CLINICAL FEATURES OF THE REHABILITATION PERIOD AFTER THE PREVIOS MYOCARDIAL INFARCTION AND DECOMPENSATED HEART FAILURE WITH ACCOUNT OF CARDIOVASCULAR RISK FACTORS

Cardiovascular diseases (CVD) are known to account for one-third of all deaths worldwide. According to the American Heart Association, 18% of men and 35% of women with prior acute myocardial infarction (AMI) developed recurrent AMI within 6 years after initial MI; 22% of men and 46% of women were disabled due to the development of chronic heart failure (CHF). The purpose of the research: to analyse clinical features of recovering period after myocardial infarction taking into account cardiovascular risk factors. Materials and methods of the research. 175 persons with myocardial infarction and related risk factors were examined. Study groups were homogenous by age, gender, disease severity, clinical signs of decompensation, that served as a basis for inclusion of the patients in the research. All patients underwent the general-clinical examination (pain syndrome analysis, medical history, objective signs), clinical and instrumental (electrocardiography, echocardioscopy, 6-minute walk test, in a quiet 30-50-m long hospital corridor in the morning) and laboratory tests (lipidogram, leptin level). Study groups were homogenous by age, gender, disease severity, duration of the post-infarction period, clinical signs of decompensation. All patients were divided into groups according to the presence of risk factors: group 1 of MI with HF (74 patients), group 2 – MI with AH (76 patients), group 3 – MI and obesity (72 patients); group 4 consisted of patients with all risk factors (78 patients) together. The obtained results were statistically processed on the personal computer by means of an advanced analytics software package STATISTICA-7 and a statistical software package “Microsoft-Excel” using the statistical variation analysis. Research results and their discussion. The most important cardiovascular risk factors, which aggravate the post infarction period are age, arterial hypertension, diabetes mellitus, heart failure, congenital and acquired valvular defects, obesity. In patients with heart failure, recovering period is characterized by stabile heartbeat, reduced exercise tolerance combined with progressing dilatation of left ventricular chambers in 83.78% of patients. Patients with arterial hypertension have stable anginal pain syndrome and reduced exercise tolerance (89.47% of cases). In obese patients, consistent fatigue, general weakness, dyspnoea, high levels of total cholesterol and leptin in blood serum (81.94% of patients) are mostly observed. In patients with combined heart failure, arterial hypertension, obesity, the recovery period clinics after myocardial infarction is characterized by significantly reduce of exercise tolerance (92.30% of patients). Shortness of breath, which was accompanied by heart palpitations, was prevalent in the group of patients with HF (89.1%) and was the least manifested in the group of patients with obesity (52.7%). Conclusions. Changes in cardiac hemodynamics in patients who had undergone the myocardial infarction with concomitant heart failure and with a combination of risk factors were accompanied by the eccentric hypertrophy onset, characterized by a combination of the left venricle cavities dilation with hypertrophy of its walls and the decreased contractility. The presence of decompensated heart failure significantly degrades the performance of six-minute walk test.