Heart rhythm and autonomic regulation disorders in chronic coronary syndrome patients with community-aсquired pneumonia

Authors

DOI:

https://doi.org/10.14739/2310-1210.2021.6.235435

Abstract

Pneumonia presents a considerable challenge in patients with cardiovascular disease due to an increase in the incidence, difficulties of diagnosis and treatment, high mortality.

Aim: to study the characteristics of cardiac arrhythmias and heart rhythm autonomic regulation in patients with chronic coronary syndrome (CCS) and community-acquired pneumonia (CAP), and to define their relationship with the clinical features of the disease.

Materials and methods. A monocenter cross-sectional study analyzed 90 patients with CCS in parallel groups. The main group included 60 CCS patients with CAP; the control group consisted of 30 patients without concomitant CAP. A complex clinical examination of patients was performed on 1–3 days of hospital stay in accordance with the National Recommendations. Holter ECG monitoring was performed using a CARDIOSENS K device (XAI-MEDICA, Ukraine).

Results. Based on the results of 24-hour ECG monitoring, heart rhythm disorders, increased duration of myocardial ischemia and ST-segment depression depth with an increase in the total duration of tachycardia episodes within 24 hours were more common in the main group patients. The severity of CAP on the PSI/PORT scale was correlated with the 24-hour mean heart rate (r = +0.31, P < 0.05), the number of ventricular extrasystoles – with respiratory rate (r = +0.29, P < 0.05), supraventricular extrasystoles – with the duration of ST-segment depression (r = +0.57, P < 0.05).

In patients with CCS and CAP, there was a decrease in the total heart rate variability (HRV), mainly in the passive period, combined with an increase in the LF/HF ratio and stress index (SI), which was directly correlated with the severity of CAP and intoxication syndrome.

Conclusions. Patients with CCS and CAP are characterized by the increased 24-hour heart rate, duration of ST-segment depression, frequency of supraventricular and ventricular arrhythmias on 24-hour Holter monitoring, paroxysms of atrial fibrillation with the decreased total HRV combined with significantly increased activity of the sympathetic autonomic nervous system.

Author Biographies

T. O. Kulynych, Zaporizhzhia State Medical University, Ukraine

MD, PhD, Associate Professor, Department of General Practice – Family Medicine and Internal Diseases

O. O. Lisova, Zaporizhzhia State Medical University, Ukraine

MD, PhD, Associate Professor, Department of General Practice – Family Medicine and Internal Diseases

O. V. Shershnova, Zaporizhzhia State Medical University, Ukraine

MD, PhD, Associate Professor, Department of General Practice – Family Medicine and Internal Diseases

A. V. Hrytsai, Zaporizhzhia State Medical University, Ukraine

MD, PhD, Associate Professor, Department of General Practice – Family Medicine and Internal Diseases

References

Lazoryshynets, V. V. (2020). Stratehichna rol simeinoi medytsyny u profilaktytsi sertsevo-sudynnykh katastrof [Strategic Role of Family Medicine in the Prevention of Cardiovascular Accidents]. Ukrainskyi zhurnal sertsevo-sudynnoi khirurhii, (3), 7-8. https://cvs.org.ua/index.php/ujcvs/article/view/359/371 [in Ukrainian].

Dyachenko, V. V., Bychkova, S. A., Zhelekhovsyj, O. A., Taranukhin, S. S., Tumarova, E. M., Petukhova, I. G., & Starokon, L. V. (2020). Osoblyvosti klinichnoho perebihu nehospitalnoi pnevmonii u khvorykh iz suputnoiu khronichnoiu sertsevoiu nedostatnistiu [The peculiarities of clinical course of community-acquired pneumonia in patients with concomitant chronic heart failure]. Suchasni aspekty viiskovoi medytsyny, 27(1), 76-85. https://doi.org/10.32751/2310-4910-2020-27-08 [in Ukrainian].

