Defects in autonomic regulation in myocardial ischemia

Aim. To evaluate cerebral and peripheral mechanisms of autonomic regulation of the cardiovascular system, their role in development of myocardial isch emia in coronary heart disease (CHD) patients with coronary atherosclerosis and X syndrome. Materials and methods. Psychometric testing, questionnaires, cardiovascular tests (by D. Y. Ewing), automatic spectral analysis of cardiac rhythm vari ability were used in investigation of psychovegetative regulation in 36 pat ients and 19 healthy subjects. Group 1 consisted of 26 CHD patients with co ronary atherosclerosis and stable angina class I-II. Group 2 consisted of 1 0 patients with symptoms of myocardial ischemia and coronarographically int act coronary arteries. Results, Patients of both groups demonstrated initial activation of cerebra l sympathicoadrenal mechanisms manifesting with high anxiety, depression, v egetative defects in regulation of both initial autonomic tone and autonomi c support of the orthostatic test. CHD patients with coronary atheroscleros is were characterized by persistent activation of cerebral sympathicoadrena l mechanisms and resistance of homeostatic baroreflex sympathetic systems. Vagal insufficiency was moderate and arose only at rest. In X syndrome pati ents,vith the same initial cerebral activation of rite sympathicoadrenal me chanisms had dystonic trend in hemodynamic autonomic parameters: higher sys tolic blood pressure in subnormal heart rate, lability of baroreflex and ce rebral mechanisms under the orthostatic test. The above features of psychov egetative relations make such patients very close to those with psychoveget ative syndrome. Conclusion. CHD patients with coronary atherosclerosis and patients with X syndrome differ by mechanisms of maladaptation of autonomic regulation.