Роль холтерівського моніторування електрокардіограми в діагностиці синкопальних станів

Abstract

Холтерівський моніторинг електрокардіограми – один із найбільш поширених неінвазивнихь методів діагностики серцево-судинної патології. Нами проведено аналіз результативності даного методу в діагностиці синкопальних станів. Проаналізовано клінічні результати моніторингу електрокардіограми 45 пацієнтів, які мали синкопальні стани. Хворі були розподілені по трьом віковим групам: І група (19 осіб (середній вік склав 22,6±2,98 роки)); ІІ група (15 осіб (середній вік склав 49,7±3,13 роки)); ІІІ група (11 осіб (середній вік склав 67,9±4,51 роки)). Серцево-судинна патологія виявилась найбільш частою причиною синкопальних станів у пацієнтів ІІІ вікової групи.

Холтеровское мониторирование электрокардиограммы – наиболее распространенный неинвазивный метод диагностики сердечно-сосудистой патологии. Нами проведен анализ результативности данного метода в диагностике синкопальных состояний. Проанализированы клинические результаты мониторирования электрокардиограммы 45 пациентов, которые имели синкопальные состояния. Больные были распределены по трем возрастным группам: І группа (19 человек (средний возраст составил 22,6±2,98 лет)); ІІ группа (15 человек (средний возраст составил 49,7±3,13 лет)); ІІІ группа (11 человек (средний возраст составил 67,9±4,51 лет)). Сердечно-сосудистая патология оказалась наиболее частой причиной синкопальных состояний у пациентов ІІІ возрастной группы.

Electrocardiogram Holter monitoring (EKG HM) is a convenient and informative non-invasive method of diagnostics, evaluation of clinical progression and treatment rates of cardiac rhythm disorders, cardiac conduction, and cardiac muscle ischemia. EKG HM results have important diagnostic meaning in identifying reasons of syncope conditions (SCs). We are interested in study of EGK Holter monitoring efficiency in diagnostics of syncope conditions. We have analyzed EKG HM results of 45 patients who had in their past medical history or were examined with respect to emergence of syncope conditions and hospitalized at Municipal Institution “City Clinical Hospital No. 3” of Chernivtsi city during last five years. All patients undergone EKG HM during 24 (66.7% of patients), 48 (22.2% of patients) and 72 (11.1% of patients) hours using DiaCard portable system, version 2.1.166 (manufactured by Solvaig, Hungary). Having analyzed the results it must be noted that 18 (%) patients suffered from the SCs were men, and 27 (%) patients were women. By age the patients were divided into three groups: І group (young people – 18 to 44 years old) – 19 people (average age is 22.6±2.98 years); ІІ group (middle-aged people – 45 to 59 years old) – 15 people (average age is 49.7±3.13 years); ІІІ group (seniors – 60 to 74 years old) – 11 people (average age is 67.9±4.51 years). In 33.33% of cases analysis of EKG HM was informative and comparable with clinical implications. In 6.67% of cases detected changes of EKG HM can only scent possible cardiac reasons of the SCs, however they do not provide a clear answer as to their origin. In 60% of cases EKG HM results were informative in view of SC reasons. It should be noted that for patients of the І age group sick sinus syndrome was one possible reasons of SC cardiac origin and tachycardia with heart rate of >150 BPMs during the monitoring. As it was found out in course of further examination the last one was a manifestation of thyroid diseases. In case of middle-aged patients most frequent reasons of the SCs are delayed conduction of ІІ-ІІІ degree and supraventricular tachycardia. In course of further diagnostic search 2 patients (10.53%) of І group were diagnosed epilepsy, a reason of the SC was vasovagal condition for 2 patients (10.53%), for the 1 patient (5.2%) – orthostatic hypotension. In case of 1 patient (6.6%) of the ІІ age group a SC reason of was progress of aortic stenosis for the last two years. In case of 2 patients (18.2%) of the ІІІ group a SC reason was transitory ischemic attacks. In case of 14 (31.1%) of all examined patients it was impossible to identify reasons of the syncope conditions. Thus, EKG HM is a compulsory examination method for patients suffered from syncope conditions. It is informative in diagnostics of cardiac reasons of the SCs. It is required to make a diagnosis at the stage differential diagnostics.