Abbasi, M., Neishaboury, M., Koohpayehzadeh, J., Etemad, K., Meysamie, A., Asgari, F., Noshad, S., Afarideh, M., Ghajar, A., Ganji, M., Rafei, A., Mousavizadeh, M., Khajeh, E., Heidari, B., Saadat, M., Nakhjavani, M., & Esteghamati, A. (2018). National Prevalence of Self-Reported Coronary Heart Disease and Chronic Stable Angina Pectoris: Factor Analysis of the Underlying Cardiometabolic Risk Factors in the SuRFNCD-2011. Global Heart, 13(2), 73-82.e1. https://doi.org/10.1016/j.gheart.2018.01.001

Ferraro, R., Latina, J. M., Alfaddagh, A., Michos, E. D., Blaha, M. J., Jones, S. R., Sharma, G., Trost, J. C., Boden, W. E., Weintraub, W. S., Lima, J., Blumenthal, R. S., Fuster, V., & Arbab-Zadeh, A. (2020). Evaluation and Management of Patients With Stable Angina: Beyond the Ischemia Paradigm: JACC State-of-the-Art Review. Journal of the American College of Cardiology, 76(19), 2252-2266. https://doi.org/10.1016/j.jacc.2020.08.078

Nakas, G., Bechlioulis, A., Marini, A., Vakalis, K., Bougiakli, M., Giannitsi, S., Nikolaou, K., Antoniadou, E. I., Kotsia, A., Gartzonika, K., Chasiotis, G., Bairaktari, E., Katsouras, C. S., Triantis, G., Sionis, D., Michalis, L. K., & Naka, K. K. (2019). The importance of characteristics of angina symptoms for the prediction of coronary artery disease in a cohort of stable patients in the modern era. Hellenic Journal of Cardiology, 60(4), 241-246. https://doi.org/10.1016/j.hjc.2018.06.003

Dziublyk, Y. O. (2020). Nehospitalna pnevmoniia i COVID-19: dyskusiini pytannia [Community-acquired pneumonia and COVID-19: discussion issues]. Ukrainskyi pulmonolohichnyi zhurnal, (4), 12-14. https://doi.org/10.31215/2306-4927-2020-110-4-12-14 [in Ukrainian].

Zaikov, S. V. (2020). COVID-19 i komorbidni khronichni zakhvoriuvannia [COVID‑19 and comorbid chronic diseases]. Infusion & Chemotherapy, (3), 5-10. https://doi.org/10.32902/2663-0338-2020-3-5-10 [in Ukrainian].

Ticona, J. H., Zaccone, V. M., & McFarlane, I. M. (2020). Community-Acquired Pneumonia: A Focused Review. American Journal of Medical Case Reports, 9(1), 45-52. https://doi.org/10.12691/ajmcr-9-1-12

Wunderink, R. G., & Waterer, G. (2017). Advances in the causes and management of community acquired pneumonia in adults. BMJ, 358, Article j2471. https://doi.org/10.1136/bmj.j2471

Yeh, J.-J., Lin, C.-L., & Kao, C.-H. (2019). Relationship between pneumonia and cardiovascular diseases: A retrospective cohort study of the general population. European Journal of Internal Medicine, 59, 39-45. https://doi.org/10.1016/j.ejim.2018.08.003

Di Pasquale, M., Henchi, S., Vanoni, N., & Blasi, F. (2017). Cardiovascular complications in patients with community-acquired pneumonia. Community Acquired Infection, 4(2), 23-31. https://doi.org/10.4103/cai.cai_7_17

Almirall, J., Serra-Prat, M., Bolíbar, I., & Balasso, V. (2017). Risk Factors for Community-Acquired Pneumonia in Adults: A Systematic Review of Observational Studies. Respiration, 94(3), 299-311. https://doi.org/10.1159/000479089

Mykhailovska, N., & Kulynych, T. (2017). The influence of community-acquired pneumonia on the clinical course of coronary heart disease: the results of retrospective analysis. ScienceRise: Medical Science, (11), 52-56. https://doi.org/10.15587/2519-4798.2017.116826

Mykhailovska, N. S., Kulynych, T. O., Grytsai, H. V., Lisova, O. O., & Riznyk, O. I. (2019). The possibilities of prediction the coronary heart disease course after community acquired pneumonia. Wiadomosci lekarskie, 72(10), 1917-1923.

