Clinical and electrophysiological characteristics of psychovegetative syndrome during rehabilitation after coronary bypass graft

Abstract

Objective. To investigate the impact of anxiety in development of psychovegetative syndrome in patients after operative myocardial revascularization, to describe the nature and direction of resulting autonomic dysfunction and to study the effect of treatment with anti-anxiety therapy for this condition.

Materials and methods. 54 patients aged 45–75 (36 – the main group, 18 – the comparison group), on average 11–12 days after the coronary artery bypass graft (CABG) and during the process of early and late postoperative rehabilitation were investigated. A score assessment of the psychological and autonomic spheres, and sleep quality was analyzed. Indicators of vegetative tone and vegetative regulation were assessed, in particular, temporal and spectral indicators of heart rate variability. In addition to basic therapy for ischemic heart disease (IHD), the patients of the main group received therapy with vegetative corrector.

Results. In most cases, in the early postoperative period after CABG, moderate anxiety disorders and sleep disturbance were registered in combination with autonomic dysregulation with sympathetic influences prevailing. Addition of psychotropic therapy to the basic therapy of IHD patients in the main group allowed for 10–14 days to significantly reduce the level of anxiety, improve sleep quality and correct the existing autonomic disorders with a tendency to further regression in the late postoperative period.

Conclusions. This study found that patients with an increased level of anxiety after CABG are characterized by the formation of a psychovegetative syndrome with predominance of sympathetic activity. The use of anxiolytic therapy can reduce the severity of anxiety and autonomic dysfunction, which can probably become an additional factor contributing to successful rehabilitation of patients after CABG in the early and late postoperative periods and prevention of IHD progression.

Keywords

coronary bypass / postoperative rehabilitation / heart rate variability / anxiety / psychovegetative syndrome / anti-anxiety therapy

References

[1] Piepoli M.F., Hoes A.W., Agewall S., Albus C., Brotons C., Catapano A.L., Cooney M-T., Corra U., Cosyns B., Deaton C., Graham I., Hall MS., Hobbs R., Løchen M-L., Löllgen H., Marques-Vidal P., Perk J., Presscott E., Redon J., Richter D.J., Sattar N., Smulders Y., Tiberi M., Bart van der Worp N.S.H., van Dis I., Verschuren W.M.M. European Guidelines on cardiovascular disease prevention in clinical practice. The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical in Clinical Practice. European Heart Journal 2016; 252: 207–274.

[2] Piepoli M.F., Hoes A.W., Agewall S., Albus C., Brotons C., Catapano A.L., Cooney M-T., Corra U., Cosyns B., Deaton C., Graham I., Hall M.S., Hobbs R., Løchen M-L., Löllgen H., Marques-Vidal P., Perk J., Presscott E., Redon J., Richter D.J., Sattar N., Smulders Y., Tiberi M., Bart van der Worp N.S.H., van Dis I., Verschuren W.M.M. European Guidelines on cardiovascular disease prevention in clinical practice. The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical in Clinical Practice. European Heart Journal 2016; 252: 207–274.

[3] Beljalov F.I. Depression, anxiety and stress in patients with ischemic heart disease. Terapevticheskii arkhiv. 2017; 8: 104–109 (in Russian).

[4] Белялов Ф.И. Депрессия, тревога и стресс у пациентов с ишемической болезнью сердца. Терапевтический архив 2017; 8: 104–109.

[5] Cristian D., Markus K., Joanna M. Current status of brain imaging in anxiety disorders. Curr Opin Psychiatry 2009; 22 (1): 96–110.

[6] Ibatov A.D. The influence of anxiety disorders on the course of coronary heart disease. Russian Medical Journal 2007; 20: 1443–1449 (in Russian).

[7] Ибатов А.Д. Влияние тревожных расстройств на течение ишемической болезни сердца. Русский медицинский журнал 2007; 20: 1443–1449.

[8] Shvalev V.N. Pathological changes in the sympathetic division of the autonomic nervous system and cardiovascular pathology. Arkhiv patologii 1999; 3: 50–52 (in Russian).

[9] Швалев В.Н. Патоморфологические изменения симпатического отдела вегетативной нервной системы и сердечно-сосудистая патология. Архив патологии 1999; 3: 50–52.

[10] Tully P.J., Baker R.A. Depression, anxiety, and cardiac morbidity outcomes after coronary artery bypass surgery: a contemporary and practical review. Journal of Geriatric Cardiology 2012; 9: 197–208.

