Cardiogenic Shock in Acute Myocardial Infarction - Losses and AchievementsN.P. Mitkovskaya
The most severe manifestation of acute cardiac failure - cardiogenic shock (CS)-occurs in 5-7% of patients and is accompanied by unfavorable outcome in 40-60% of cases, thus remaining the main cause of death among patients admitted to hospital with acute myocardial infarction. The North- American register INTERMACS, created for analyzing the effectiveness of application of various systems for rendering assistance to patients with severe cardiac failure, including the systems of artificial circulatory support, classifies cardiogenic shock as INTEMACS1.
Prevalence and Clinical Significance of high Residual Platelet Reactivity in Patients with Unstable AnginaGelis L.G., Medvedeva E.A., Russkih I.I.
Patients with UA with different treatment strategies had a fairly high percentage of detected resistance to antiplatelet agents: 1G-26,4%, 2G-45,6%, 3G - 47% which in the future (within 18 months of observation)resulted in the development of recurrent coronary events. Cardiovascular complications occurred in 38 individuals (29,9%) with UA within 18 months follow-up, of whom 29 patients had high residual platelet reactivity. The risk of recurrent coronary events in patients with high residual platelet reactivity is significantly higher than in patients sensitive to antiplatelet agents: relative risk RR=5,5; confidence interval [95% CI of 2.7-19]; p=0.0001. Simul¬taneous resistance to clopidogrel and acetylsalicylic acid (ASA) was detected in 6.3% of patients which was associated with a high risk of repeated coronary events within 18 months of observation (r=0.74; p=0.0002), while the relative risk was RR=8.9 in comparison with patients with good sensitivity to antiplatelet agents; confidence interval [95% CI 6,7-31]; p=0.0001.
Prevalence of Major Cardiovascular Diseases among Almaty ResidentsS.F. Berkinbayev, G.A. Djunusbekova, А.Т. Musagaliyeva, K.М. Koshumbayeva, А.Kh. Isabekova, B.A. Аkhyt, D.M. Akpanova, G.R. Aliyeva
In Almaty, the incidence of arterial hypertension is 35.8%, isch¬emic heard disease (angina pectoris) - 10.7%, myocardial infarction - 2.9%, stroke - 2.5%, atrial fibrillation - 2.1%. The most common risk factors for cardiovascular disease are overweight, dyslipidemia and a sedentary lifestyle. When constructing the model of logistic regression, it is shown that the risk of developing arterial hyperten¬sion is higher in men, in persons with overweight, Russian and other European nationalities (in comparison with Kazakhs). The chance of myocardial infarction and acute cerebral circulatory disorders is higher in men, as well as in people with arterial hypertension. The incidence of uncontrolled arterial hypertension is generally 22.7% (the standardized indicator is 20.8%). Antihypertensive drugs are regularly taken by 45.2% of people with arterial hypertension.
Cardiovascular Risk in Patients with Acute Calculus CholecystitisD.S. Gerasimionak, E.A. Grigorenko, L.V. Kartun, N.P. Mitkovskaya
The ischemic depression of the ST segment was observed in six patients of the main study group on the 2nd day after the operation and in ten patients from the comparison group. The number of patients with ischemic changes on the ECG was four in the main group on the 4th day after surgery, and fifteen in the group without cardioprotective therapy (p <0.05). In the remote postoperative period, 14% (n = 20) of patients were hospitalized for acute coronary syndrome (ACS). In 10% (n = 2) of cases, a subendocardial myocardial infarction was diagnosed.
Prognostic assessment of posttransplantation survival of liver transpant recipientsE.A. Grigorenko, O.O. Rummo, N.P. Mitkovskaya
For increasing the prognostic accuracy of the MELD scale in the assess¬ment of posttransplantation mortality it is essential to combine its application with the assessment of such risk factors as the presence of paroxysms of ventricular tachycardia and diastolic dysfunction of the right ventricle. For the designed modified MELD model, considering the given risk factors, the coefficient of concordance was 0,82, which confirms good prognostic accuracy of the designed model.
Subjective Assessment of Situational and Personal Anxiety in Individuals with Excessive Body WeightO. М. Drapkina, R. N. Shepel, A. N. Kaburova
The signs of SA and PA were significantly more prevalent in patients with excessive body mass compared to the normal weight patients. Most of the patients in the 2nd group (96,67%) had moderate and high level of PA. Selection of patients with moderate and high levels of anxiety using the subjective questionnaire may have a positive influence on the effectiveness of treatment of overweight patients.
State of Retina Vessels,Light Sensitivity of the Visual System and their Correlation with Brain Structural Changes in Patients with Arterial HypertensionA.I. Kubarko, E.A. Bur, Y.A. Kubarko, L.L. Avdei
Thresholds of light sensitivity and their deviation were higher (р<0,05) in patients with arterial hypertension, than in patients from the comparison group. The relative vessel area (arterial, arterial and venous) and the number of vessels (arterial, arterial and venous) in patients with arterial hyperten¬sion were lower than in patients from the comparison group (р<0,05).
The total and corrected brain ventricle volume and the width of the 3rd ventricle in patients with arterial hypertension were larger than in patients from the comparison group.
The inverse correlation between ventricle volume and total and cor¬rected volume of brain and hemispheres was found (r from -0,37 till -0,54, p<0,05). The reverse correlation was also found between morphological parameters of the retina vessels (relative area, number of arterial vessels) and the volume of brain ventricles (r from -0,28 till -0,47, p<0,05).
