda iz metabolichnym syndromom [Influence of cardioprotective metabolic therapy on the occurrence of rhythm and conduction disorders in patients with myocardial infarction with metabolic syndrome]. Arytmolohiia – Arrhythmology, 2 (26), 58-59 [in Ukrainian].
Makarchuk, O.M., Rymarchuk, O.M., & Drohomyretskyi, L.V. (2015). Nedyferentsiiovana dysplaziia spoluchnoi tkanyny yak faktor imovirnykh hestatsiinykh uskladnen [Undifferentiated connective tissue dysplasia as a factor of probable gestational complications]. Akusherstvo. Hinekolohiia. Henetyka – Obstetrics. Gynecology. Genetics, 2, 18-20 [in Ukrainian].
Seliuk, M.M., Kozachok, M.M., Lyovkin, I.M., & Seliuk, O.V. (2017). Vybir optymalnoi kombinatsii metabolichnykh preparativ dlia likuvannia patsiientiv z kardiovaskuliarnoiu patolohiieiu [Optimal combinations of metabolic drugs for the treatment of cardiovascular disorders]. Semeynaya medytsyna – Family Medicine, 2 (70), 60-64 [in Ukrainian].
Astashkin, E.I., & Glezer, M.G. (2012). Role of L-carnitine in energy metabolism cardiomyocytes and treatment of diseases of cardiovascular system. Cardiol. Cardiovasc. Surg., 6 (2), 58-65.
DiNicolantonio, J.J., Lavie, C.J., Fares, H., Menezes, A.R., & O'Keefe, J.H. (2013). L-carnitine in the secondary prevention of cardiovascular disease: systematic revien and meta-analysis. Mayo Clin. Proc., 88 (6), 544-551. DOI: 10.1016/j.mayocp.2013.02.007.
George, J., Shmuel, S.B., Roth, A., Herz, I., Izraelov, S., Deutsch, V., …, & Miller, H. (2004). L-arginine attenuates lymphocyte activation and antioxidized LDL antibody levels in patients undergoing angioplasty. Atherosclerosis, 174 (2), 323-327. DOI: 10.1016/j.atherosclerosis.2004.01.025.
Dobrokhotova, Yu.E., & Borovkova, Ye.I. (2017). Pregravidarnaya podgotovka i vedeniye beremennosti u patsiyentok s displaziyey soyedinitelnoy tkani [Pregravid preparation and management of pregnancy in patients with connective tissue dysplasia]. Ginekologiya – Gynecology, 19 (5), 44-49 [in Russian].
Shug, A.L., Thomsen, J.H., Folts, J.D., Bittar, N., Klein, M.I., Koke, J.R., & Huth, P.J. (1998). Changes in tissue levels of carnitine and other metabolites during myocardial ischemia and anoxia. Arch. Biochem. Biophys., 187 (1), 25-33. DOI: 10.1016/0003-9861(78)90003-6.
Rizzon, P., Biasco, G., Di Biase, M., Boscia, F., Rizzo, U., Minafra, F., …, & Bagiella, E. (1989). High doses of L-carnitine in acute myocardial infarction: metabolic and antiarrhythmic effects. Eur. Heart J., 10 (6), 502-508. DOI: 10.1093/oxfordjournals.eurheartj.a059519.
Opie, L.H. (1979). Role of carnitine in fatti acid metabolism of normal and ischemic myocardium. Am. Heart J., 97 (3), 375-388. DOI: 10.1016/0002-8703(79)90440-x.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Actual Problems of Pediatrics, Obstetrics and Gynecology
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish in this journal agree to the following terms:
1. The authors reserve the right to authorship of the work and pass the journal right of first publication of this work is licensed under a Creative Commons Attribution License, which allows others to freely distribute the work published with reference to the authors of the original work and the first publication of this magazine.
2. Authors are entitled to enter into a separate agreement on additional non-exclusive distribution of work in the form in which it was published in the magazine (eg work place in the electronic repository institution or publish monographs in part), provided that the reference to the first publication of this magazine.
3. Policy magazine allows and encourages authors placement on the Internet (eg, in storage facilities or on personal websites) manuscript of how to submit the manuscript to the editor and during his editorial processing, since it contributes to productive scientific discussion and positive impact on the efficiency and dynamics of citing published work (see. The Effect of Open Access).
