Features of the clinical course of chronic obstructive pulmonary disease in patients with related coronary heart disease
The interaction between the lung and the heart is a vast and clinically complex topic, since disorders of one often affect and contribute to disorders of the other. The detection of chronic obstructive pulmonary disease (COPD) in patients with known coronary heart disease (CHD), and vice versa, is very important due to the lower quality of life, higher hospitalization and, ultimately, higher mortality of such patients. This analysis focuses on the cardiovascular contribution to the symptoms of COPD and their relationship with the diagnostic status of patients and echocardiographic findings. Objective: to study the clinical course of COPD in patients with concomitant coronary heart disease (CHD) and especially treatment. Materials and methods. Three groups were distinguished among 117 examined: the first group (42 patients) – patients consisted of a combination of stable coronary heart disease (chronic heart failure I–II FC) and COPD; the second (40 patients) – patients with stable coronary artery disease without concomitant COPD; the third control group (35 patients) consisted of patients with COPD without CHD. The groups were representative by age and disease duration (from 5 to 14 years). In the course of the study, information was collected from all patients on the following items: demography, clinical manifestations, therapy, electro-, echocardiographic, and spirometric examination methods were performed. In addition, the modified Medical Research Council (mMRC) was assessed for a modified dyspnea severity scale, and a COPD assessment test was performed. The study showed that patients with a combination of stable coronary artery disease and COPD have a higher heart rate and respiration, in contrast to people with stable coronary artery disease. COPD also brings into the clinical picture, a decrease in volume spirographic indices, significantly increases the supraventricular extrasystole and blockade of the right bundle branch block according to ECG data. An analysis of drug prescribing models revealed a difference in treatment options and treatment regimens depending on the prevalence of the clinical picture. It was shown that patients with comorbid course in 45.2 % of cases did not receive therapy in accordance with GOLD or national recommendations for the treatment of COPD. Doctors underestimated the history and symptoms of a combination of СHD and COPD with predominance of CHD symptoms, just as 73.8 % of patients in the first group did not receive adequate treatment of CHD with a prevalence of symptoms of COPD.