DOI: https://doi.org/10.22263/2312-4156.2016.5.7
Lollini V.A.*, Lollini S.V.*, Smirnova O.I.**
Sudden Cardiac Death – the role of post-reperfusion arrhythmias. Diagnostic value of prognostic predictors
*Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
**Novopolotsk City Hospital, Novopolotsk, Republic of Belarus
Vestnik VGMU. 2016;15(5):7-18.
Abstract.
The purpose of this review is to analyze modern views about the causes of sudden cardiac death (SCD) and the role of reperfusion arrhythmias in it as well as the diagnostic value of the existing prognostic predictors.
Despite optimal medicamentous therapy and often successful surgical treatment, patients with coronary artery disease (CAD) have an increased risk of SCD. The most common cause of SCD in these patients is the development of reperfusion arrhythmias.
According to modern concepts, the etiology and pathogenesis of fatal arrhythmias involve the interaction of a great number of factors: the presence of the anatomical substrate in the form of ischemic myocardium, electrical instability of the heart muscle, daily adaptation mechanisms, genetic defects and neurohumoral trigger factors. The role of such trigger agents is played by unesterified fatty acids – the energy myocardium substrate. Increased concentrations of these acids promote the activation of lipid peroxidation and have an impact on the structure of formed elements biological membranes. Moreover, in patients with CAD the synthesis of endothelin-1 (ET-1) increases as a result of endothelial dysfunction, this is also referred to a group of trigger factors with respect to the development of arrhythmias. The increased synthesis and reduced clearance lead to the accumulation of the above arrhythmogenic substances in the ischemic area of the myocardium. As a result of the stent and thus myocardial perfusion restoration, their «washout» and entering the systemic circulation take place. Acting in combination with electrolyte and autonomic balance disturbances in patients with coronary artery disease the vulnerable myocardium acquires arrhythmogenic predisposition.
Key words: sudden cardiac death, arrhythmias, prognostic predictors.
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Information about authors:
Lollini V.A. – Doctor of Medical Sciences, professor of the Chair of Internal Medicine No.1, Vitebsk State Order of Peoples’ Friendship Medical University;
Lollini S.V. – Candidate of Biological Sciences, associate professor of the Chair of General Hygiene & Ecology, Vitebsk State Order of Peoples’ Friendship Medical University;
Smirnova O.I. – physician of the Department of Anesthesiology & Resuscitation, Novopolotsk City Hospital.
Correspondence address: Republic of Belarus, 210023, Vitebsk, 27 Frunze ave., Vitebsk State Order of Peoples’ Friendship Medical University, Chair of Internal Medicine No.1. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Lollini Vladimir A.
