Chronobiological Analysis of Blood Pressure in a Patient with Atrial Fibrillation at the Development of Heart Failure and Its Therapeutic and Surgical Treatment
Dynamics of blood pressure (BP) and heart rate (HR) was traced by automatic monitoring every 30？min uninterruptedly along several months in a patient suffering from combined atrial fibrillation and heart failure during the development of disease and its therapeutic and surgical treatment (pacemaker implanting and atrioventricular ablation). Analyses of spectral components as well as signal’s shape revealed instabilities in circadian and semicircadian parameters. A new approach for signal’s form description without using cosine approximation is suggested. The meaning that referring a patient as dipper, night peaker, or nondipper might be useful at choosing tactics of his treatment is impugned, because all these “types” can transform themselves in the same person in few days. Optimization timing of treatment provides better results if not the “types” of daily profile would be taken to account but the real form of the BP-signal and timing its first and second derivatives. 1. Introduction The peculiarity of the case described in the paper was a possibility to trace objectively and in many details the hemodynamic changes continuously at all stages of the development and treatment of the heart disease: from the very beginning of cardiac insufficiency to its culmination, next therapeutic correction and final surgical intervention. Uninterrupted monitoring of systolic and diastolic blood pressure (SBP and DBP) and heart rate (HR) provided recording data, and next applying of specialized chronobiological programs ensured obtaining quantitative information dealing with dynamics of the process. Before the events described, the patient (GSK, further the patient, P, a man of 82), was suffering for years with essential hypertension. Atrial fibrillation with AV connections dysfunction was registered during the last 6 years, and he had renal failure during the last 3 years. Cardiovascular functions (SBP, DBP, and HR) are monitored in P uninterruptedly since 1998 (the second continuous monitoring in the world). Every 30 minutes data are automatically registered by TM-2421 recorder (A & D, Japan) and after their cumulation transferred into the computer. Dynamics of processes was analyzed using specialized software for analyzing trends, global, and gliding spectra [1] and the signal’s waveform [2, 3], methods previously described shortly in [4]. For 14 years it provided an opportunity to observe the behavior of cardiovascular functions at many very different changes in environmental conditions and external impacts to the organism [5–8]. 2. Short History of the Disease
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