The influence of the treatment recommendations completeness on the first day of myocardial infarction with the Q wave of the left ventricle with expansion to the right ventricle on the clinical course of the disease

Abstract

The aim — to determine the correlation between the implementation completeness of the recommendations for treatment on the first day of the Q­IM of the left ventricle (LV) posterior wall (PW) with expansion to the right ventricle (RV) on the clinical course of the disease.Materials and methods.155 patients with Q­MI of the PWLV with expansion to the RV aged 64.11 ± 2.42 years, 103 (66.5 %) men and 52 (33.5 %) women were examined. Patients were divided into two groups: the 1st group — 29 (18.7 %) patients, who demonstrated severe hemodynamic complications (cardiogenic shock (CS) and Killip III); the 2nd group — 126 (81.3 %) patients with a stable hemodynamics. The quality of therapy was evaluated in the first 24 hours of MI treatment.Results and discussion. Severe hemodynamic complications were more common in women (p = 0.0016) and were associated with later hospitalization (p < 0.05), and with a low frequency of the ECG RV3—RV4 (p = 0.00001) recording at the prehospital stage. The development of CS and Killip III in patients with Q­IM of the PWLV with expansion to the RV was associated with low frequency of adequate doses of antiplatelet drugs prescription (p = 0.001), anticoagulants (p = 0.00002) and statins (p = 0.037) in the prehospital stage. The correlation between the development of severe hemodynamic disorders and the insufficient use of infusion solutions for the purpose of preload restoration on the RV (p = 0.011) and the high frequency of drugs with vasodilator properties application, in particular, ACE/ARA (p = 0.0004), nitrates (89 7 %, p = 0.0005), diuretics (62.1 %, p = 0.0012) and MgSO4 (51.7 %, p = 0.002) was established.Conclusions. In patients with Q­IM PWLV with expansion to the RV, the development of life­threatening hemodynamic complications, in particular, CS and Killip III, is significantly associated with a low level of diagnosis of the RV MI and non­compliance with the requirements of treatment recommendations on the first day of MI.