Ta'lim innovatsiyasi va integratsiyasi

FEATURES OF HEART FAILURE IN PATIENTS WITH CORONARY HEART DISEASE AND THYROTOXICOSIS

Khusainova Munira Alisherovna

Muydinov Alimardon Ismatullayevich

Ergashova Nargiza Nuriddinovna

Keywords: Keywords: chronic heart failure, coronary heart disease, thyrotoxicosis, vegetative imbalance, threshold level NT-proBNP, left ventricular remodeling.

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Abstract

ABSTRACT
Goal. To evaluate the diagnostic significance of criteria for chronic heart failure
(CHF) and to study the features of structural and functional remodeling of the left heart
in patients with coronary heart disease (CHD) and thyrotoxicosis.
Material and methods. 131 patients aged 45-65 years with coronary heart disease
were examined, CHF and/or thyrotoxicosis. The clinical condition of patients and
exercise tolerance were assessed, and the level of N-terminal stress was determined. A
fragment of the precursor of the cerebral natriuretic peptide (NTproBNP), Holter
electrocardiogram monitoring and echocardiographic examination (EchoCG) with
Dopplerography were performed.

Results. Cardiac arrhythmias were detected more often in patients with coronary
heart disease, CHF and thyrotoxicosis than in patients with coronary heart disease and
CHF without thyrotoxicosis (atrial fibrillation, sinus tachycardia, supraventricular
extrasystole), a more pronounced autonomic imbalance with a predominance of
activity of the sympathetic link of the autonomic nervous system. Elevated levels of
NT-proBNP (>125 pg/ml) were detected in both patients with CHF and patients with
thyrotoxicosis, regardless of the presence of cardiovascular diseases. Concentration of
NT-proBNP in patients with coronary heart disease and thyrotoxicosis without CHF
exceeded the threshold value by 2.8 times (p=0.001). The highest level of NT-proBNP
in patients with coronary heart disease, CHF and thyrotoxicosis is due to The effect on
its secretion is not only remodeling of the left ventricle (LV), but also hyperfunction of
the thyroid gland. A higher threshold value of NT-proBNP was determined (according
to the results of this study — 556.4 pg/ml) for the diagnosis of CHF with preserved
and intermediate LV ejection fraction (LVEF) in patients with coronary heart disease
and thyrotoxicosis. The analysis of echocardiography parameters in patients with
coronary heart disease, CHF and thyrotoxicosis revealed significantly lower values of
linear and volumetric LV indices, LV type I diastolic dysfunction in 100% of cases, an intermediate type of LV ejection fraction (48%), more the frequent occurrence of
concentric LV hypertrophy (84% of cases).
Conclusion. To diagnose HF in patients with coronary heart disease and
thyrotoxicosis, it is necessary to take into account the features of the clinical picture,
heart rate variability, LV remodeling, and use a higher threshold level of NT-proBNP. 

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