Durerea toracic anterioar.

Contribuii privind studiul clinic i al investigaiilor, raportate

la cardiopatia ischemic
Rezumat tez doctorat
Introducere: Durerea, conform caracterizrii savantului Ambros Bierce, reprezint o stare de spirit
inconfortabil, care poate avea o baz fizic n ceva care i este fcut trupului sau poate fi pur mental,
cauzat de norocul altcuiva. Patologia uman cunoate peste 10.000 de afeciuni nsoite de durere.
De remarcat ns, c la specia uman durerea se asociaz frecvent cu fenomene psihice, uneori cu
caracter deosebit de manifest, care reprezint n ansamblul lor suferina, ceea ce exprim atitudinea
bolnavului fa de durerea sa. Dintre numeroasele definiii care s-au dat durerii de-a lungul a peste
dou milenii, redate n diverse volume de specialitate, am optat pentru definiia IASP (International
Association for the Study of Pain) din 1994, care descrie durerea ca pe o experien senzorial i
emoional dezagreabil, rezultat datorit unei leziuni tisulare veritabil i/sau potenial sau de o
descriere cu termeni care fac referire la o asemenea leziune. Fr a reprezenta un concept perfect,
aceast definiie cuprinde parametrii eseniali pentru ilustrarea majoritii laturilor fenomenului
dureros. Durerea toracic anterioar acut i/sau cronic reprezint o component important a durerii
viscerale, fiind unul din cele mai frecvente motive pentru care pacientul solicit asisten medical.
Material i metod: Evaluarea clinic i exploratorie s-a efectuat pe un eantion de 432 pacieni,
dintre care 206 de sex feminin (47,3%) i respectiv 226 de sex masculin (52,3%), cu vrsta medie de
57,12 13,5 ani (deviaia standard). Subiecii au aparinut la patru eantioane, incluse ntr-un studiu
clinico-epidemiologic, care s-a desfurat n perioada 01.2002 10.2007, n Clinica a V-a Medicin
Intern i Gerontologie Geriatrie , Spitalul Universitar C. F. Iai, U.M.F. Gr. T. Popa Iai.
Rezultate: Din punct de vedere al vrstei, loturile au prezentat o distribuie relativ uniform (lotul
martor vs. loturi de studiu), lucru confirmat i de analiza statistic de tip Chi-Square Tests. Studiul
nostru a relevat faptul c incidena sexului masculin n rndul pacienilor cu afectare cardiovascular
(hipertensivi, lot A) este de aproximativ 1,5 ori mai mare fa de cea a pacienilor de sex feminin,
rezultate care confirm studiile actuale de prevenie i tratament a afeciunilor cardiovasculare. n
cadrul lotului II sau B care prezentau afectare mixt, hipertensiv i metabolic, s-au nregistrat din
punct de vedere al sexelor valori egale, ceea ce arat o afectare echilibrat a populaiei studiate, dar cu
o pondere crescut pentru intervalul de vrst 60 70 ani. Pentru cel de-al treilea lot, cu afectare
cardiovascular ischemic, nerespectnd distribuia sexelor la fel ca n sudiile populaionale de mare
anvergur (Framingham, EUROPE), n care a predominat sexul feminin, cel masculin avnd o
inciden crescut a afectrii cardiovasculare i ischemice, legat de predispoziia crescut a acestuia
la factorii de risc cardiovascular global. Studiul statistic al valorilor tensiunii arteriale la loturile de
pacieni din studiu a artat medii de 151,27 mmHg, cu o deviaie standard de 16,905, valorile maxime
fiind prezente la loturile I i II, explicaia constnd n alegerea intit a subiecilor respectiv. Din
studiul efectuat a reieit o valoare a frecvenei cardiace medii de 84,22/min, cu o deviaie standard de
9,61. Analiza pacienilor relev frecvene n jurul valorii de 75 80/min, chiar 85/min, cu o inciden
maxim la valori de 90/min, respectiv o scdere ulterioar spre valori de peste 100/min, respectnd n
proporii relativ asemntoare curbei lui Gauss. n lotul general, IMC a prezentat variaii relativ
normale, cu o distribuie centrat n jurul valorii de 24 Kg/m 2, cu un caz de obezitate patologic (IMC
= 54 Kg/m2, sex feminin). Frecvena valorilor, conform clasificrii ATP III, care se ncadreaz n
gradul de supraponderabilitate, a fost de peste 50%. Valori medii ale glicemiei au fost de 101,54
mg/dl, cu o deviaie standard de 9,84, iar intervalul de ncredere 95% CI a fost ntre 99,77 i 103,31,
modificri asemntoare prezentnd i ceilali parametri studiai.
