2018 Том 2, №1
 

Acute heart failure: epidemiology, risk factors, prognosis, diagnosis, treatment and prevention
N.P. Mitkovskaya
Acute heart failure (AHF) is a clinical syndrome, which complicates the course of numerous cardiovascular diseases; it appears suddenly or is characterized by rapid or steadily progressing exacerbation of HF symptoms, which require immediate hospitalization and specialized care. In spite of great contribution of health care and financial expenses connected with AHF and chronic heart failure (CHF), a lot of issues still remain unresolved in the field of diagnosis, drug therapy, prognosis and prevention of this syndrome. A high incidence of comorbid pathology is revealed, which to a great extent determines the occurrence, development and prognosis of AHF. Detection of malignant neoplasms in patients with the previously diagnosed HF has become very frequent, and specialists express concern regarding diagnosis of cancer in patients with HF.
Some clinical and laboratory cardiovascular, noncardial, patient-conditioned or iatrogenic indices are independent predictors of the outcome in AH. To assess the risk of unfavorable outcomes in case of hospitalization, it is necessary to develop and implement into practical health care risk scores based on generally accessible indices, which will make it possible to define with a high degree of accuracy the risk of hospital lethality of the patient.
Each hospitalization in case of AHF is connected with deterioration of the heart function, which is never restored to the initial condition after the discharge from the hospital and is accompanied by progressing HF. The average survival of patients with HF decreases in proportion to the number of hospitalizations, therefore, for prevention of AHF episodes it is necessary to fully arrest the congestive conditions in the hospital, to educate patients with CHF, to patiently titrate oral medications to the maximally tolerated effective doses, to thoroughly monitor patients after the discharge from the hospital in order to reveal and correct decompensation as early as possible. It is useful to develop a modern and effective model of monitoring the course of the disease, capable of improving the efficiency of medical care, the quality of life and prognosis of patients – telemedical monitoring.
After the hospitalization of the patient with AHF it is necessary to assess the clinical status for the identification of life-threatening syndromes which require specific organizational tactics: acute coronary syndrome; hemodynamic “catastrophe”, respiratory failure, life-threatening tachi- or bradyarrythmia. Practical health care faces a set of tasks, which call for continuous improvement and assistance of scientists: improvement of the quality of life for patients with HF, decrease in mortality, reduction of the number and duration of rehospitalizations; refinement and creation of new diagnostic and therapeutic technologies, prompt selection of patients, who can be helped by nondrug therapy (invasive ventilation, temporary assist circulation) and in the future – resynchronization therapy or heart transplantation, optimization of drug therapy of CHF and of diseases, which triggered AHF, after the stabilization of the condition and before the discharge from the hospital.
The influence of topographic and anatomical characteristics of the intramural course of the coronary artery on the patients quality of life
S.V. Dechko, A.E. Beimanov, P.F. Chernoglaz, D.I. Yurievich
The aim of the study was to investigate the effect of topographic and anatomical characteristics of the intramural course of the coronary artery on the quality of life of patients with a verified diagnosis. Methods. A retrospective study was carried out at three clinical bases in Minsk: "City Clinical Hospital No 1", "City Clinical Emergency Hospital" and "City Clinical Hospital No 9". The object of the study was the data of percutaneous interventions protocols of the catheterization laboratory.
A group of patients with the described intramural course of the coronary artery, which included 314 cases in the past 6 years, was identified. The age of patients ranged from 30 to 86 years. The degree of contraction during the systole varied from minor stenosis (20% and less) to 100%.
The information was analyzed using a computer program for statistical processing SPSS Statistics version 21.0 (StatSoft, Inc., USA). To study the parameters of the patients quality of life the SF-36 questionnaire was used. The intramural course of the coronary artery has a wide range of topographic and anatomical characteristics and is found primarily in men over 30 years old. In 25% of cases the intramural course of the coronary artery is not accompanied by atherosclerotic lesion of the coronary arteries. Most frequently, the vessel is clogged by 50-75% during cardiac contraction.
The analysis of answers given by the patients with the verified intramural course of the coronary artery suggests that the tunneled segment can affect the quality of life mainly at a young age. The influence of vessel lumen narrowing on the indicators of mental health and vital activity of patients was found.
Evaluation of the incidence and the degree of expression of depression in patients with class I obesity
O.M. Drapkina, R.N. Shepel
Objective. To study the incidence of depression in patients with class I obesity.
