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[The course of ischemic heart disease in rheumatic defects in persons over 45]
Insights
Rheumatic heart disease patients frequently develop coronary heart disease (CHD) complications like myocardial infarction and angina pectoris. Angina pectoris significantly worsens prognosis, especially in older adults and those with heart failure.
Area of Science:
- Cardiology
- Rheumatology
- Internal Medicine
Background:
- Rheumatic heart disease (RHD) poses significant risks for developing coronary heart disease (CHD).
- Understanding the specific CHD manifestations in RHD patients is crucial for prognosis and management.
Observation:
- A study followed 239 RHD patients, identifying high incidences of myocardial infarction (MI) (16.73%), cardiosclerosis (CS) (41.84%), and angina pectoris (AP) (77.4%).
- AP was more common in isolated valvular disease, while combined AP and CS occurred in combined forms.
- Stable AP was prevalent, but unstable forms affected one-fifth of patients.
Findings:
- AP incidence was higher in elderly patients, women with aortic valvular disease, men with stage III circulatory failure, and those with cardiomegaly.
- MI presented with moderate pain and often led to circulatory failure. Electrocardiographic changes in MI resembled rheumatic carditis.
- Post-MI CS accelerated chronic congestive heart failure in over 93% of patients.
Implications:
- Early detection and management of CHD in RHD patients are vital.
- Targeted interventions for AP and MI complications can improve patient outcomes.
- Further research into the specific pathophysiological links between RHD and CHD is warranted.
Abstract:
Coronary heart disease (CHD) was followed up in 239 patients with rheumatic heart disease. According to the clinical data 40 (16.73%) patients had myocardial infarction (MI), 100 (41.84%) cardiosclerosis (CS), 185 (77.4%) angina pectoris (AP). AP (44.35%) prevailed among the isolated (66.1%) forms of valvular disease, associated AP and CS (23%) among the combined (33.9%) forms. In the majority of patients, AP originated and ran its course as stable throughout many years; in one-fifth of patients, the disease occurred as unstable. The incidence of AP was significantly higher in the senior age group, in women with aortic valvular disease, in men with stage III circulatory failure, and in cardiomegaly, AP aggravated the disease and life prognosis. MI was manifested by a moderately pronounced painful attack; it was frequently complicated by acute or incremental chronic circulatory failure. Small-focal MI was seen more frequently while the electrocardiographic changes associated with the disease resembled those seen in rheumatic carditis. Postinfarction CS stimulated the onset and progress of chronic congestive heart failure in 93.02% of patients.