The aim: To evaluate the structural changes of the brain in relation to the formation of cognitive disorders (CD) in patients with arrhythmias

Materialsand methods: 147 patients with different clinical forms arrhythmias against the background of ischemic heart disease were examine. At the first stage, all patients with arrhythmias assessed cognitive functions. At the second stage, patients were distributed divided into two groups: the main group patients with CD, control – patients without CD. These groups underwent computed tomography examination of the brain.

Results:CD were established in 83% patients with arrhythmias. Mild CD were more often diagnosed in patients with persistent form of atrial fibrillation (AF), severe CD – in patients with permanent form of AF and atrioventricular blockade ІI-III degrees. Neuroimaging changes were found in 73.8% patients with CD and in 36% patients without CD. They were manifested by atrophic changes of the cortex, internal hydrocephalus, a decrease in the density of the brain sub- stance of the periventricular area. In patients with CD, compared to patients without CD, showed lacunar foci with predominant localization in the parietal and frontal lobes of the brain, periventricular and subcortical leukoaraiosis. Multiple correlations were established between CD and structural changes of the brain.

Conclusions: The increase in the severity of CD in patients with arrhythmias is associated with atrophic changes at the cortical-subcortical level, accompanied by the phenomena of internal hydrocephalus, periventricular and subcortical LA, lacunar foci, with a predominant localization in the frontal-temporal-occipital lobes, in the visual hump and basal ganglia of both cerebral hemispheres.

UDC 616.12-008.313:073.96:616.89-008.45/.46/.47

Background. The purpose of our work was to find out the dependence of changes in the cognitive sphere on the features of the structural and functional state of the heart and central hemodynamics in patients with arrhythmias.

Material and methods. We have examined 139 patients with different clinical forms of arrhythmias. All of them underwent extended neuropsychological testing and central hemodynamic studies. The state of central hemodynamics was assessed by an ultrasound examination of the heart. The state of intracardiac hemodynamics, structural changes in various parts of the heart were evaluated; based on this, the type of heart remodeling was determined. Correlations of hemodynamic indicators with the results of neuropsychological testing were evaluated.

Results. In patients with mild cognitive disorders (CD), the left ventricular myocardial contractility index did not differ significantly from that in patients without CD, but in people with moderate CD it was 9.6 % lower (p = 0.044). With moderate CD, the dilatation of the left parts of the heart increased (end-diastolic volume — by 16.5 %, p = 0.049; left atrium — by 9.9 %, p = 0.049), which, along with increased hypertrophy of the interventricular septum by 12.8 % (p = 0.048) and of the left ventricular posterior wall by 12.9 % (p = 0.048), led to an increase in the pulmonary artery pressure by 24.8 % (p = 0.015). Among patients with CD, concentric (42.2 %) and eccentric (22.6 %) left ventricular hypertrophy was more often detected (p = 0.048 and p = 0.027); in those without CD, concentric remodeling of the left ventricle prevailed (p = 0.037). In patients with mild CD, higher stroke volume was recorded — by 8.3 % (p = 0.049) compared to those without CD. However, according to indicators of cardiac output, cardiac index and total peripheral vascular resistance, differences were unreliable (p > 0.05). Patients with moderate CD reported an increase in stroke volume and cardiac output by 7.6 (p = 0.043) and 14.9 % (p = 0.014), respectively, compared to those without CD. Indicators of central hemodynamics had the greatest impact on the sphere of attention, regulatory functions, visual-spatial and mnestic deficits. The highest odds ratio for the development of CD were found for left ventricular ejection fraction (2.52, 95% confidence interval: 1.82–3.29, p < 0.001).

Conclusions. The identified associations of cognitive dysfunction, central hemodynamics and heart remodeling are important for optimizing an individualized approach to patient management and predicting the development of CD.

Зміна військово-політичної ситуації в Україні поставила перед медичною спільнотою нові завдання, першочергове з яких – оптимізація викладання військової терапії. Назріла нагальна проблема реформування викладання предмету «Військова терапія» за сучасними стандартами. Оптимізація викладання «Військової терапії» вимагає уніфікації назви дисципліни, удосконалення програмного забезпечення та приведення навчального матеріалу у відповідність до сучасних стандартів провідних країн світу. Шляхами вирішення існуючих проблем є оновлення навчальних базових програм з військової терапії та їх уніфікація з централізованим переглядом з точки зору сучасних реалій медицини. Важливе значення мають створення сучасних підручників для студентів вищих медичних навчальних закладів з «Військової терапії» та постійне їх оновлення, організація та проведення науково-практичних конференцій за участю військових спеціалістів з терапевтичних дисциплін для обговорення нагальних питань. В результаті нашої роботи з’ясували, що, із врахуванням сучасних реалій, викладання «Військової терапії» на терапевтичних кафедрах вищих медичних закладів України потребує удосконалення, для чого запропоновані конкретні шляхи.

The change in the military-political situation in Ukraine presented the medical community with new tasks, the first of which is the optimization of teaching military therapy. The urgent problem of reforming the teaching of the subject of "Military Therapy" according to modern standards has come. Optimizing the teaching of "Military Therapy" requires the unification of the name of the discipline, improvement of the provision, and bringing the educational

material in line with the modern standards of the world's leading countries. Ways to solve existing problems are to update the basic training programs on military therapy and unify them with a centralized review from the point of view of modern realities of medicine. The creation of current textbooks for students of higher medical institutions on "Military Therapy" and their constant updating, organization and holding of scientific and practical conferences with the participation of military specialists in therapeutic disciplines to discuss urgent issues are of great importance. As a result of our work, it was found that taking into account modern realities, the teaching of "Military Therapy" at the therapeutic departments of higher medical institutions in Ukraine needs improvement, for which specific ways are proposed.