Feldman, C., Normark, S., Henriques-Normark, B., & Anderson, R. (2019). Pathogenesis and prevention of risk of cardiovascular events in patients with pneumococcal community-acquired pneumonia. Journal of Internal Medicine, 285(6), 635-652. https://doi.org/10.1111/joim.12875

Ruiz, L. A., Serrano, L., España, P. P., Martinez-Indart, L., Gómez, A., González, B., Artaraz, A., & Zalacain, R. (2021). New-onset atrial fibrillation in patients with pneumococcal pneumonia. Impact of timing and duration on short- and medium-term mortality. Journal of Infection, 82(1), 67-75. https://doi.org/10.1016/j.jinf.2020.11.005

Özdemir, İ. H., Özlek, B., Özen, M. B., Gündüz, R., Çetin, N., & Bilge, A. R. (2020). Hydroxychloroquine/azithromycin treatment, QT interval and ventricular arrhythmias in hospitalised patients with COVID‐19. International Journal of Clinical Practice, 75(2), Article e13896. https://doi.org/10.1111/ijcp.13896

Mjelva, Ø. R., Svingen, G., Pedersen, E., Seifert, R., Kvaløy, J. T., Midttun, Ø., Ueland, P. M., Nordrehaug, J. E., Nygård, O., & Nilsen, D. (2018). Fibrinogen and Neopterin Is Associated with Future Myocardial Infarction and Total Mortality in Patients with Stable Coronary Artery Disease. Thrombosis and Haemostasis, 118(4), 778-790. https://doi.org/10.1055/s-0038-1629912

Sibelius, U., Grandel, U., Buerke, M., Mueller, D., Kiss, L., Kraemer, H.-J., Braun-Dullaeus, R., Haberbosch, W., Seeger, W., & Grimminger, F. (2000). Staphylococcal α-Toxin Provokes Coronary Vasoconstriction and Loss in Myocardial Contractility in Perfused Rat Hearts: Role of Thromboxane Generation. Circulation, 101(1), 78-85. https://doi.org/10.1161/01.cir.101.1.78

Restrepo, M. I., & Reyes, L. F. (2018). Pneumonia as a cardiovascular disease. Respirology, 23(3), 250-259. https://doi.org/10.1111/resp.13233

Cilli, A., Cakin, O., Aksoy, E., Kargin, F., Adiguzel, N., Karakurt, Z., Ergan, B., Mersin, S., Bozkurt, S., Ciftci, F., & Cengiz, M. (2018). Acute cardiac events in severe community-acquired pneumonia: A multicenter study. The Clinical Respiratory Journal, 12(7), 2212-2219. https://doi.org/10.1111/crj.12791

Kaliyaperumal, D., Rk, K., Alagesan, M., & Ramalingam, S. (2021). Characterization of cardiac autonomic function in COVID-19 using heart rate variability: a hospital based preliminary observational study. Journal of Basic and Clinical Physiology and Pharmacology, 32(3), 247-253. https://doi.org/10.1515/jbcpp-2020-0378

Pieralli, F., Vannucchi, V., Nozzoli, C., Augello, G., Dentali, F., De Marzi, G., Uomo, G., Risaliti, F., Morbidoni, L., Mazzone, A., Santini, C., Tirotta, D., Corradi, F., Gerloni, R., Gnerre, P., Gussoni, G., Valerio, A., Campanini, M., Manfellotto, D., Fontanella, A., … FADOI-ICECAP Study Group. (2021). Acute cardiovascular events in patients with community acquired pneumonia: results from the observational prospective FADOI-ICECAP study. BMC Infectious Diseases, 21(1), Article 116. https://doi.org/10.1186/s12879-021-05781-w

Published

2021-10-29

How to Cite

1.
Kulynych TO, Lisova OO, Shershnova OV, Hrytsai AV. Heart rhythm and autonomic regulation disorders in chronic coronary syndrome patients with community-aсquired pneumonia. Zaporozhye Medical Journal [Internet]. 2021Oct.29 [cited 2024Oct.5];23(6):766-71. Available from: http://zmj.zsmu.edu.ua/article/view/235435

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Original research