CLINICAL AND INSTRUMENTAL CHARACTERISTICS OF HEART FAILURE IN PATIENTS WITH DIFFERENT FORMS OF ATRIAL FIBRILLATION
Authors: Kulaets N. M. 
Published: January 2023

The incidence of heart failure (HF) in the general population has reached an epidemic threshold, which is a very important problem for modern medicine. HF is accompanied by frequent comorbidity with atrial fibrillation (AF). At the current stage of scientific research, considerable attention is directed to improve the treatment of patients with HF on the background of AF with the aim of developing a complex and individual approach to the treatment of such patients.

The purpose. Study the clinical and instrumental features of heart failure in patients with various forms of atrial fibrillation.

Materials and methods. 90 patients aged 45-65 were examined. All patients were divided into groups: I group – patients with HF with sinus rhythm or AF (persistent and persistent), (n=50). II group - patients without HF with AF, (n=40). III – control group: 36 practically healthy people.

The control group included persons who did not have any complaints and denied any history of cardiovascular diseases. The groups probably did not differ among themselves in terms of age and gender composition.

All patients underwent a collection of complaints, disease history, life history, electrocardiography (ECG), echocardiography (ECHOKG), Holter ECG monitoring, heart rate variability (HRV), and a 6-minute walking test. AF diagnosis was carried out according to the clinical protocol for providing medical care to patients with atrial fibrillation, approved by the order of the Ministry of Health of Ukraine dated 07.03.2006 No. 436.

The diagnosis of coronary heart disease (CHD) was carried out in accordance with the order of the Ministry of Health of Ukraine No. 436 of 03.07.2006 and the classification, standards of diagnosis and treatment of cardiovascular diseases of 2021.

ECG recording was performed on a Cardiofax electrocardiograph (Electrokardiograph, 8820G, Germany) in 12 commonly accepted leads with recording of at least 4 PQRST cardiac complexes. According to the ECG data, the presence of deviation of the ST segment from the isoline, its size and shape, the polarity and amplitude of the T wave, signs of left ventricular hypertrophy, as well as the presence of heart rhythm and conduction disorders were evaluated.

Research results. The analysis of the main clinical manifestations of HF in patients with AF showed that in most cases, 20 (80.0%) of patients had an anginal attack, which was combined with a palpitation in 24 (96.0%) and interruptions in the work of the heart in 23 (92, 0%) patients, shortness of breath in 22 (88.0%), anxiety in 13 (52.0%) and lack of air in 8 (32.0%) patients. Patients with AF without HF were troubled by anginal attacks, palpitations in 22 (88.0%) patients, heart failure in 20 (80.0%), shortness of breath in 18 (72.0%) patients. In patients with HF and AF, according to the ECG, depression of the ST segment, hypertrophy of the left ventricle, dispersion of the QT interval were detected.

Conclusions:

For patients with heart failure, the presence of anginal pain syndrome, shortness of breath, palpitations and interruptions in the work of the heart is typical.

According to ECG data, ST segment depression, left ventricular hypertrophy, QT interval dispersion, atrial fibrillation, sinus tachycardia and extrasystole (supraventricular and ventricular) were found.

Patients with heart failure demonstrated a lower level of household physical activity, worse indicators of the 6-minute walk test, worse quality of life.