FUNCTIONAL CONDITION OF PATIENTS WITH CHRONIC HEART FAILURE WITH VITAMIN D DEFICIENCYJournal: Art of Medicine (Vol.3, No. 2)
Publication Date: 2019-05-28
Authors : N.I. Baryla;
Page : 6-13
Keywords : heart failure; vitamin D; exercise; breathing.;
The purpose of the work is to study the functional state of patients with chronic heart failure with vitamin D deficiency after performing a 6-minute step test. Materials and methods research. A total of 75 (46 men and 24 women) patients with chronic heart fail- ure II A severity were diagnosed with vitamin D defi- ciency (mean age 58.6 ± 6.64 years). Testing has been performed using a six-minute walking test, body mass index was calculated, external respiration rates were evaluated using spirography, and an SF-36 questionnaire has been used to assess the quality of life. The average level of vitamin D in the blood plasma of patients was 17.2 ± 0.04 ng/ml, which corresponds to its deficiency. By the level of vitamin D deficiency, all patients were divided into Group A with a high level of vitamin D deficiency up to 10.9 ng/ml, group B with an average levelof vitamin D deficiency 23.7 ng/ml. Results. In all examined patients, a decrease in the left ventricular ejection fraction to 40-49% has been detected. The main complaints are palpitations, flatu- lence, persistent dyspnea, tachypnea and orthopnea, night cough, swelling of the legs, loss of appetite, depression. During physical examination, tachycardia was detected on the background of heart rhythm disturbances, a shift of the heart push to the left by 2 cm or more, hard and wheezing, a small amount of wheezing. The result of the six-minute walking test was on average 250.5 ± 158.96 m. Of all the parameters of the 6-minute walk test, the travelled distance had the strongest correlation with indi- cators of lung function and quality of life. It was not possible to discover the advantages of the proper quanti- ties and the work of the six-minute walking test over their absolute value. The significantly lower a 6-minute walk test results found in patients with high vitamin D defi- ciency were probably due to the fact that such patients had lower consumption of fresh fruits and vegetables, fewer treatment options and were less responsible for performing medical appointments, as indicated in the quality of life questionnaire. The absolute difference of 127 m has been found in 6 patients with chronic heart failure. It also shows that people with a higher degree of vitamin D deficiency have less tolerance to physical activity. Dysfunctions of external respiration lead to more pronounced manifestations of chronic cardiac failure, so it is possible to negatively influence such disturbances to exercise tolerance. Probable correlation of a 6-minute walk test with spirometry indicates the relationship be- tween the degree of respiratory failure and exercise toler- ance. A strong 6-minute walk test with quality of life indicators shows the ability to improve the well-being with increased exercise tolerance, which can be used to evaluate the effectiveness of therapeutic regimens after a course of rehabilitation. Conclusions. In patients with chronic heart fail- ure with vitamin D deficiency, the results of a 2-step performance of six-minute walking test indicate a low exercise tolerance and have a high degree of correlation with a decrease in respiratory function, which can be used to evaluate the effectiveness of therapeutic and rehabilita- tion measures. The main factors affecting the result of the six-minute walking test were dysfunctions of external respiration, age, and the presence of asphyxiation. The other factors contributing to decreased levels of а low exercise tolerance may be overweight and poor quality of life. The effect of sex on the result of the six-minute walking test is not established.
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