ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH CARDIOVASCULAR COMPLAINTS AND ANXIETY DURING THE RUSSIAN-UKRAINIAN WAR: CASE SERIES
Abstract
Any war influences the mental and physical health of inhabitants of the country suffering from aggression. Anxiety is one of the mental disorders with increased prevalence during the war. A close relationship between anxiety and carbon dioxide concentration in the human body was revealed. There is no doubt about the pivotal role of the later in vascular tone control and the appropriate functioning of the endothelium. This paper presented case series of three female patients with similar complaints exacerbated after a stressful situation (bombing) in the period of the Russian-Ukrainian War. In addition to routine investigational methods (anamnesis taking, physical examination, electrocardiography, and transthoracic echocardiography at rest), Hamilton Anxiety Score and capnometry were used. The trend of drastically decreased end-tidal concentration of carbon dioxide and mild to severe anxiety levels was noticed. We consider there is a connection between the severity of anxiety and end-tidal concentration of carbon dioxide that indirectly reflects the possible endothelial dysfunction. Therefore, taking into consideration patho-mechanisms and pathology data, using differential pathogenetic methods of surgical invasion and computer monitoring of post-operative period we managed to decrease mortality in severecerebro-cranial traumas to 29-30% comparing to pre computer periods 36-38 % and comparing to data of other clinics 35-45%.
References
Betancourt, T. S., Thomson, D., & VanderWeele, T. J. (2018). War-Related Traumas and Mental Health Across Generations. JAMA psychiatry, 75(1), 5–6. https://doi.org/10.1001/ jamapsychiatry.2017.3530
Fontanarosa, P. B., Flanagin, A., & Golub, R. M. (2022). Catastrophic Health Consequences of the War in Ukraine. JAMA, 327(16), 1549–1550. https://doi.org/10.1001/jama. 2022.6046
Carpiniello B. (2023). The Mental Health Costs of Armed Conflicts-A Review of Systematic Reviews Conducted on Refugees, Asylum-Seekers and People Living in War Zones. International journal of environmental research and public health, 20(4), 2840. https://doi.org/10.3390/ijerph20042840
Lim, I. C. Z. Y., Tam, W. W. S., Chudzicka-Czupała, A., McIntyre, R. S., Teopiz, K. M., Ho, R. C., & Ho, C. S. H. (2022). Prevalence of depression, anxiety and post-traumatic stress in war- and conflict-afflicted areas: A meta-analysis. Frontiers in psychiatry, 13, 978703. https://doi.org/10.3389/fpsyt.2022.978703
Lum L. C. (1981). Hyperventilation and anxiety state. Journal of the Royal Society of Medicine, 74(1), 1–4. https://doi.org/10.1177/014107688107400101
Sauty, A., & Prosper, M. (2008). Le syndrome d'hyperventilation [The hyperventilation syndrome]. Review of Medical Suisse, 19(4), 2502-5. French. https://pubmed.ncbi.nlm.nih.gov/19127893/
Lum L. C (1987). Hyperventilation Syndromes in Medicine and Psychiatry: A Review. Journal of the Royal Society of Medicine, 80(4), 229-231. https://doi.org/10.1177/ 014107688708000413
Curley, G., Laffey, J. G., & Kavanagh, B. P. (2010). Bench-to-bedside review: carbon dioxide. Critical care (London, England), 14(2), 220. https://doi.org/10.1186/cc8926
Zavgorodnia, V. A (2019). Вплив різних рівнів CO2 на гемодинаміку: аналітичний огляд літератури [Effect of different CO2 levels on hemodynamics: an analytical review of the literature] [in ukr]. Herald of Cherkasy University. Biological sciences series, 2, 3-19. http://eprints.cdu.edu.ua/2564/
Wang, Q., Pelligrino, D. A., Koenig, H. M., & Albrecht, R. F. (1994). The role of endothelium and nitric oxide in rat pial arteriolar dilatory responses to CO2 in vivo. Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism, 14(6), 944–951. https://doi.org/10.1038/jcbfm.1994.126
Mitchell, C., Rahko, P. S., Blauwet, L. A., Canaday, B., Finstuen, J. A., Foster, M. C., Horton, K., Ogunyankin, K. O., Palma, R. A., & Velazquez, E. J. (2019). Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography, 32(1), 1–64. https://doi.org/10.1016/j.echo.2018.06.004
Kupnik, D., & Skok, P. (2007). Capnometry in the prehospital setting: are we using its potential?. Emergency medicine journal: EMJ, 24(9), 614–617. https://doi.org/10.1136/emj.2006. 044081
HAMILTON M. (1959). The assessment of anxiety states by rating. The British journal of medical psychology, 32(1), 50–55. https://doi.org/10.1111/j.2044-8341.1959.tb00467.x
On-line medcalculator “Hamilton Anxiety Scale”. https://www.mdcalc.com/calc/1843/hamilton-anxiety-scale#next-steps
Fathi, A. R., Yang, C., Bakhtian, K. D., Qi, M., Lonser, R. R., & Pluta, R. M. (2011). Carbon dioxide influence on nitric oxide production in endothelial cells and astrocytes: cellular mechanisms. Brain research, 1386, 50–57. https://doi.org/10.1016/j.brainres.2011.02.066
Talabko, Yu. O., Tyravska, Yu. V., & Savchenko, O. V. (2023) Carbon dioxide as the regulator of vascular tone. Scientific Collection «InterConf+», 31(147), 21-27. https://doi.org/10.1080/interconf/10.51582/interconf.19-20.03.2023.046
Sara, J. D. S., Ahmad, A., Toya, T., & Lerman, A. (2021). Anxiety disorders are associated with coronary endothelial dysfunction in women with chest pain and nonobstructive coronary artery disease. Journal of American Heart Association, 10(17), e021722. https://doi.org/10.1161/JAHA.121.021722
Views:
182
Downloads:
101
Copyright (c) 2023 Oleksandr Savchenko, Yuliya Tyravska, Viktoriia Sobol, Yuliya Moshkovska
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.