[11] Kubzansky L.D., Kawachi I. Going to the heart of the matter: do negative emotions cause coronary heart disease? J. Psychosom. Res. 2000; 48 (4–5): 323–337.

[12] Kubzansky L.D., Kawachi I. Going to the heart of the matter: do negative emotions cause coronary heart disease? J. Psychosom Res. 2000; 48 (4-5): 323–337. 1

[13] Mkrtchyan V.N., Bendeliani N.G., Kozhokova L.Z. Anxiety and depression in pathogenesis of atherosclerosis and ishemic heart disease. Byulleten' NTSSSKH im. A.N. Bakuleva RAMN 2014; 15 (2): 10-16 (in Russian).

[14] Мкртчян В.Р., Бенделиани Н.Г., Кожокова Л.З. Тревога и депрессия в патогенезе атеросклероза и ишемической болезни сердца. Бюллетень НЦССХ им. А.Н. Бакулева РАМН 2014; 15 (2): 10–16.

[15] Slobozhaninova E.V., Savinykh E.A., Chepurnykh A.Ya., Shamsutdinova R.A. Coronary artery bypass graft in the treatment of coronary heart disease. Medical Newsletter of Vyatka 2020; 3: 81–84 (in Russian).

[16] Слобожанинова Е.В., Савиных Е.А., Чепурных А.Я., Шамсутдинова Р.А. Взаимосвязь личностной тревожности и типа темперамента с приверженностью к лечению у больных гипертонической болезнью. Вятский медицинский вестник 2020; 3: 81–84.

[17] Verbitskiy E.V. Anxiety and sleep in experiment and clinic. S.S. Korsakov Journal of Neurology and Psychiatry 2017; 117 (4): 12–18 (in Russian).

[18] Вербицкий Е.В. Взаимоотношения тревоги и сна в эксперименте и клинике. Журнал неврологии и психиатрии им. С.С. Корсакова 2017; 117 (4): 12–18.

[19] Tobaldini E. Short sleep duration and cardiometabolic risk: from pathophysiology to clinical evidence. Nat. Rev. Cardiol. 2019; 16 (4): 213–224.

[20] Sabirovа E.Y., Chicherinа E.N., Epshtein A.M. Coronary artery bypass graft in the treatment of coronary heart disease. Actual state of the question. Medical Newsletter of Vyatka. 2012; 4: 49–54 (in Russian).

[21] Сабирова Э.Ю., Чичерина Е.Н., Эпштейн А.М. Аортокоронарное шунтирование в лечении больных ишемической болезнью сердца. Современное состояние вопроса. Вятский медицинский вестник 2012; 4: 49–54.

[22] Burlakov A.V., Bocharova M.V. Mental disorders in the preoperative period of coronary artery bypass surgery. Psikhiatriya i psikhofarmakoterapiya. 2003; 5 (6): 12–15 (in Russian).

[23] Бурлаков А.В., Бочарова М.В. Психические расстройства в предоперационном периоде аортокоронарного шунтирования. Психиатрия и психотерапия 2003; 5 (6): 12–15.

[24] Mukhtarenko S.Yu., Murataliev T.M., Radzhapova Z.T., Neklyudova Y.N. Affective disorders and quality of life in patients with coronary heart disease according to psychometric tests data. Klinicist 2018; 12 (2): 28–36 (in Russian).

[25] Мухтаренко C.Ю., Мураталиев Т.М., Раджапова З.Т., Неклюдова Ю.Н. Аффективные расстройства и качество жизни у больных коронарной болезнью сердца по данным психометрических тестов. Клиницист 2018; 12 (2): 28–36.

[26] Minakova I.V., Minakova N.E., Dubachev A.A. Indicators of the spectral analysis and traditional parameters of variability of the cardiac rhythm at patients after reconstructive cardiointetvention. Journal of New Medical Technologies 2010; 17 (2): 133–136 (in Russian).

[27] Минакова И.В., Минакова Н.Э., Дубачев А.А. Показатели спектрального анализа и традиционных параметров ВРС у больных после реконструктивных кардиовмешательств. Вестник новых медицинских технологий 2010; 17 (2): 133–136.

[28] Kupper N., Denollet J., Widdershoven J.W., Kop W.J. Cardiovascular reactivity to mental stress and mortality in patients with heart failure. JACC Heart Fail 2015; 3 (5): 373–382.

[29] Kupper N., Denollet J., Widdershoven J.W., Kop W.J. Cardiovascular reactivity to mental stress and mortality in patients with heart failure. JACC Heart Fail. 2015; 3 (5): 373–382.