Materials and methods. 60 patients were included in the study, the mean age was 55.05 ± 17.27 years, the number of men and women was 20 (33.33%) and 40 (66.67%), respectively. Depending on the body mass index, patients were divided into 2 groups: 1st group - patients with normal body weight (n = 30); 2nd group - patients with class I obesity (n = 30). All patients were evaluated by anthropometric indicators (height, weight and body mass index). Evaluation of the depressive syndrome was assessed by Beck's Depression Inventory .
Results. Symptoms of depression of varying severity were 20% (p = 0.02) more common in persons with class I obesity compared with patients with normal body weight (53.3% and 33.3%, respectively). The average mark on the Beck scale in the 1st group was 7.47 ± 5.45, while in the 2nd group it was 10.13 ± 5.13. The overall incidence of depression in the 2nd group was 4-fold higher in women than in men (n = 12 (40%) and n = 3 (10%), respectively.) In people with normal body weight, the symptoms of depression were found in 33.3% of participants (n = 10).
Conclusions. 1. In persons with class I obesity depressive symptoms are more common than in individuals with normal body weight. 2. Every third participant in the group of patients with normal body weight had symptoms of depression. Undoubtedly, this fact should be taken into account by doctors (especially specialists of primary health care) with the aim of correcting and preventing possible development of diseases associated with depression. 3. Having studied the severity of depression in persons with class I obesity on the basis of the Beck's Depression Inventory, it is possible to recommend using scientifically based methods of correction and prevention of pathological personality disorders. 4. The obtained results can be used for optimal strategies, tactics and means of psychological, psychotherapeutic and medical influence, for the development of methods for the preventing mental disorders and pathological personality behavioral disorders in persons with class I obesity.
Cardiotoxic effect of antitumor therapy in the development of diastolic dysfunction of the left ventricle in women in the treatment of breast cancer
Mitkovskaya N.P., Kananchuk N.B., Petrova E.B., Galitskaya S.S., Shapoval E. V., Mikulich D.V.4, Smirnov S.U., Gutkovskaya E. A.
Methods
71 female patients with breast cancer (BC) were divided into groups according to the presence of arterial hypertension (AH) and cardiotropic therapy (CTT): ВС group with antitumor treatment alone (38 cases), ВС+CTT group – patients with antitumor treatment who received carvedilol combined with valsartan and had no hypertension (22 cases); ВС+ CTT + AH group – patients who had hypertension and received carvedilol combined with valsartan (11 cases).
Results
After completing the full course of treatment for breast cancer in BC group a decrease in transmitral flow ratio, an increase in myocardial mass, left ventricular mass index, meridional stress, left ventricular end-diastolic pressure and left ventricular end-diastolic stress wall (p<0,05) have been revealed.
Direct correlation between the degree of reduction of ejection fraction and increase in the left ventricular end-diastolic stress wall (r=0,34; р<0,05), as well as between decreased transmitral flow ratio and increased left ventricular end-diastolic stress wall (r=0,41; р<0,05) have been found.
Conclusions
The earliest changes in the structural and functional parameters of the left ventricle as a result of antitumor treatment are represented by some parameters of diastolic dysfunction.
The purpose of cardiotropic therapy is to reduce the cardiotoxic effect of chemoradiotherapy.
Differences in morphological parameters of the vessels of the paramacular retina area in patients with arterial hypertension and diabetes mellitus
Kubarko A.I., Sologub E. I., Kubarko Y.A.
Objective –to study the effect of arterial hypertension and hyperglycemia in diabetes mellitus on the morphological parameters of the paramacular area vessels of the eye fundus to identify differences in the state of the retina vessels and cardiovascular risks
Material and methods. The evaluation of the morphological parameters of the vessels was carried out with the help of software ARIA (Automated Retinal Image Analyzer) native v 1.0 on the digital photos of the eye fundus of 50 patients with type 2 diabetes mellitus on the nonproliferative and pre-proliferative stages of diabetic retinopathy; 20 patients with arterial hypertension of 1-2 degrees and 40 healthy subjects. Photos of the eye fundus obtain using fundus camera Visucam Pro Nm, Carl Zeiss (Germany) and camera Visucam 500, Carl Zeiss (Germany) when examining patients and subjects in Minsk Consulting and Diagnostic Centre and Minsk City Clinical hospital №10.
The analyzed vessels branches were visually divided into arterial and venous ones taking in account their color, diameter and location of the site of main vessels from which it were branching.
