Correction of gastrocardial syndrome in patients with hernias of the esophageal orifice of the diaphragm during antireflux operations

Introduction. Hernia of the esophageal opening of the diaphragm in 90% of cases is the main cause of the development of reflux esophagitis. The doctrine highlighted a large group of extraesophageal manifestations of reflux esophagitis, including gastrocardiac syndrome.Аim. The purpose of this publication is to evaluate the effectiveness of antireflux surgery in patients with hiatal hernia through the prism of its effectiveness in the dynamics of gastrocardial syndrome regression.Material and мethods. The paper presents the results of diagnostics and surgical treatment of 101 patients with hiatal hernia.Results. According to the data of instrumental research methods, cardiac hernias of the esophageal opening of the diaphragm were detected in 45 (44.5%) patients, cardiofundal in 40 (39.6%), subtotal in 15 (14.8%), total in 1 (0.9%). The main place in the clinical picture of gastrocardial syndrome was occupied by the pain syndrome behind the breastbone (83.1%). Thus, arrhythmias were found in 16 (40.0%) patients with cardiofundal, in 10 (66.6%) subtotal and in 1 (100.0%) total hiatal hernia, and angina pectoris is characteristic of cardiac hernias and was observed in 20 (44.4%) patients. The clinical manifestation of reflex angina pectoris and arrhythmias depended on the degree of shortening of the esophagus. Thus, arrhythmias were more common in patients with cardiofundal (50.0%), subtotal (71.4%), total (100.0%) hiatal hernia with II degree of shortening of the esophagus, and angina pectoris characteristic of cardiac (75.0%) hiatal hernia. with II degree of shortening of the esophagus. Reflex angina is typical for patients of the older age group, and manifestations of arrhythmia are recorded at a younger age. Heart rate variability was considered, according to electrocardiogram and Holter ECG monitoring before and after surgical treatment, where the parameters significantly (p> 0.05) decreased.Conclusions. The phenomena of gastrocardial syndrome regressed after antireflux surgery in 44 (43.5%) patients. Surgical treatment from the endovideosurgical approach did not worsen the results of surgical treatment.

Stable Angina Pectoris: One-Year Outcomes of Patients with Obstructive Coronary Artery Disease: Multicenter Sutdy in Dakar (Senegal)

Background: CAD management is important in prevention of disease progression. But we have very little study or research on the evolution of stable angina in amulatory patients without coronary antecedents and with obstructive coronary disease. Purpose: The objective of our study was to analyze the clinical and angiographic profil of patients with stable chest pain and to assess their angina status one year outcomes. Patients and methods: All patients who presented with symptomatic angina pectoris and/or signs of ischemia and first diagnosis of obstructive CAD in the Cardiology Departments of Idrissa Pouye General Hospital and Aristide Le Dantec National University Hospital Center of Dakar, from March 01, 2019 to December 31, 2020 were selected. The clinical characteristics, initial angiographic findings, therapeutic strategy and outcome within the first year were analyzed. Results: During the study period, 84 outpatients presenting with symptomatic stable chest pain and first obstructive coronary artery disease were selected. The mean age was 63.01± 9.37 years. Male preponderance was observed with 63(75%) patients; Clinical symptoms were dominated by typical pain with 46.4% (n=39) ; the risk factors were dominated by hypertension 61.9% (n=52); diabetes 41.7% (n=35) and dyslipidemia 33.3% (n=28). During follow-up, 10 patients (11.90%) remained untraceable while 9 patients (10.71%) were not available for check-up; 3 patients (3.57%) died during follow-up. Only 62 patients (73.80) could be evaluated; among those who were alive and controlled, 26 patients (41.93%) with angina at baseline still had angina symptoms, 2 patients (3.22%) had undergone myocardial infarction; one (1.61%) had undergone urgent revascularization; one (1.61%) patient developed heart failure. Finally 32 patients (51.61%) were event-free and angina-free Conclusion: The management of outpatients with stable chest pain and first obstructive CAD appears favourable, with good adherence to guideline-based therapies one year outcomes. Stable chest pain is not associated with an increased risk for adverse cardiovascular outcomes but there remains room for improvement in terms of risk factor control.

Overview of Microvascular Angina Pectoris and Discussion of Traditional Chinese Medicine Intervention

Previous research and treatment of coronary heart disease mostly focused on the large epicardial vessels, with limited research on the small endocardial coronary arteries or arterioles that could not be detected by coronary angiography, especially microvascular angina caused by microvascular stenosis or microcirculation dysfunction. Conventional Western medicine therapies have no specific efficacy, but traditional Chinese medicine has significant advantages in this regard. In particular, traditional Chinese medicine of supplementing Qi and activating blood circulation protects the vascular endothelium, relaxes coronary microvessels, reduces myocardial no-reflow after ischemia-reperfusion, increases myocardial hypoxia tolerance, constrains the aggregation of platelet, and increases the rate of blood flow. Moreover, these treatments can significantly improve patients’ symptoms through multitarget comprehensive intervention. Here, we analyzed the pathogenesis of microvascular angina pectoris, the treatment status of modern medicine, and the research on the multitarget intervention of traditional Chinese medicine to provide new research ideas for correctly identifying the role of coronary microcirculation in coronary artery disease to solve clinical problems and prevent cardiovascular events.