Effectiveness of treatment with mebicar in patients with permanent atrial fibrillation, which arose on the background of anxiety and depression.
Resume. Violation of the heart rhythm is widespread at present. Therefore, the study of this nosology is of considerable interest, since the etiology and pathogenesis of arrhythmias are the most urgent issues. Anxiety-depressive symptoms and a tendency to chronic stress lead to the depletion of the body, which contributes to the development of cardiovascular disease. Arrhythmia on the nerve soil appears as a result of frequent psycho-emotional states. Therefore, the treatment is aimed at reducing the risk of cardiovascular mortality and improving the quality of life. The aim of the study is to assess the severity of clinical and hemodynamic indices by using anxiolytic drug mebicar. Observations were performed on patients with stable coronary heart disease (SIHD) in combination with atrial fibrillation (AF) using a clinico-psychopathological method of investigation (structured interview). The level of predisposition to stress was determined on the L. Rider scale, the level of anxiety-depressive symptoms through the hospital scale of anxiety and depression of HADS by means of a survey. The PHQ-15 health questionnaire and the questionnaire for identifying social factors that may have an impact on health were used to assess health status. The study of cardiac hemodynamics was performed using an electrocardiogram (ECG). The evaluation of the free radical oxidation state was carried out using a spectrophotometric method to determine the activity of catalase, glutathione peroxidase, superoxide dismutase in the blood serum. Determination of cortisol level in serum was carried out by immunoassay (ELISA) on the ER-500 Microplate Reader. The concentration of N-terminal fragment of the brain natriuretic peptide precursor (NTproBNP) in serum was determined by ELISA using a Biosan PST-60HL shaker. The results of the survey showed a direct dependence of the manifestation of AF on the level of psychoemotional stress. We found that in group 1b there were complaints of increased excitability (p<0.001), (p-reliability difference of indices before and after treatment), fatigue (p<0.001), deterioration of memory (p<0.01), loss appetite (p<0.05), sleep disturbance (p <0.001), signs of severe sweating (p<0.001), indicating the appearance of astheno-vegetative syndrome. The reduction of manifestations of high stress (p<0.01) in patients of group 1b was noted. A similar pattern was detected in the severity of anxiety in men (p<0.01). The manifestations of somatization disorders (p<0.01), (p<0.001) in the corresponding groups of patients under investigation were determined. Among the social factors influencing health are the presence of the nervous atmosphere at home (p<0.01), the influence of the media (p<0.01), political events (p<0.01). The value of the ECG parameters confirms the violation of the processes of intra-ventricular conduction repolarization (p<0.05), (p<0.001). After analyzing the activity of catalase, glutathione peroxidase (GP), superoxide dismutase (SOD), we can note that the higher the level of psychological distress, the higher the data of the indicators and, accordingly, more distinct signs of antioxidant oxidation are: SOD – 49.87±1.59 and 37.80±5,37 (p<0.05), catalase – 17.67±1.50 and 11.11±2.08 (p<0.05). Determination of the content of cortisol also depends on what level of anxiety-depressive symptoms (p<0.05). In patients, we observed an elevated serum NT-proBNT level probably against a background of a deteriorated course of the disease (p>0.05).
Application in the complex therapy of patients with SIHD in conjunction with AF anxiolytics of the benzodiazepine series (mebicar) has allowed stopping anxiety-depressive disorders. After the treatment, the clinico-psychopathological examination confirmed the reliably positive dynamics of the psychological status of patients. Indicators of the spectrophotometric method and the titration method indicated that the higher the anxiety-depressive symptoms, the higher the rates of free radical oxidation. Analyzing the level of cortisol, we observed its increase depending on the degree of anxiety and depression; NT-proBNT metrics are respectively.
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