Results. In patients with type 2 diabetes mellitus on non diabetic retinopathy stages a reduction of the number of the branches of predominantly of arterial blood vessels, reduction of the internal diameter, and an increase of a crimp the arterial and venous vascular of paramacular area of the retina were identified. The branching of the retina vessels in patients with diabetes mellitus remain unchanged that indicates the absence of morphological signs of neovascularization.
Hypertensive patients showed minimal reduction in the number of blood vessels branches, minimal decrease in vascular density in paramacular area of retina and minimal increase tortuosity branches of the lower east artery, than patients with type 2 diabetes mellitus.
Conclusion. The study of the morphological parameters of the vessels of eye fundus in healthy subjects, in patients with type 2 diabetes mellitus and patients with arterial hypertension by methods of quantitative evaluation, revealed in the early stages of type 2 diabetes mellitus a decrease in the number of branches of the vessels greater, compares with patients with hypertension, a decrease in internal diameter and increase in the tortuosity of arterial and venous vessels of the paramacular retina area, suggesting that small nutrition vessel are the target of hyperglycemia , other factors of diabetes mellitus and arterial hypertension. The revealed morphological changes in vessels of paramacular aea of the retina can be, in case of their progression, considered as a predictor of cardiovascular risks.
Specific features of treatment of supraventricular form of paroxysmal tachycardia in children
Sechko E.V., Zasim E.V., Strogiy V.V., Saviuk N.I.
The analysis of hospital treatment of pediatric patients with supraventricular form of paroxysmal tachycardia (PT) was carried out in comparison with the approaches and results of the treatment of foreign colleagues; case histories of patients with this disease were studied and case monitoring was performed. At the same time, the main drugs for rapid relief of symptoms and prophylactic treatment of PT were determined taking into account their effectiveness. For routine preventive therapy of PT attacks beta-blockers should be primarily used, then propafenone is recommended and, taking into account the side effects, cordarone should be employed. In the early age, the most effective combination is the use of antiarrhythmic drugs. Approaches to the treatment and follow up of children with PT in the Republic of Belarus correspond to the world level and are comparable with the results of foreign studies.
Glucose control in patients with myocardial infarction
E.S. Smirnova, S.S. Galitskaya, N. P. Mitkovskaya
Aim: to investigate homeostasis markers of unfavourable prognosis and to define target glucose levels in patients with large-focal myocardial infarction (MI) and hyperglycemia (HG) without previous carbohydrate metabolism disorders.
Methods. Results of the examination of 185 patients with acute large-focal MI without previous carbohydrate metabolism disorders are presented in the article. Patients were divided into 2 groups: with HG (study group, n=106) and without HG (control group, n=79). Clinical, laboratory and instrumental investigations were performed. The obtained data were processed with the statistical software packages Excel, Statistica (version 10.0, StatSoft, Inc., USA), SPSS (version 16.0, SPSS Incorporation, USA).
Results. Patients with MI and HG were characterized by more severe systemic inflammation, hemostasis disturbances and changes in hormonal state, and myocardial necrosis markers than patients without HG. In patients with MI and HG without previous carbohydrate metabolism disorders a blood glucose level decrease below 8.0 mmol/l was associated with proinflammatory cytokine concentration reduction, D-dimer level decrease and reduction of initially elevated amount of nitrates and nitrites. In patients with MI and HG a blood glucose level decrease to 4.5–6.1 mmol/l and to 6.2–8.0 mmol/l did not affect inflammation parameters, the total amount of nitrates and nitrites, D-dimer level, incidence of complications, in-hospital mortality, unstable angina rate, recurrent myocardial infarction incidence and mortality during a 36-month follow-up.
Conclusions. Stress HG in case of acute MI leads to unfavourable prognostic changes in inflammation, hemostasis and hormonal parameters, biochemical markers of myocardial necrosis. Specific features of MI course and homeostasis parameter changes have been revealed depending on the dynamics of glycemia in the acute period of MI.
Six months results after coronary artery chronic total occlusion recanalization by antegrade approach
Stelmashok Valeriy, Polonetsky Oleg, Koush Alena, Pashkevich Stanislau, Kavalenka Dzmitry
Aim. To assess 6-month results after coronary artery chronic total occlusion (CTO) recanalization by antegrade approach.
Methods. The study included 117 patients who had undergone coronary artery CTO recanalization for the period from 2009 to 2012. After 6 months, all patients were examined with coronary angiography, intravascular ultrasound and optical coherence tomography. Clinical outcomes, coronary patency, the development of restenosis, thrombosis and other negative events were registered.
