Гипотермия ассоциируется с рядом электрокардиографических изменений, которые варьируют в зависимости от степени гипотермии. В данной статье мы рассматриваем факторы риска развития гипотермии, клиническое значение волны Осборна, механизмы ее возникновения, критерии выявления волны Осборна на электрокардиограмме, а также представляем клинический случай, когда даже незначительная гипотермия в сочетании с неврологической патологией индуцирует появление волны Осборна. Также рассматривается прогностическое значение волны Осборна в возникновении желудочковых аритмий.

Introduction. One of the risk factors for pulmonary embolism is age > 40 years. Lately, more and more cases of thromboembolism occur at a young age, that requires special attention in diagnosis and treatment. Objectives. The purpose of this article was to analyze the clinical case of thromboembolism at a young age. Material and methods. Our patient B., 33- year-old male was urgently hospitalized with the chest pain when breathing in, shortness of breath, blood-streaked sputum cough and body temperature up to 37-38.5 °С. 17.12.18 the bone immobilization of the right fibula due to a fracture was performed. 30.12.18 - the patient felt compressive pain in the right side of the chest, shortness of breath, blood-streaked sputum cough. An ambulance was called, but the patient was not hospitalized. Since 31.12.2018 till 05.01.2019 – body temperature rose to 38°C. 06.01.19 - a recurrence of initial symptoms. 07.01.19 - the chest pain intensified, patient was transported by ambulance to a hospital. During the examination: vesicular breathing, weakened in the lower sections, mostly on the right, respiratory rate -20/min, heart rate 100 beats/min, blood pressure 120/70 mm Hg. The main diagnosis: thromboembolism of the lobar arteries of the right lung. Class I, very low risk (43 points by PESI scale – Pulmonary Embolism Severity Index, 5 points by the Padua prediction score). Complication: right-sided inferior infarction-pneumonia. Concomitant diagnosis: fracture of the right fibula. Recommended treatment: rivaroxaban 12 mg; eplerenone 50 mg, ceftriaxone 1 g bid intravenous injection (IV), levofloxacin 500 mg IV, oxygen therapy. Results. Laboratory and instrumental studies were carried out. Laboratory tests revealed an increased in leukocytes, erythrocyte sedimentation rate, ALT, troponin І. ECG: right axis deviation. Computed tomography (CT) of the chest: CT signs of thromboembolism of the arteries of the right lung, right-sided inferior infarction-pneumonia, changes are more typical for an inflammatory process in the initial stage. Ultrasound examination of the abdominal organs and kidneys: diffuse changes of the liver parenchyma, traces of fluid in the right pleural cavity. Conclusions. Prolonged immobilization in young patients can be only one risk factor for the formation of pulmonary embolism. In order to predict possible complications in patients with pulmonary thromboembolism, it is necessary to take into account the initial state of the patient and associated diseases in each case.

Atrial fibrillation is one of the most common sustained disorders of cardiac rhythm and is associated with an increased risk of mortality, morbidity due to thromboembolic complications, and heart failure. It is important to highlight that the causative factors are vast. It is well-known that thyroid dysfunction has a proarrhythmic effect and increases the risk of cardiovascular disease. Hyperthyroidism or thyrotoxicosis is recognized to be a baseline risk factor for the development of atrial fibrillation. However, the role of hypothyroidism in atrial arrhythmogenesis is less recognized and not fully understood. At the moment radiofrequency catheter ablation is actively used in the treatment of atrial fibrillation, which in most cases has high efficiency and persistent effect. Despite that, the recurrence of supraventricular tachyarrhythmia can be observed in some patients even after radiofrequency cathe­ter ablation. Patients with a history of hypothyroidism or even high-normal thyroid-stimulating hormone levels are more likely to have a recurrence of supraventricular tachyarrhythmia after radiofrequency catheter ablation. Therefore, thyroid-stimulating hormone levels should be determined in patients who have undergone radiofrequency catheter ablation of atrial fibrillation, especially paroxysmal atrial fibrillation. Consequently, it should be noted that the assessment and correction of modifying risk factors before radiofrequency catheter ablation may provide opportunities for future prevention of recurrence of supraventricular paroxysmal arrhythmias, improve the prognosis and overall quality of life in patients of this group. We have demonstrated the clinical case and emphasized the association of high-normal thyroid-stimulating hormone levels with supraventricular tachyarrhythmia recurrence after radiofrequency catheter ablation for atrial fibrillation.