Ustych O. Features of the clinical course of coronary heart disease with intact and small changed coronary arteries in the residents of the mountain and lowland regions of Transcarpathia

The thesis is devoted to the study of the peculiarities of the course of coronary heart disease (CHD) in patients with angiographically normal or small changed coronary arteries (СА) living in the mountainous areas of the Ukrainian Carpathians. The dissertation is devoted to the study of clinical, gender, age, angiographic and laboratory characteristics of CHD in patients with intact and small changed coronary arteries who are residents of the mountain and lowland settlements of Transcarpathia. The results of the examination of 7974 patients, of which 246 patients with ischemic heart disease were selected based on intact and small changed coronary arteries, including 65 patients with myocardial infarction based on angiographically intact and small changed coronary arteries. Among 7974 patients intact CA were found in 11.8% of patients, small changes were found in 9.1% of the patients. Among the mountain population, intact CA were found in 13.5%, and small changed in 10.4%, among the lowland population 10.8% and 8.4% of patients respectively. Among patients with intact CA, there were 58.5% men and 41.5% women, among patients with small changed CA there were 65.1% and 34.9% respectively. It was established that the residents of the mountain areas with a history of myocardial infarction were 8 years younger than the residents of the lowland areas, 49.23 ± 1.69 versus 57.47 ± 1.82 g. (P = 0.001). The highest indicators of systolic function of left ventricul (LV) and larger left atrium were observed in residents of mountain areas, at the same time they had higher indicators of diastolic function of LV, a greater thickness of the posterior wall of the LV and interventricular septum. Residents of mountain settlements, both men and women, rarely sought medical assistance until the development of myocardial infarction and consequently did not receive treatment despite threatening symptoms from the cardiovascular system (the frequency of seeking medical care in the mountain residents by the time of the onset of myocardial infarction was 36, 4%, and in lowland residents 74,4% (p <0,05). The number of consultations of physicians in lowland residents was higher than in mountain residents 3,77 ± 0,44 versus 0,36 ± 0,11 times ( p <0.05). Industry - medicine.