Dudchenko M. A., Shtompel V. Yu., Tretyak N. G.

LITERATURE REVIEWS

Scentific article

The problem of complication of the diagnosis and treatment of coronary heart disease (HCD) is often due to polymorbidity. Particulary important is the combination of HCD with extracardiac diseases, which also have cardiovascular disorders. The problems of association of HCD with osteochondrosis of the spine, vascular pathology of the brain, diseases of the thyroid gland and diseases of the digestive system. Features of the clinical and pathogenetic flow of HCD in combination with these pathological conditions and mechanisms of their mutual encumbrance. Reflector and projection effects between the heart and the spine, neck, shoulder, chest tissue with the combination of HCD and cervico-upperthoracic osteochondrosis are important. This thingnificantly changes the typical picture of HCD and is characterized by protracted intractable states, severe pain irritation, association with both physical activity and changes in the position of the body, hands, cough, and at rest. The mutual burden of cardio-vertebral pathology was based on more pronounced hemodynamic, rheological and metabolic disorders. In this case, neurological manifestations of cervical chest osteochondrosis were mainly left-sided. For the integral determination of the indigenous pathogenesis of HCD in combination with cerviocthoracic osteochondrosis, the authors proposed a stress vertebrate test for the rectal electrocardiogram under mechanical load on the spine and a method for instrumental diagnosis of degenerative changes in intervertebral discs. The research of clinical and hemodynamic indexes in patients with HCD under the influence of vegetative dysfunctions with concomitant diseases is presented: osteochondrosis of the spine, dyscirculatory encephalopathy and thyroid gland hyperplasia. The dependence of the state of central and peripheral hemodynamics on vegetative regulation options was established. Patients who have coronary artery disease and dyscirculatory encephalopathy, a predominantly hypokinetic type of circulation with a decrease in vegetative reactivity was observed. This indicates a violation of the interaction of ergotropic and trafotropic structures. Patients who have coronary artery disease and hyperplasia of the thyroid gland, the hyper- and normokinetic type of hemodynamics are prevalent and there is more adequate vegetative reactivity, but with excessive vegetative maintenance of activity. Patients who have HCD and dyscirculatory encephalopathy, the heterogeneous maintenance of activities that was not consistent with the hemodynamics components was observed more often. Decompensation vegetative functions promotes adaptive reactions of the heart and blood vessels adequacy of myocardial hemorrhage in different conditions of activity, limiting the course of coronary artery disease. The influence of concomitant diseases of the digestive system on the character of pain coronary syndrome and the state of the autonomic nervous system, patients with HCD, with the associated course of the disease was revealed. The problem of polymorbidity requires the development of perspective areas for improving the quality of diagnosis and an individualized approach to treatment of patients. Correct assessment of clinical syndromes of combined pathology allows to determine the appropriate tactics of their correction taking into account both general pathogenetic links, and differentiated manifestations with optimal selection of drugs for complex therapy

cardialgia, autonomic nervous system, hemodynamics, metabolic disturbanses.

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«Bulletin of problems biology and medicine» Issue 2 Part 2 (151), 2019 year, 30-33 pages, index UDK 616.132.2-071

10.29254/2077-4214-2019-2-2-151-30-33