Патогенетичні передумови перебігу бронхіальної астми у поєднанні з ішемічною хворобою серця

Abstract

На основании изучения особенностей клинического течения бронхиальной астмы (БА) у 36 пациентов, находившихся на стационарном лечении в терапевтическом отделении клиники ОНМедУ в 2013–2014 гг., было выявлено, что у 30,5 % больных диагнозу БА сопутствовала ишемическая болезнь сердца (ИБС), диагностированная до поступления в стационар. За период госпитализации еще у 7 (22,2 %) пациентов выявлены на ЭКГ изменения реполяризации: ST-депрессия или элевация на 1–2 мм, уплощение, остроконечный или отрицательный зубец Т. Таким образом, в группе высокого кардиоваскулярного риска выявлено 52,7 % больных БА. Проведенные исследования позволили сделать вывод о целесообразности введения в алгоритм диагностики БА холтеровского мониторирования ЭКГ, тредмил-теста либо велоэргометрии, биохимических маркеров повреждения миокарда, позволяющих провести уточненную диагностику и оптимальную терапию больных с сочетанной патологией (БА и ИБС).

Peculiarity of this comorbidity is the fact that initially coronary heart disease (CHD) occurs latently and “masking” for respiratory symptoms such as cough, expiratory dyspnea, suffocation, chest heaviness after forced expiration, decreased exercise tolerance and quality of life. However, eventually the complaints specific to cardiovascular disease join, such as: the pain behind the sternum and in the heart and the sternum, palpitations, a feeling of “disruption”, rhythm disturbances, tinnitus and others. Also one should note that prescription of system and inhaled corticosteroids (systemic glucocorticosteroids, inhaled corticosteroids) in combination with long-acting β2-agonists, which are the leading drugs in the treatment of moderate and severe asthma currents may contribute to the development of the side and iatrogenic effects: stimulation of β1-receptors, which leads to an increase in the mechanical work of the heart, and other tachyarrhythmias arrhythmogenic effects, the syndrome of “stealing” organ pathology such as hypertension and myocardial dystrophy, accompanied by increased load on the coronary vessels and the myocardium, thereby even greater worsening of ischemic heart disease I–II functional class (FC) in combination with BA. On the basis of clinical features of asthma in 36 patients, who were hospitalized in therapeutic department ONMedU clinics in 2013–2014, the following was revealed: 30.5% of patients were diagnosed asthma accompanied by coronary artery disease (diagnosed before admission). During the period of hospitalization, even in 7 patients (22.2%) identified at the ECG repolarization changes: ST — depression or elevation (1–2 mm), flattening, spiky or negative prong T. Thus, 52.7% of patients with asthma had high cardiovascular risk. The studies led to the conclusion of appropriateness of diagnostic algorithm BA — Holter ECG, treadmill test or velergometry, biochemical markers of myocardial damage in place to refined diagnosis and optimal treatment of patients with comorbidity (BA and CHD).