The dystrophic changes in the cardiac muscle in patients with diabetes innocens result in dysfunction of the myocardium both auricles and ventricles. No wonder, that ciliary arrhythmia taking the second place of frequency among all disturbances of heart rhythm after extrasystolia (about 40% of all rhythm disturbances), can complicate course of diabetic cardiomyopathy. Last time this problem again becomes the center of attention of cardiologists. First of all it is connected with danger to patients’ life due to auricles fibrillation caused by tromboembolic complications in difference to a lot of other supraventricles arrhythmias that don’t cause danger to life. On the background of diabetes innocens the paroxysmal and steady forms of ciliary arrhythmia especially often appear while the long in time and chronic arrhythmias appear in patient with rheumatic damages, thyrotoxicosis or ischemic heart disease. Among antiarrhythmic drugs for treatment of paroxysmal and steady forms of ciliary arrhythmia there are drugs of IA class (chinidinum, disopiramidum, novocainamidum), drug of IC class (flecainidum, propaphenonum) and drugs of III class (amiodaronum, dofetilidum, sotalolum, ibutilidum) that are most often applied. For these purposes the preparations of III class most suitable, especially amiodaronum and dofetilidum. At absence of serious structural damages of a myocardium it is used propaphenonum. Chinidinum is an effective drug, but during long use it increase risk of sudden death. From many antiarrhytmic drugs is the best of all amiodaronum. It has not only expressed antiarrhytmic action, but also decreases considerably risk of sudden death in the patients who have transferred infarct myocardial. It is especially important for patients with diabetes innocens, as the risk of sudden death after infarct myocardial in them is especially high. We investigated efficiency of amiodaronum in 34 patients with ischemic heart disease having paroxysmal or steady form ciliary arrhythmia. Functional possibilities of these patients corresponded to II-III functional classes. 18 patients suffered the compensated form of diabetes innocens of the 2nd type with mild and average degree of severity. 19 patients (55.9%) have transferred the myocardium infarct earlier (in term from 6 months to 2 years). Among them there were 11 patients (32.4%) had diabetes innocens. The investigated patients had exertion stenocardia (angina pectoris) of II-III functional classes. The patients had the age of 43 to 59 years (on average 54 years). All the patients were separated in two groups: the 1st group included 16 patients with ischemic heart disease in combination with ciliary arrhythmia; the 2nd group included 18 patients having ischemic heart disease and diabetes innocens of the 2nd type and ciliary arrhythmia. Before the administration of amiodaronum all the patients were registrated with EKG (electrocardiogram), they were asked according to anamnesis. Holters monitoring and ultrasonic heart investigation had been carried out. During carrying out cardioversia amiodaronum was administered intravenously and jetly in the dose 300-450 mg within 10 minutes (the daily dose was to 1200 mg). Then amiodaronum was administered in dose 200 mg 3 times a day. Within 5-8 days, and on the 8th day 200 mg 2 times a day during 7 days. Amiodaronum results in expressed antiarrhythmic effect in the majority of patients with ciliary arrhythmia having ischemic heart disease and combination ischemic heart disease and diabetes innocens of 2nd type. The treatment with amiodaronum does not render negative influence on cardiohemodynamics in the investigated patients. The additional useful property of this drug is the antianginal effect. The preventive use of amiodaronum with the purpose the prevention of fibrillation of auricles is less effective in patients with accompayning diabetes innocens of 2nd type. For more expressed antiarrhytmic effect in case of diabetes innocens it is necessary to combine amiodaronum with renitek or lozartan, aprovelum and also potassium drugs.
Keywords: coronary heart disease, diabetes, atrial fibrillation, amiodarone, aprovel, losartan
Full text: PDF (Eng) 83.28K