Results. Development of cardiac death was observed in 0.9 % of patients (n = 1), acute myocardial infarction – in 0.9 % (n = 1), stroke – in 0.9 % (n = 1). Target lesion failure (TLF) was detected in 23.1 % of patients, in 59.3 % of cases that was combined with the presence of angina symptoms. The main reason of TLF was restenosis development. It was observed in 81.5 % of patients. Other reasons requiring repeated PCI in the target lesion correction were subacute and late stent thrombosis, late malposition of stent structural elements and stent fragmentation.
We observed high patients adherence to constant medical therapy including acetylsalicylic acid (97,4 % of adherence), clopidogrel (62,5 % of adherence) and statins (95.7 % of adherence). There was no correlation between the antiplatelet drugs discontinuation and the subacute/late stent thrombosis development.
Conclusion. The obtained data show good 6-month results after coronary artery CTO recanalization that makes it possible to recommend the interventional techniques for coronary artery CTO correction in clinical practice.
Are we underestimating the gradient in patients with aortic stenosis and atrial fibrillation: it’s time to consider ventricular preload
Samual Hayman, Pantelis Diamantouros, Rodrigo Bagur, Michael Chu, Bob Kiaii, Bryan Dias, Patrick Teefy MD
Purpose: To understand the significance of variation in gradient beat-to-beat pressure gradients in patients with significant aortic stenosis and concomitant atrial fibrillation and determine its relationship to severity.
Methods: Assess the beat-to-beat variability of pressure gradients in patients significant aortic stenosis and concomitant atrial fibrillation from retrospective analysis of Doppler or catheter-based hemodynamic measurements and correlate with the preceding RR interval based on the corresponding electrocardiogram. Results: There is a direct correlation between the preceding RR interval and the mean pressure gradient in patients with significant aortic stenosis and concomitant atrial fibrillation. The variation seems to be more prominent in those with severe stenosis and preserved left ventricular function and may aid in classifying the degree of stenosis as severe in some with seemingly more moderate stenosis based on traditional averaging of consecutive beats.
Conclusions: Variation in pressure gradients beat-to-beat are important to consider in patients with aortic stenosis and concomitant atrial fibrillation and correlate with severity and contractile characteristics.
Efficiency of observing patients in the setting of a specialized center for treatment of chronic heart failure
Fomin I.V., Vinogradova N.G., Farzaliev M.I-ogly, Allakhverdieva, S.M-kyzy, Krylova A.N., Samarina A.S., Tyurin A.A.
Relevance. Frequent repeated hospitalizations due to acute decompensation of heart failure worsen the prognosis of patients with CHF. This dictates the necessity to set up medical and physical rehabilitation system of effective control after discharge from the hospital at an outpatient stage. The main task of setting up a center for CHF treatment was to develop and refine the system of managing patients with CHF.
Objective. To establish the differences in two strategies for monitoring patients with CHF after acute heart failure decompensation and to determine the efficiency of treatment, rehabilitation methods and life expectancy, depending on monitoring them in the setting of a specialized city center for CHF (CCHF) treatment and in real outpatient practice.
Materials and methods. The study included 648 patients with CHF of any etiology older than 18 years of age. Group 1 comprised 412 patients with CHF who were monitored at the inpatient department of the CCHF with acute heart failure decompensation and after the discharge they continued rehabilitation at the outpatient department of CCHF. Group 2 comprised 236 patients with CHF who were discharged for acute heart failure decompensation from the CCHF and preferred to be monitored in other outpatient clinics in Nizhny Novgorod.
Results. After 1 year of follow-up, group 1 patients became significantly more hemodynamically stable. The overall mortality rate in group 1 was 4.13 %, and in group 2 – 14.83 % (OR = 4.0, 95 % CI: 2.2-7.4, p <0.001). Mortality from cardiovascular causes is significantly higher in group 2: 11.4 % compared to 3.3 % in group 1 (OR = 3.8, 95 % CI: 2.0-7.4, p < 0.001), as well as mortality from acute heart failure decompensation: 7.6 % vs. 2.1 % of cases (OR = 3.8, 95 % CI: 1.7-8.7, p <0.001). Nonfatal cardiovascular complications were registered significantly more rarely in group 1 than in group 2: 1.6 % vs 5.1 % (OR = 3.2, 95 % CI: 1.2-8.3, p = 0.01). In group 2, the incidence of fatal and nonfatal strokes and thromboembolic complications was significantly higher - 6.3 % compared to 1.4 % of cases in group 1 (OR = 4.4, 95 % CI: 1.7-11.6, p < 0.001). An increase in the proportion of re-hospitalized patients with CHF during the year was recorded in group 2 compared to group 1: 50.3 % and 31.8 % of patients (OR = 2.2, 95 % CI: 1.5-3, 2, p <0.001). The physical activity of patients who were observed in the department of the CCHF was significantly higher than among patients who were treated in other outpatient clinics in Nizhny Novgorod.
