Remodeling of the heart and blood vessels, features of anxiety-depressive status in elderly patients with myocardial infarction in combination with atrial fibrillation


DOI: https://dx.doi.org/10.18565/therapy.2020.7.22-27

Neobutov N.N., Kolbasnikov S.V

1) City Clinical Hospital No. 7, Tver; 2) Tver State Medical University of the Ministry of Healthcare of Russia
Objective: to evaluate the parameters of the pulse wave contour analysis and endothelial function, as well as structural and functional changes in the myocardium and the severity of emotional disorders in patients with myocardial infarction with various forms of atrial fibrillation (AF) in order to include psychocorrectional measures in cardiac rehabilitation.
Material and methods. The study was conducted in 138 patients (average age 72,8±8,9 years), with a diagnosis of myocardial infarction with AF. In relation to the forms of AF patients were classified into 2 groups: the 1st consisted of 83 (60.1%) patients with a paroxysmal form, the 2nd group – 55 (39.9%) with a constant form.
Results. As the study showed, the most unfavorable course of myocardial infarction occurs in patients with a constant form of AF, in the form of significant structural changes in the myocardium, namely, there was a statistically significant increase in LP 4,6±0,6 mm; PP 4,2±0,5 mm; SLA 41,1±8,6 mm, combined with signs of severe heart failure. Similarly, a photoplethysmographic method revealed a decrease in the elasticity of the arterial vascular wall, a significant increase in PD (600,9±16,2 m/s) was recorded; a decrease in RI of (21,2±2,3%) and a significant violation of endothelial function in the large muscle arteries, with a statistically significant decrease in SF (12,2±2,6 ms), especially in eldery patients with a constant form of AF. With a paroxysmal form of AF the emotional load is characterized mainly by depressive disorders, and with a constant form – anxious disorders.
Conclusions. In patients with myocardial infarction with a constant form of AF, in contrast to patients with a paroxysmal form, significant structural changes in the myocardium, endothelial dysfunction with a decrease in the elasticity of the arterial vascular wall are noted. This study for the first time links emotional disorders in elderly patients with myocardial infarction in various forms of AF, that must be taken into account when conducting preventive and psychocorrectional measures and solving expert issues.
Keywords: myocardial infarction, atrial fibrillation, vascular wall stiffness, anxiety-depressive disorders
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About the Autors

Nikolay. N Neobutov, cardiologist of City Clinical Hospital No. 7. Address: 170036, Tver, 76/1 Petersburgskoe highway. Tel.: +7 (915) 729-36-64. E-mail: gitarast16@mail.ru. ORCID: 0000-0002-4486-3444
Sergey. V. Kolbasnikov, MD, professor, head of the Department of general medical practice (family medicine) of faculty of continuing professional education of Tver State Medical University of the Ministry of Healthcare of Russia.
Address: 170100, Tver, 4 Sovetskaya Str. Tel.: +7 (4822) 56-19-88 E-mail: s.kolbasnikov@mail.ru

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