THE EFFECTIVENESS AND SAFETY OF THERAPY OF ARRHYTHMIC AND AUTONOMIC DISORDERS IN PATIENTS WITH CHRONIC CORONARY SYNDROME AFTER COMMUNITY ACQUIRED PNEUMONIA
DOI:
https://doi.org/10.11603/1811-2471.2021.v.i4.12805Keywords:
chronic coronary heart disease, community-acquired pneumonia, arrhythmias, autonomic dysfunc-tion, L-arginineAbstract
SUMMARY. Сommunity-acquired pneumonia (CAP) in anamnesis is designed to cause dysfunction of neuroregulatory systems, to cause arrhythmic disorders, which affects the course of chronic coronary syndrome (CCS).
The aim – to assess the effectiveness and safety of corrections of arrhythmic and autonomic disorders in patients with CCS after CAP with the help of inclusion into the basic therapy of L-arginine.
Material and Methods. The study included 60 patients with CCS: stable angina pectoris II–III functional class, who had prior CAP of the III clinical group (age 70.5 (65.76; 72.24) years, men – 55.67 %, women – 44.33 %. Depending on the prescribed treatment, patients were divided into 2 subgroups: subgroup 1 – 30 people who received only basic therapy of CCS and CAP, subgroup of 2 – 30 patients who were added exogenous L-arginine to the basic therapy according to the scheme. A comprehensive clinical study in accordance with the National Recommendations, daily ECG monitoring by Holter using the device "Cardiosens K" (KHAI MEDICA, Ukraine) according to the generally accepted method were performed.
Results. Under the influence of basic therapy with the addition of L-arginine in patients with CCS after CAP, a decrease in the total duration of tachycardia during the day by 33.13 %, the number of ventricular arrhythmias by 63.2 %, the duration of ST segment depression by 74.36 % was observed. Paroxysms of atrial fibrillation after treatment were not recorded in any patients of subgroup 2, while in subgroup 1 were observed in 3 (10 %) patients. Additional administration of L-arginine on the background of basic treatment helped to increase the overall variability of heart rate (rMSSD and TP) and restore sympathetic-parasympathetic balance (LF/ HF ratio) due to the growth of the parasympathetic component, which was more significant in the active period.
Conclusion. The addition of exogenous L-arginine to the basic treatment of patients with CCS after CAP helps to reduce arrhythmic, ischemic disorders on the background of restoring the overall variability of heart rhythm and normalization of sympatho-parasympathetic imbalance.
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