Conclusion. The introduction of the system of managing patients with CHF after an episode of acute heart failure decompensation turned out to be significantly more effective in comparison with the generally accepted approach. Managing patients with CHF after hospitalization for acute heart failure decompensation requires active continuous titration of basic drugs, physical rehabilitation, as well as training the patient to control his condition, which is possible only due to “patient schools”, maintaining a close contact between the doctor, nurse and patient and a stable schedule of examinations and phone calls.
Right ventricle outflow tract stenting as a stage of palliative intervention before radical correction of fallot’s tetralogy in children
P.F. Charnahlaz, Y.I. Linnik, A.V. Bashkevich, E.V. Korolkova, A.I. Savchuk, N.S. Shevchenko, K.V. Drozdovski
The aim of the present study is to develop a method of surgical treatment of Fallot’s tetralogy in children on the basis of endovascular stenting of the right ventricle outflow tract. Methods. The article presents the experience of stenting the right ventricle outflow tract in 30 patients aged 3.40 [0.92 ÷ 9.62] months with Fallot’s tetralogy prior to the stage of radical correction of the defect in the Republic centre of pediatric surgery within the period from 2007 to 2017. Results. In the course of the study the method of endovascular stenting of the right ventricle outflow tract in children with Fallot’s tetralogy was developed as a stage of palliative intervention prior to radical correction of the defect. Conclusions. Stenting the right ventricle outflow tract has been found feasible as a stage of correcting Fallot’s tetralogy in low-weight patients from a high-risk group. This type of correction by means of stenting is characterized by a low incidence of postoperative complications and a more favorable postoperative course in general. Stenting the right ventricle outflow tract in children with Fallot’s tetralogy makes it possible to achieve the appropriate size of the pulmonary artery branches necessary for the radical correction of the defect. Postoperative hemodynamics after stenting is more physiological.
Biochemical predictors of acute heart failure development in the early postoperative period after coronary artery bypass surgery and valve repair in individuals with ischemic heart disease and preserved ejection fraction
N.A. Shibeko, L.G. Gelis, T.V. Rusak, V.V. Shumovetc
Aim. To determine the prognostic significance of cardiac biomarkers in the development of acute heart failure in operated patients with ischemic heart disease and preserved left ventricular ejection fraction.
Methods. 92 patients with IHD (with preserved EF) and forthcoming coronary artery bypass surgery (CABS) were examined. Of them 50 patients (54 %) underwent CABG and 42 patients (46 %) - CABS combined with mitral and/or tricuspid valve repair. Initial examination consisted of echocardiography with tissue Doppler mapping, coronary angio¬graphy, MRI - cardiac examination, as well as identifying the levels of cystatin C, natriuretic peptide (NT-pro-BNP), galectin-3, stimulating sST-2 and high-sensitive troponin.
Results. While determining the threshold values of acute heart failure predictors, brain natriuretic peptide and sST 2 proved to be independent predictors. When the preoperative threshold level of sST2 is exceeded > 45 ng/ml, the odds ratio (OR) of postoperative period complicated course is 5.345 (95 % CI 3.6-9.78, p = 0.01), for the NT-pro- BNP > 500 pg/ml - 6.578 (95 % CI 4.3-9.96, p = 0.02).
Conclusion. Cardiac biomarkers have demonstrated a high level of informative value for acute heart failure prognosis in operated patients with ischemic heart disease and preserved left ventricular ejection fraction.
Some non - pharmacological methods of treatment of hypertension
Birulya A. A.