Discuii i concluzii: Durerea toracic anterioar, prin multitudinea de aspecte patologice care o
definesc, devine n acelai timp alarm i capcan, oblignd la discernare diagnostic clinic i
exploratorie particular, relaia cu cardiopatia ischemic fiind ntotdeauna o urgen. Corelaiile
efectuate pe grupe de pacieni demonstreaz asocierea semnificativ a patologiilor cardiovasculare,
metabolice i ischemice cu simptomatologia clinic dureroas de la nivel toracic anterior. Patologiile
incriminate n producerea sindromului dureros toracic presupun o multitudine de investigaii clinice,
dar i paraclinice cu caracter specific, de aceea este necesar o corelaie a acestora prin realizarea unui
algoritm facil de diagnostic i terapeutic.
Anterior chest pain. Contributions to the clinical study and investigations , reported in
ischemic heart disease
Summary of doctoral thesis
Introduction: Pain, according to Ambrose Bierce characterization scientist , is "an uncomfortable
mood , which may have a physical basis in something that his body is made or may be purely mental ,
caused by someone else's good fortune". 10,000 known human pathology with pain disorders. Note,
however, that the human species is commonly associated with pain psychic sometimes very manifest
character who is suffering as a whole, which expresses the attitude of the patient to the pain. Among
the many definitions that have been given pain over more than two million, played in various
specialized volumes, we opted for the definition IASP (International Association for the Study of
Pain, 1994), which describes the pain as "an experience unpleasant sensory and emotional resulting
tissue damage due to real and/or potential, or a description of the terms that refer to such injury". Not
to be a perfect concept, it includes essential parameters to illustrate the most painful aspect of the
phenomenon. Acute anterior chest pain and/or chronic is an important component of visceral pain is
one of the most common reasons patients seek medical attention.
Methods: Clinical evaluation and exploratory was performed on a sample of 432 patients, of whom
206 were female (47.3 %) and 226 male (52.3 %) with mean age of 57.12 13.5 years (standard
deviation). Subjects belonging to four samples included in clinical and epidemiological study, which
was conducted between 01.2002 - 10.2007, the clinic will of Internal Medicine and Gerontology -
Geriatrics, University hospital CF Science, University "Gr T. Popa" Iai.
Results: In terms of age groups showed a relatively uniform distribution (vs control group, study
groups), as confirmed by statistical analysis Chi-Square Tests type. Our study showed that the
incidence of males among patients with severe cardiovascular (hypertension , lot A) is about 1.5 times
higher than that of female patients , the results confirm the current studies of prevention and treatment
of diseases cardiovascular. In group II or B who had joint damage, hypertension and metabolic were
recorded in terms of gender equal value, which indicates a balanced involvement of the population
studied, but increased weight for age range 60-70 years. For the third batch, with severe
cardiovascular disease, disregarding gender distribution as the purpose of the studies large-scale
population (Framingham, EUROPE), in which females predominated, the men having a higher
incidence of cardiovascular and ischemic damage, linked to increased susceptibility to its global
cardiovascular risk factors. Statistical study of blood pressure in the groups of patients in the study
showed average 151.27 mmHg, with a standard deviation of 16.905, peaks are present in groups I and
II, the explanation consists in choosing targeted subject. From the study showed an average heart rate
value 84,22/min, with a standard deviation of 9.61. Analysis of frequencies reveals patients around 75
- 80/min, 85/min even with a maximum incidence of 90/min values, ie a further decrease to values
above 100/min respecting relatively similar proportions Gauss curve. The group generally relatively
normal BMI showed variations with a distribution centered around 24 kg/m 2, with a case of
pathological obesity (BMI = 54 kg/m 2, female). The frequency values , according to the classification
ATP III, which fall in the degree of overweight, was over 50 %. Mean blood glucose values were
101.54 mg/dl, with a standard deviation of 9.84 and 95 % confidence interval CI was between 99.77
and 103.31, showing similar changes in the other parameters studied.
Discussion and Conclusions: Chest pain earlier by the many pathological aspects that define,
becoming both "alarm" and "trap" in the same time, forcing the clinical diagnostics and exploratory
discernare particular, the relationship with coronary heart disease is always an emergency.
Correlations carried out on groups of patients show significant association with cardiovascular
2
pathologies, metabolism and clinical symptoms of ischemic pain in the chest above. Pathologies
incriminated in producing chest pain syndrome involving a multitude of clinical investigations and
laboratory specific character, so it is necessary to their correlation by conducting a diagnostic and
therapeutic algorithm easy.