Prediction and diagnosis of right ventricular heart failure and ventricular dysfunction during the exacerbation of bronchial asthma in children
Background. Bronchial asthma (BA) already in childhood can be accompanied by cardiovascular complications in the form of acute pulmonary heart disease, ventricular dysfunction, metabolic cardiomyopathy, rhythm and conduction disorders, which not only aggravates the course of the disease, but also reduces the quality of life of patients. The heart remodeling in BA is preceded by clinical manifestations of heart failure and can independently aggravate systolic and diastolic dysfunction of the ventricles. The purpose of the study was to improve the prediction of cardiovascular complications in the period of bronchial asthma exacerbation in children by identifying the risk factors for ventricular dysfunction and developing additional informative clinical and echocardiographic diagnostic criteria for right ventricular heart failure. Materials and methods. Under our supervision, there were 85 children with asthma aged 5 to 17 years. Pulse oximetry, spirography, electrocardiography, Doppler, and echocardiography were performed. The examination was carried out in the period of asthma exacerbation, during hospitalization of the patient and during the period of improvement, on the days 5–6 of staying in the pulmonary department of the Municipal Institution “Regional Children’s Clinical Hospital” of Dnipropetrovsk Regional Council. The criteria for inclusion in the study were allergic and mixed persistent, moderate and severe asthma during the period of exacerbation. The study did not include patients with asthma in remission period, children with an intermittent course of asthma and a mild persistent asthma. To determine the type and degree of ventilation insufficiency, a spirographic method was used to evaluate the indicators of vital lung capacity (VLC), forced expiratory volume in 1 second (FEV1), FEV1/VLC. The mathematical and statistical processing of the research materials was carried out using the methods of biostatistics implemented in the packages of Microsoft Excel programs (Office Home Business 2KB4Y-6H9DB-BM47K-749PV-PG3KT), Statistica 6.1 (StatSoft Inc., Serial number AGAR909E415822FA). Results. The prognostic clinical risk factors for the development of systolic and diastolic dysfunction of the cardiac ventricles in case of a possible attack of bronchial asthma were identified: the presence of a severe bronchial asthma in a sick child; presence of tachycardia at rest; violation of the ventricular myocardial repolarization on the electrocardiogram; presence of concomitant chronic tonsillitis; bacteria in the nasopharynx; female sex. Additional informative diagnostic criteria for the development of right ventricular heart failure during the period of exacerbation of bronchial asthma in children have been developed. It has been found that the use of euphylline in combination with b2-agonists for the bronchodilator therapy of children in the period of exacerbation of bronchial asthma negatively affects the diastolic function of the cardiac ventricles and promotes the preservation of elevated pressure in the pulmonary artery. Conclusions. The issue of improving the prediction of cardiac ventricular dysfunction and timely diagnosis of cardiovascular complications in the period of asthma exacerbation in children is solved by identifying clinical risk factors for ventricular dysfunction and developing additional informative, clinical and echocardiographic diagnostic criteria of right ventricular heart failure.
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