[30] Bokeriya L.A., Aronov D.M., Barbarash O.L., Bubnova M.G., Knyazeva T.A., Lyamina N.P., Malikov V.E., Novikova N.K., Petrunina V.E., Arzumanyan M.A., Sumin A.N., Chumakova G.A., Akchurin R.S., Alishbaya M.M., Barbarash L.S., Bojcov S.A., Boldueva S.A., Buziashvili Yu.I., Galyavich A.S., Glezer M.G., Gordeev M.L., Zajcev V.P., Ivanova G.E., Ioseliani D.G., Karpov R.S., Mazaev V.P., Martynov A.I., Merzlyakov V.Yu., Misyura O.F., Perepech N.B., Repin A.N., Ruda M.Ya., Sigaev I.Yu., Smulevich A.B., Syrkin A.L., Chazov E.I., Chazova I.E., Shlyahto E.V., Yakushin S.S. Russian clinical guidelines. Coronary artery bypass grafting in patients with ischemic heart disease: rehabilitation and secondary prevention. Cardiosomatics 2016; 7 (3–4): 5–71 (in Russian).

[31] Бокерия Л.А., Аронов Д.М., Барбараш О.Л., Бубнова М.Г., Князева Т.А., Лямина Н.П., Маликов В.Е., Новикова Н.К.,

[32] Veyn A.M. Diseases of the autonomic nervous system: Rukovodstvo dlya vrachei. M.: Meditsina 1991: 624 (in Russian).

[33] Петрунина В.Е., Арзуманян М.А., Сумин А.Н., Чумакова Г.А., Акчурин Р.С., Алишбая М.М., Барбараш Л.С., Бойцов С.А., Болдуева С.А., Бузиашвили Ю.И., Галявич А.С., Глезер М.Г., Гордеев М.Л., Зайцев В.П., Иванова Г.Е., Иоселиани Д.Г., Карпов Р.С., Мазаев В.П., Мартынов А.И., Мерзляков В.Ю., Мисюра О.Ф., Перепеч Н.Б., Репин А.Н., Руда М.Я., Сигаев И.Ю., Смулевич А.Б., Сыркин А.Л., Чазов Е.И., Чазова И.Е., Шляхто Е.В., Якушин С.С. Российские клинические рекомендации. Коронарное шунтирование больных ишемической болезнью сердца: реабилитация и вторичная профилактика. КардиоСоматика 2016; 7 (3–4): 5–71.

[34] Khodyrev G.N., Khlybova S.V., Tsirkin V.I., Dmitrieva S.L. Methodological aspects of analysis of temporal and spectral parameters of heart rate variability (review). Medical Newsletter of Vyatka 2011; 3-4: 60–71 (in Russian).

[35] Вейн А.М. Заболевания вегетативной нервной системы: руководство для врачей. М.: Медицина 1991; 624.

[36] Kiselev A.R., Vulf K.A., Shvarts V.A., Karavaev A.S., Borovkova E.I., Bockeria O.L. Comparative evaluation of autonomic regulation of circulation in patients undergone coronary artery bypass grafting or correction of acquired valvular heart disease. Saratov J. Med. Sci. Res. 2018; 14 (1): 45–9 (in Russian).

[37] Ходырев Г.Н., Хлыбова С.В., Циркин В.И., Дмитриева С.Л. Методические аспекты анализа временных и спектральных показателей вариабельности сердечного ритма (обзор литературы). Вятский медицинский вестник 2011; 3–4: 60–71.

[38] Beinart R., Zhang Y., João A.C,. Lima J.A., Bluemke D.A., Soliman E.Z., Heckbert S.R., Post W.S., Guallar E., Nazarian S. The QT interval is associated with incident cardiovascular events: the MESA study. J. Am. Coll. Cardiol. 2014; 64 (20): 2111–2119.

[39] Киселев А.Р., Вульф К.А., Шварц В.А., Караваев А.С., Боровкова Е.И., Бокерия О.Л. Сравнительная оценка вегетативной регуляции кровообращения у пациентов, перенесших аортокоронарное шунтирование или коррекцию приобретенных пороков сердца. Саратовский научно-медицинский журнал 2018; 14 (1): 45–49.

[40] Makarov LM. Features of using the analysis of heart rate variability in patients with heart disease. Fiziologiya cheloveka 2002; 28 (3): 65–68 (in Russian).