The number of people suffering from arterial hypertension is steadily increasing making it necessary to look for the most effective methods of treatment of this disease. In some cases correction of the risk factors enables doctors to reduce arterial hypertension without using drug therapy. This article gives a brief overview of the risk factors such as smoking, alcohol abuse, overweight, hypodynamic lifestyle, stress, poor diet including high salt intake leading to hypertension and aggravating its course. The existing methods (including experimental ones) contributing to the reduction of arterial pressurehave been studied: denervation of renal arteries, stimulation of carotid sinus baroreceptors, arteriovenous fistula, carotidbody ablation, surgical neurovascular decompression, enhanced external counterpulsation. The article highlights the pathogenetic mechanisms of influence of different risk factors on the increase of blood pressure and the possibility to reduce it by their correction. The alternative methods ofhypertension treatment, the mechanisms of their influence, effectiveness, the duration of the effect and possible complications are also considered.The paper provides the findings of experimental study of the currentmethods and their applicationin the Republic of Belarus and in the Russian Federation.
Heparin-induced thrombocytopenia
S.V. Dudarenko, O.A. Ezhova
A wide use of heparin in medicine (cardiology and cardiosurgery, traumatology, neurosurgery, intensive care medicine, etc.) has recently caused a number of problems. In the use of heparin cardiologists, intensive care specialists and other physicians increasingly face the problem of heparin-induced thrombocytopenia (HIT). The introduction of new methods into resuscitation practice and the use of ECMO-technologies, chronic hemodialysis, the use of artificial circulation apparatus makes HIT a problem of current importance due to the possibility of extremely dangerous and even potentially fatal complications. HIT is characterized by a specific disease pattern, the leading significance in which is not bleeding, but multiple venous and arterial thrombosis. In clinical practice, difficulties appear not only in the diagnosis, but also in the choice of tactics for managing patients with identified HIT syndrome.
Women and Men: Sex Differences in Cardiovascular Risk Prevention
T. Kikalishvili, V. Chumburidze
Cardiovascular disease (CVD) is the leading cause of death in women, and knowledge of the clinical con¬sequences of atherosclerosis and CVD in women has grown tremendously over the past 20 years. Research efforts have increased and many reports on various aspects of ischaemic heart disease (IHD) in women have been published highlighting sex differences in pathophysiology, presentation, and treatment of IHD. For the past three decades, dramatic declines in heart disease mortality for both men and women have been observed, especially in the > 65 years' age group. But despite it according to the Global Burden of Disease, in 2004, CVD caused almost 32 % of deaths in women worldwide vs. 27 % in men. In Europe, 54 % of all females' death are from CVD vs. 43 % in men. Recent evidence has emerged that recognizes new, potentially independent, CVD risk factors exclusive to women. In particular, common disorders of pregnancy, such as gestational hypertension and diabetes, as well as frequently occurring endocrine disorders in women of reproductive age are associated with accelerated development of CVD and impaired CVD-free survival. With the recent availability of prospective studies comprising men and women, the equivalency of major risk factors prevalence and effects on CVD between men and women can be examined. Furthermore, female-specific risk factors might be identified enabling early detection of apparently healthy women with a high lifetime risk of CVD. Therefore, we examined the available literature regarding the prevalence and effects of the traditional major risk factors for CVD in men and women.
Influence of transport noise and air pollution on metabolic and cardiovascular morbidity and mortality
Pyko A.V., Mukalova O.A., Pyko A.A., Mitkovskaya N.P.
In a modern developing society, there are two most important environmental risk factors: transportation noise and air pollution. In this review, we evaluated and discussed epidemiological evidence of the effect of these factors on metabolic disorders and cardiovascular morbidity and mortality. We consider the issue of mutual and independent impact of transportation noise and air pollution on human health as well as possible ways of reducing the impact of these environmental factors. Raising the awareness of society and professionals about adverse health effects of transportation noise and air pollution, defining these environmental factors as independent risk factors for cardiovascular and metabolic outcomes, will help to develop an effective legal framework for reducing levels of transportation noise and air pollution and their adverse health effects.
Comorbidities in Heart Failure: How to Optimize the Treatment?
V. Chumburidze, T. Kikalishvili V
In most patients, and particularly in elderly patients, heart failure (HF) is accompanied by a range of comorbidities that play an integral role in its progression and response to treatment. Comorbidity is defined as a chronic condition that coexists in an individual with another condition that is being described. A distinction is made between noncardiac comorbidities and cardiac conditions that are directly related to the presence of HF such as arrhythmias as well as conditions that precede and contribute to its aetiology such as hypertension, diabetes mellitus, and hyperlipidemia. In this article, we will initially focus on noncardiac comorbidities and discuss the general problem of comorbidity in HF. Then we will examine specific comorbidities and how to manage patients with HF in the best way. Finally, we will consider the problem of multidrug therapy when managing patients with comorbidities.