The larger volume of brain ventricles was associated with the diminished relative area of vessels, especially in the subgroup of patients with arterial hypertension. The enlarged ventricles indicate the processes of brain atrophy, that can be found in patients with arterial hypertension, as well as decreased area of vessels, caused by their remodeling. The larger volume of ventricles was also associated with the decreased light sensitivity of the visual system. Taking into account the fact that more than 30 areas in the brain are responsible for the vision, the processes of brain atrophy could lead to the decrease in this parameter.
Cardiovascular Risk Stratification in Patients with Rheumatoid ArthritisT.A. Kurak, L.L. Avdej, T.V. Iljina, E.G. Oganova, E.I. Shkrebneva, Zh.N. Kot, L.V. Kartun, N.P. Mitkovskaya
Patients with rheumatoid arthritis are characterized by left ventricular remodeling with the development of its hypertrophy, diastolic dysfunction and a large-scale carotid and coronary atherosclerosis. Systemic inflammation in patients with rheumatoid arthritis promotes increases in blood levels of soluble intercellular adhesion molecule-1 and matrix metalloproteinase-9. The most informative features that determine the degree of coronary and carotid atherosclerosis in patients with rheumatoid arthritis are indicators of inflammatory activity (high-sen¬sitivity C-reactive protein levels, the index DAS 28), the content of brain natriuretic peptide, age and presence of hypertension.
Clinical and Immunological Features and Arthritic Status of Patients' Relatives with First and Second Degree of Kinship Suffering from Rheumatoid ArthritisN.A. Martusevich, E.A. Dmitrieva, N.P. Mitkovskaya
Pain in the joints was noted in 13 (26,5%) subjects; morning stiffness up to more than 30 minutes for 1 subject (2,0%). Tenderness and swelling in the joints were detected in 15 patients (30,6%). 20 subjects (40,8%) were positive for ACCP or MCV: increased level of ACCP was determined in 5 people (10,2%), MCV - in 19 subjects (38,8%); ACCP and MCV in 4 relatives (8,2%); CRP - in 1 patient (4.,1%), RF was negative for all subjects. In 55% of cases (n=11) a positivite immunological marker was accompanied by the presence of an articular syndrome and in 45% of cases (n=9) it was asymptomatic. MRI revealed the presence of changes in 20,4% of cases (n=10). Erosion was found in 8 of 15 patients with joint syndrome (53,3%); presence of synovitis - in 9 patients (60,0%), signs of bone edema - in 26,6% of cases (n = 4).
Cardiovascular System in Women with Silent Myocardial IschemiaI.V. Pateyuk, V.I. Terechov, T.V. Ilina, E.A. Podgolina, T.V. Statkevich, N.P Mitkovskaya,
The article is devoted to the study of the influence of regional peculiarities of distribution of adipose tissue on the functional state of the cardiovascular system in women with silent myocardial ischemia. The study included 70 patients in postmenopausal period with episodes of asymptomatic diagnostically significant ST segment depression revealed by means of the method daily monitoring of electrocardiogram. It was found that for postmenopausal women with silent myocardial ischemia epicardial obesity is an unfavorable factor associated with high cardiovascular risk.
Interventional Cardiology: from History to RealityA.E. Beymanov, E.A. Grigorenko, N.P. Mitkovskaya
The development of physiology, radiology and surgery in the twentieth century was largely possible due to the use of invasive diagnostic methods. Over the past thirty years one of the most rapidly developing branches of modern minimally invasive medicine - endovascular surgery - has emerged on the basis of diagnostic angiography. Percutaneous transluminal angioplasty, proposed by C. T. Dotter, marked the beginning of a new era in the treatment of atherosclerotic artery disease and has become the basis for further development of percutaneous interventions in different areas of medicine. The article highlights the main historical milestones in the development of interventional cardiology in the world and the Republic of Belarus, and identifies controversial issues for further research and scientific discussion.
Anemia in Cardiovascular DiseasesS.P. Sidaruk, E.B. Petrova, N.P. Mitkovskaya
Anemia is common in patients with heart disease and occurs in one third of patients with congestive heart failure and 10% to 20% of patients with coronary heart disease. The cause of anemia in heart disease is multifactorial and may include chronic inflammation, absolute and functional iron deficiency, impaired production and activity of erythropoietin, hemodilution, renal dysfunction. Hemodynamic and non-hemodynamic changes in anemia in the presence of chronic heart disease contribute to a high incidence of cardiovascular complications. Anemia is an independent risk factor for cardiovascular disease outcomes and probably acts as a mediator and a marker of a poor prognosis. The treatment for anemia in patients with heart disease includes erythropoiesis-stimulating agents, red blood cell transfusion and iron replacement.
Current Treatment of Massive Pulmonary ThromboembolismT.V. Statkevich, I.V. Patsiayuk, T.V. Ilina, D.V. Demidovich, A.S. Yanukovich
Massive pulmonary embolism is an acute, severe disease, which is based on the occlusion of the main pulmonary arteries with a reduction of more than 60% of pulmonary blood flow by thrombotic masses. The clinical presentation of the disease is associated with the occurrence of severe disorders of pulmonary and systemic hemodynamics and
is manifested by the development of arterial hypotension or shock. Mortality in the first hours of the disease reaches 68%, which allows pulmonary embolism rank third among the most common causes of death, second only to myocardial infarction and stroke. Effective therapy using all available current techniques can help improve the prognosis and survival of this category of patients.