[41] Beinart R., Zhang Y., João A.C,. Lima J.A., Bluemke D.A., Soliman E.Z., Heckbert S.R., Post W.S., Guallar E., Nazarian S. The QT interval is associated with incident cardiovascular events: the MESA study. J. Am. Coll. Cardiol. 2014; 64 (20): 2111–2119.

[42] Kiseleva, I.V., Agapov A.A., Akchurin R.S., Sobolev A.V., Ryabykina, G.V., Chikovani S.I. Heart rate variability in patients with ischemic heart disease before and after coronary artery bypass graft. Journal of arrhythmology 2003; 32: 42–43 (in Russian).

[43] Макаров Л.М. Особенности использования анализа вариабельности ритма сердца у больных с болезнями сердца. Физиология человека 2002; 28 (3): 65–68.

[44] Oynotkinova O.Sh., Spasskiy A.A., Baranov A.P., Poddubskaya E.A., Shklovskii B.L., Leksina N.Yu. Psychotropic and antioxidant therapy in the rehabilitation of cardiac patients. Arhiv vnutrennej mediciny 2013; 2: 65–70 (in Russian).

[45] Киселева И.В., Агапов А.А., Акчурин Р.С., Соболев А.В., Рябыкина Г.В., Чиковани С.И. Вариабельность ритма сердца у больных ИБС до и после коронарного шунтирования. Вестник аритмологии 2003; 32: 42–43.

[46] Bakumov P.A., Evseev A.V. The using of tranquilizers in therapeutic practice. Lekarstvennyj vestnik. 2004; 2: 9–17 (in Russian).

[47] Ойноткинова О.Ш., Спасский А.А., Баранов А.П., Поддубская Е.А., Шкловский Б.Л., Лексина Н.Ю. Психотропная и антиоксидантная терапия в реабилитации кардиохирургических больных. Архивъ внутренней медицины 2013; 2: 65–70.

[48] Davydov A.T., Petrova N.N., Litvincev S.V., Vutko D.Yu., Strel'nikov A.A. Modern antidepressants, their role and place in psychiatric and general medical practice. Reviews On Clinical Pharmacology and Drug Therapy 2007; 1: 49–62 (in Russian).

[49] Бакумов П.А., Евсеев А.В. Применение транквилизаторов в терапевтической практике. Лекарственный вестник 2004; 2: 9–17.

[50] Ljubimov A.V., Karchaa A.R. Application of Teraligen® in treatment of cerebral vegetative dysfunction. Nauchnye vedomosti Belgorodskogo gosudarstvennogo universiteta. Serija: Medicina. Farmacija 2012; (4): 20–25 (in Russian).

[51] Давыдов А.Т., Петрова Н.Н., Литвинцев С.В., Вутко Д.Ю., Стрельников А.А. Современные антидепрессанты, их роль и место в психиатрической и общемедицинской практике. Обзоры по клинической фармакологии и лекарственной терапии 2007; 1: 49–62.

[52] Jones P.B, Buckley P.F. Schizophrenia: Klinicheskoe rukovodstvo. Moscow: MEDpress-inform 2008; 192 (in Russian).

[53] Любимов А.В., Карчаа А.Р. Применение препарата Тералиджен® в терапии надсегментарных (церебральных) вегетативных нарушений. Научные ведомости Белгородского государственного университета. Серия: Медицина. Фармация 2012; (4): 20–25.

[54] Roohafza H., Sadeghi M., Khani A., Andalib E., Alikhasi H., Rafiei M. Psychological state in patients undergoing coronary artery bypass grafting surgery or percutaneous coronary intervention and their spouses. Int. J. Nurs. Pracl. 2015; 21 (2): 214–220.

[55] Джонс П. Б., Бакли П. Ф.  Шизофрения: клиническое руководство. М.: МЕДпрессинформ 2008; 192.

[56] Açıkel M. Evaluation of Depression and Anxiety in Coronary Artery Bypass Surgery Patients: A Prospective Clinical Study. Braz. J. Cardio-vasc. Surg. 2019; 34 (4): 389–395.

[57] Roohafza H., Sadeghi M., Khani A., Andalib E., Alikhasi H., Rafiei M. Psychological state in patients undergoing coronary artery bypass grafting surgery or percutaneous coronary intervention and their spouses. Int J Nurs Pracl. 2015; 21 (2): 214–220.

[58] Açıkel M. Evaluation of Depression and Anxiety in Coronary Artery Bypass Surgery Patients: A Prospective Clinical Study. Braz J Cardiovasc Surg. 2019; 34 (4): 389–395.

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