Журнал «Медицина неотложных состояний» 1 (56) 2014

Bradysistolic violations of heart rhythm (bradyarrhythmias) is a broad spectrum of arrhythmias, which differ according to the etiology, the pathogenesis, the mechanism of the emergence and the versions of the clinical course. A typical consequence of most bradyarrhythmias are increased heart failure and excessive increase of the degree of cognitive dysfunction. The duration of the retention of bradyarrhythmias and the progression of cognitive disorders – defining moment in relation to quality of life, as well as the nearest and remote prognosis in these patients. Seems appropriate to establish a relationship of neurological symptomatology is not only with the neuropsychologicaltesting, but also with changes of activity markers of inflammation, which play an important role in the pathogenesis of both bradyarrhythmias and vascular cognitive disorder.

Aim.The study of clinical diagnostic value the concentration of inflammation mediators (С-reactive protein, interlejkin-6, tumor necrosis factor-alpha) in patients withcognitive dysfunction in different clinical forms of bradyarrhythmias.

Methods.Found 47 patients (the average age of 59.7 ± 6.3 years) with with different clinical forms of bradyarrhythmias with coronary heart disease. Formed four groups: 22 patients with atrioventricular blockade II degree, 14 – with atrioventricular blockade III degree, 11 – with sick sinus syndrome and 20 patients with coronary heart disease without arrhythmia. All patients were determined the content of CRP, THF-α and IL-6. With the help of neuropsychological methods identified cognitive disorders in 36 patients who determined the levels of inflammatory markers and their correlation with the results of neuropsychological testing.

Results.Bradyarrhythmiaswere accompanied by a significant increase in the concentration of  THF-α, CRP and IL-6, compared with patients with patients form without arrhythmias. Based on the results of the test, the Mini-Mental State Examination revealed significantly lower scores in patients with atrioventricular block third degree and sick sinus syndromecompared with kontrol group. Patients in the control group good correlations between THF-α and IL-6 were identified with the MMSE test on verbal associations, and hearing memory. If you have cognitive disabilities, these correlations have evolved. They found between the THF-α and the MMSE, punch Schulte. Reliable correlations also exist between the content of CRP and the results of tests Schulte and MMSE.

Conclusion.The results of the study show that the rates of local immune inflammation can be taken into account in the early diagnosis of patients with bradyarrhythmias.