CLINICAL MANIFESTATIONS OF VENTRICULAR TACHYARRHYTHMIAS IN MODERN INTERPRETATION

Аннотация

For many years, coronary heart disease (CHD) has been the main cause of death in many economically developed countries, including Uzbekistan. New diagnostic technologies and improvements in the prognostic assessment of patients, along with the ever-evolving evidence base for different treatment strategies, require regular review and updating of existing recommendations. Key words: Angina, tension angina, stable angina. СОВРЕМЕННЫЕ ПУТИ ВОЗНИКНОВЕНИЯ И ПРОФИЛАКТИКИ СТАБИЛЬНОЙ СТЕНОКАРДИИ. Аннотация. На протяжении многих лет ишемическая болезнь сердца (ИБС) является основной причиной смертности во многих экономически развитых странах, в том числе в Узбекистане. Новые диагностические технологии и улучшения в прогностической оценке пациентов, а также постоянно развивающаяся доказательная база для различных стратегий лечения требуют регулярного пересмотра и обновления существующих рекомендаций. Ключевые слова: Стенокардия, стенокардия напряжения, стабильная стенокардия. Complications: The most commonly diagnosed form of coronary artery disease is stable angina. Stable angina is a clinical syndrome characterized by chest discomfort that occurs during physical exertion or emotional stress. The attack occurs at the same load level and passes within 1-5 minutes. after termination. Purpose of study: Patients with stable angina are considered to have a relatively good prognosis. In clinical trials of antianginal and prophylactic therapy and/or revascularization, the annual mortality rate is 1.2-2.4% per year [1-6], the annual rate of cardiac death is 0.6-1.4% and death between non-lim myocardial infarction (MI). 0.6% in the RITA-2 (Second Randomized 74 Interventional Treatment of Angina) trial [4] and 2.7% in the COURAGE (Clinical Outcomes Using Revascularization and Aggressive Drug Evaluation) [1] trial. However, the individual prognosis of a particular patient with stable angina can vary significantly depending on his main clinical, functional and anatomical features. Research results: This is shown in data from the REACH (Reducing Atherothrombosis for Sustainable Health) [7] registry: the annual mortality rate in high-risk patients with peripheral arterial disease, post-infarction cardiosclerosis and diabetes mellitus (DM) is 3.8% formed, and in low-risk patients it was 3.8%. Prognostic assessment is an important part of the diagnosis of stable angina. On the one hand, there is a need to identify patients with more severe disease whose outcomes may be improved by more aggressive treatment, including revascularization. On the other hand, it is also important to identify patients with less severe disease and better prognosis, thereby avoiding unnecessary aggressive tests and revascularization procedures. The prognosis is determined by several factors: 1. Coronary reserve, i.e. increased work of the left ventricle and the possibility of sufficient increase in coronary blood flow with the amount of myocardium with insufficient blood supply. In conditions of energy starvation, the contractility of the myocardium can be significantly reduced, which leads to ischemia of a large part of the left ventricle or a small heart failure, but this is enough to reduce the function of the pump and increase the existing contractility disorders. previous myocardial injury. 2. risk factors that accelerate the development of atherosclerosis and the formation of unstable plaque, the sudden rupture of atheromatous plaque responsible for the development of unstable angina and acute coronary events are not related to the severity of pre-existing stenosis. According to the 2013 ESC guidelines for the diagnosis and treatment of stable angina, once stable CAD is diagnosed and optimal medical therapy (OMT) is initiated, coronary risk stratification is performed based on invasive tests that are not usually available. selection of patients who may benefit from revascularization. Depending on the severity of symptoms, early coronary angiography can be performed with appropriate confirmation of the importance of stenoses and subsequent revascularization, bypassing noninvasive tests. Revascularization confers a clear prognostic benefit only in high-risk patients and provides little or no improvement in prognosis in those who already have a good prognosis. Previously, in the ESC recommendations [8], an annual risk of cardiac death greater than 2% was considered the recommended threshold for revascularization. The 2013 guidelines [9] 75 revised the severity of angina pectoris, suggesting that surgical treatment significantly improves the prognosis compared to medical treatment and that high-risk patients should be considered those with a risk of cardiac death greater than 3% per year did Summary: Duke treadmill index = exercise time in minutes - 5 × ST deviation in mm - 4 × angina index (angina index: 0 - angina was absent, 1 - angina appeared, 2 - angina to stop the test caused). An approximate assessment of the risk of myocardial infarction and deat