Analysis of Cardiac Rhythm Disorders and Vegetative Nervous System Function in Patients With Acute Myocarditis and Anxiety-Depressive Symptoms

Objective of the study – to investigate the impact of anxiety and depression caused by military actions on heart rate variability parameters and the characteristics of heart rhythm disturbances in patients with myocarditis.Material and methods. The study involved 60 patients with acute myocarditis who were divided into three groups based on the results of the HADS (Hospital Anxiety and Depression Scale) questionnaire. Group 1 included 20 patients with predominant anxiety (HADS-A ≥8; HADS-D <8). Group 2 consisted of 20 patients with predominant depression (HADS-A <8; HADS-D ≥8). Group 3 comprised 18 patients exhibiting both pronounced anxiety and depression (HADS-A ≥8; HADS-D ≥8). The control group included 20 patients with myocarditis without significant signs of anxiety or depression (HADS-A <8; HADS-D <8). All patients underwent Holter ECG monitoring to assess the number of ventricular and supraventricular extrasystoles, episodes of non-sustained ventricular tachycardia, and heart rate variability (HRV) parameters: SDNN, RMSSD, and the LF/HF ratio.Results. In patients of group 1, the values of SDNN, RMSSD, HF power, and the LF/HF ratio were significantly lower (by 11.2%, 9.8%, 11.8%, and 9.4%, respectively; p < 0.05) compared to the control group. In patients of group 2, a reduction in SDNN by an average of 11.9%, RMSSD by 15.4%, HF by 10.1%, and LF/HF by 12.2% (p < 0.05) was observed compared to the control group. When comparing HRV parameters between groups 1 and 2, no significant differences were found except for RMSSD, which was 10.3% lower in group 2 (p < 0.05). In group 3, SDNN, RMSSD, HF, and the LF/HF ratio were significantly lower both compared to the control group and to patients in groups 1 and 2. In group 1, supraventricular arrhythmias predominated, while the number of ventricular extrasystoles was comparable to that of the control group. Patients in group 2 demonstrated a significantly higher number of ventricular extrasystoles compared to groups 1 and the control group. In group 3, the frequency of ventricular rhythm disturbances, particularly episodes of non-sustained ventricular tachycardia, was the highest. Additionally, patients in this group more frequently presented with AV block and bundle branch blocks — in 51.6% and 55.1% of cases, respectively.Conclusions. In patients with symptoms of anxiety, supraventricular arrhythmias were more frequently recorded against the background of predominant sympathetic regulation of the autonomic nervous system. In those with depressive symptoms, a significantly higher number of ventricular extrasystoles and episodes of non-sustained ventricular tachycardia were observed, along with a marked decrease in time and spectral parameters of heart rate variability. The combination of anxiety and depression was associated with the most pronounced disturbances in autonomic regulation and significantly more frequent ventricular arrhythmias, both in comparison with the control group and with patients exhibiting isolated symptoms of anxiety or depression.