Clinical and functional examination of the miners who suffered from coronary heart disease showed a higher ectopic activity of the myocardium during their work under underground conditions and during the subsequent 4 hours after its termination. It also indicated a significantly higher fatal cases of sudden coronary death in the miners in the aforementioned periods. To prevent the development of complications occurred in miners, the status of the cardiovascular system was proposed to be dynamically controlled.
The article is devoted to coronary disease in miners of deep Donbass mines. Data of its prevalence, chemical and functional features are given. Rapid progress of the disease was found to correlate with unfavourable factors of occupational environment. Mechanisms of dangerous heart rythm disorders formation during the work are shown. The main points of the programme improving the health care of miners suffering from coronary heart disease are described.
The authors studied autopsy protocols, microscopic and histochemical data on the heart for miners who had died suddenly. No positive trend in the sudden coronary death incidence in miners was reported. A great number of sudden deaths were registered in mines. The deaths are attributed to severe atherosclerosis responsible for irreversible changes in the myocardium, coronary vascular spasms, emergence of pathological agitation triggering lethal ischemia.
As a result of epidemiological and clinico-functional studies occupational peculiarities of ischemic heart disease (IHD) among miners were detected. The role of a number of industrial factors in the development of arrhythmia with unfavourable prognosis was assessed. Persons at risk for development and progress of IHD were identified. A method of dynamic control over their cardiovascular system was suggested. The findings of the study formed the basis for a complex follow-up programme for miners with IHD.
In the process of carrying out medikal checkups of miners a shop physician must take an active part in forming groups at risk of ischemic heart disease (IHD) and in ensuring dynamic preshift and postshift monitoring of the state of miners' cardiovascular system through the use of comprehensive methodological complex and further health promotion of this occupational group. Those attributed to the groups of extreme risk must discontinue their work in a mine. It was necessary to find some appropriate employment for them in order to avoid their contact with colliery occupational conditions. Early conditions of IHD by means of the suggested complex and timely appropriate employment promoted better diagnosis of atypical early forms of IHD and prevention of its complications.
The article contains a study of 529 myocardial infarction cases in coal miners with provisional assessments of their health states after the rehabilitation course. Inadequacy of the resort treatment procedures was established, the clinico-functional examinations of the patients were irregular and limited to one or two procedures, which hampered the objective assessment of the measures taken. The drug treatment procedures were also inadequate both in respect of the patients' health conditions and with regard to specific drug prescriptions, dosages and frequency of administration. The results of the prolonged study revealed that 50% rehabilitation cases were unduly handled and returned to clinic with health complications after 6 months. The rehabilitation course did not include the psychotherapeutic rehabilitation component, which would be of paramount importance for the patients under the new health circumstances. Out-patient admission epicrises were not performed whatsoever, or were of a low quality, thus accounting for future rehabilitation failures.
By means of epidemiological, clinico-functional, experimental, pathomorphological, histological and mathematical-statistical methods the authors showed that hard physical work under conditions of heating microclimate promoted quick development and advance of coronary heart disease in deeply working coal miners. Negative dynamics of sudden coronary death (SCD) rate was established, its pathophysiological mechanisms were specified. SCD risk factors were singled out and arranged accordingly to their importance. SCD in miners was suggested to be considered as professionally conditioned state.