Львівський клінічний вісник (Dec 2018)
The Clinical Presentation, Electrocardiogram and Echocardioscopy Features in Case of Acute Coronary Syndrome without ST Elevation Patients of Different Gender with Essential Arterial Hypertension and Helicobacter Pylori Infection
Abstract
Introduction. The acute coronary syndrome is one of the main causes of cardiovascular mortality, especially in case of comorbidities. One of the most common concomitant diseases and a risk factor of acute coronary syndrome development is essential arterial hypertension. The Helicobacter pylori infection is one of the most common infections worldwide and there is an evidence about extra abdominal manifestation of this infection including coronary artery disease due to the systemic inflammation that leads to the endothelium damage with the consequent dysfunction and enhances coagulation and atherogenesis. Nevertheless, different trials showed controversial results regarding Helicobacter pylori infection impact on coronary artery disease development and course. The possible link between Helicobacter pylori infection and electrocardiogram (ECG) and echocardioscopy changes in acute coronary syndrome without ST segment patients with essential hypertension of different age is unclear and requires clarification. Aim. To investigate the clinical presentation features, electrocardiogram and echocardioscopy changes acute coronary syndrome without ST segment elevation patients of different age with essential hypertension and Helicobacter pylori infection. Materials and methods. We examined 197 patients that were hospitalized with acute coronary syndrome without ST segment elevation and preexisting essential arterial hypertension with dyspeptic complaints in the Thanscarpathian Regional Clinical Cardiology Dispensary and cardiology intensive care unit in the Central City Clinical Hospital (Uzhhorod). The patients were examined and treated according to the acute coronary syndrome without ST segment elevation, essential arterial hypertension and dyspepsia management protocols. All patients were divided by the groups of men and women infected and not infected with Helicobacter pylori (HP + and HP – respectively). Results. The pain syndrome evaluation by the 10-point scale revealed significantly higher pain intensity in HP+ groups of acute coronary syndrome without ST segment elevation and essential arterial hypertension patients in both genders versus HP- groups and in men versus women regardless of HP infection. Physical examination showed significantly higher prevalence of calf edema among both male and female acute coronary syndrome without ST segment elevation and essential arterial hypertension patients infected with HP versus the groups of HP- ones. Abdominal ultrasound detected the significant progression of hepatomegaly in HP+ versus HP- males while in females the liver size difference in HP+ versus HP- group was not significant. ECG of HP+ versus HP- acute coronary syndrome without ST and essential arterial hypertension patients showed significantly higher frequency of rhythm disorders among men, while in women the heart rate changes (both tachycardia and bradycardia) prevailed as well as signs of left ventricular hypertrophy and myocardium ischemia. Echocardioscopy revealed significantly lower ejection fraction in the group of HP+ acute coronary syndrome without ST segment elevation and essential arterial hypertension males versus HP- ones and in men versus women regardless of HP infection while in women the difference in ejection fraction was not significant in HP+ and HP-groups. The frequency of left ventricular hypertrophy was higher in the groups of HP+ patients (80.0 % in men and 40.0 % in women) versus HP- groups (70.0 % among men and 28.0 % in women respectively) as well as the prevalence of left atrium dilatation (in 70.0 % of HP+ men versus 56.0 % in HP- men and 50.0 % versus 14.0 % in HP+ and HP- women respectively). The obtained data indicate the possible association of Helicobacter pylori infections and left heart overload with heart failure progression. Conclusions. The pain intensity and calf edema degree were significantly higher in HP+ acute coronary syndrome without ST segment elevation patients with essential arterial hypertension versus HP- ones showing worse clinical profile in case of Helicobacter pylori infection, especially in men. ECG of acute coronary syndrome without ST segment elevation with essential hypertension and Helicobacter pylori infection patients versus HP- patients detected significantly higher prevalence of arrhythmias in men and the heart rate changes in women infected with Helicobacter pylori. Echocardioscopy revealed significantly lower ejection fraction as well as left ventricular hypertrophy and left atrium dilatation in the HP+ acute coronary syndrome without ST segment elevation and essential arterial hypertension patients and in men versus women. The obtained data indicate a possible association of Helicobacter infection and left heart overload with heart failure progression.
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