Heart rhythm disturbances and blood pressure profile in patients with combat injuries

Abstract

Aim. To investigate possible rhythm and conduction disturbances, as well as the blood pressure (BP) profile in young and middle-aged patients with combat wounds. Materials and methods. The cross-sectional study enrolled 102 patients who suffered limb injuries in the period from 13 to 114 days (median 38 days) before admission to the hospital. The age of the patients included in the study ranged from 20 to 59 years, with an average of 35.7±8.5 years. Patients underwent Holter ECG monitoring and 24-hour BP monitoring. The following questionnaires and scales were used: a questionnaire to identify signs of autonomic changes (A. Vein), a scale for assessing the severity of psychophysiological response to stress, an insomnia severity index, the Hamilton scale for assessing anxiety, the Hamilton scale for assessing depression, a questionnaire for PTSD screening, visual analog pain scale. Results. The mean heart rate per day reached 84.6±11.1 per minute, the minimum heart rate was 56.9±10.1, the maximum heart rate was 134.4±18.6 per minute. The group mean duration of tachycardia was 498.1±316 minutes (8 hours 18 minutes). There was an inverse correlation between the age of patients and the duration of tachycardia per day (r=-0.29; p=0.04), maximum heart rate (r=-0.28; p=0.007), minimum heart rate per day (r=-0.23; p=0.02). In patients 20-29 years old, the maximum heart rate reached 141.4±19.4, in patients over 40 years old – 134.3±17.9 (p=0.009). The mean value of the circadian index for the group was 1.17±0.13 (0.68-1.47). In 69.7%, the circadian index was rigid. Heart rate variability was within normal values in 32.2% of the examined patients, in 48.8% it was reduced, and in 19.1% it was sharply reduced. Heart rhythm disturbances were recorded in 65.5% of patients. The most frequently detected sinus arrhythmia (in 76.2% of cases of all arrhythmias), migration of the supraventricular pacemaker (in 27.0%) and atrial rhythm (in 11.1%). Arterial hypertension was detected in 67.7% of the examined patients. The maximum systolic BP (SBP) corresponding to arterial hypertension of the 1st degree was registered in 43.9% of patients, grade 2 – in 19.7%, grade 3 – in 3.0%, high normal BP – in 16.7%, normal BP – in 16.7%. Maximum diastolic BP (DBP) corresponding to grade 1 hypertension was found in 30.8% of patients, grade 2 – in 30.8%, grade 3 – in 15.4%, high normal BP – in 10.8%, normal BP – in 12.3%. The mean daily SBP was 126 mm Hg, DBP was 81 mm Hg. The mean daytime SBP was 128 mm Hg, DBP was 82 mm Hg. The mean nighttime SBP is 118 mm Hg, DBP is 77 mm Hg. The maximum SBP was 148 mm Hg, DBP was 97 mm Hg. When analyzing the types of daily BP curves, the vast majority of patients (44.6%) were classified as “non-dipper” type, both for SBP and DBP. Conclusions. The study results indicate that patients with combat injuries very often have sinus tachycardia, which is recorded over a long period of time. Heart rate is highest in the youngest injured patients and decreases as age increases. Sinus arrhythmia is very common, other rhythm and conduction disorders are much less common. High BP, especially DBP, is often recorded.

Keywords

• wounds
• combat trauma
• heart rate
• blood pressure
• arterial hypertension.