Focus is on the comorbid patient, strategy and tactics of the therapeutic approach
On May 16-17, 2019, the V Congress of the Eurasian Association of Therapists (EAT) was held within the walls of the leading medical university of the Republic of Belarus, the educational institution “Belarusian State Medical University”. The chairman of the EAT throughout the entire period of its existence is a doctor of medical sciences, professor G.P. Harutyunov. The responsible organizer of the 5th EAT Congress in the Republic of Belarus was the Department of Cardiology and Internal Diseases of the Belarusian State Medical University under the direction of Doctor of Medical Sciences, Professor Natalia Mitkovskaya. This event became a bright, rich and creative calling card of its organizers on Belarusian soil, uniting the leading experts of the Russian Federation, Belarus, Kazakhstan, Uzbekistan, Moldova, Japan, Canada and Sweden.
A case of complete detachment of the conduit of the ascending aorta and aortic valveA.P. Shket, E.V. Vasilevich, A.A. Komarovski, S.I. Kozlov, O.I. Kozlov, V.A. Tokunov, A.A. Khadanovich, Y.A. Selyn
In cardiac surgery departments, repeated operations are increasingly performed in patients who have undergone valve correction or coronary bypass surgery in the past. The operational risk in this group of patients is much higher than in the group of primary operations, and is due to the adhesive process, the risk of re-access to the heart, various anatomical and pathological scenarios of pathology. A clinical case of a 47-year-old patient is presented. Primary surgery was performed in 2006 for aortic stenosis and aneurysm of the ascending aorta. On the second operation, the separation of the conduit of the ascending aorta and aortic valve, the complete separation of both ostiums of the coronary arteries with the formation of a false aneurysm of the ascending aorta was revealed. The patient underwent a replacement of the aortic valve, ascending aorta, the left coronary artery reimplantation, CABG to RCA. This case is of great interest due to the extremely rare occurrence of such a variant of pathology.
WPW syndrome in childhood: unsolved problemsE.V. Zasim, V.V. Strogiy
This review presents current data on the causes, pathogenesis of development from the standpoint of electrophysiology of the cardiac conduction system of the WPW syndrome, and also discusses the methods of diagnosis and treatment of this syndrome in childhood. Particular attention is paid to the role of anatomical and physiological features, the development of the autonomic nervous system and the formation of the cardiac conduction system in children. The role of connective tissue dysplasia and the presence of an inflammatory process in the cardiac system are considered among the possible causes of WPW syndrome today. A comparative characteristic of antiarrhythmic therapy in children for the prevention of tachycardia attacks is provided, and some indications for radiofrequency ablation and its effectiveness in children with this pathology are presented.
Complex problems of antithrombotic therapy for acute coronary syndrome in patients with atrial fibrillationA.S. Rudoy, Yu.S. Lysyy
The choice of anticoagulant, the number of antiplatelet agents and the duration of antithrombotic therapy in patients with acute coronary syndrome with indications for oral anticoagulants, in particular for atrial fibrillation, remain complex and ambiguous. On the one hand, the development of acute coronary syndrome requires the appointment of dual antiplatelet therapy, on the other, the combined use of anticoagulant and antiaggregants significantly increases hemorrhagic risks. There is a clinical situation, when you need a clear knowledge of the strategy and choice of antithrombotic drugs, in particular the knowledge about the balance between the risk of developing stent thrombosis, thromboembolic and hemorrhagic complications. In the presented review, the data concerning the regime of antithrombotic therapy are systematized in various types of acute coronary syndrome in patients with atrial fibrillation, depending on the choice of treatment tactics (pharmaco-invasive or conservative).
Cardiovascular risk factors in renal transplant recipients in the early postoperative periodM.V. Smaliakova, N.P. Mitkovskaya, A.V. Kalachik, L.V. Kartun
The kidney transplantation is the optimal method of renal replacement therapy, which improves the quality and prolongs the life span of patients with chronic kidney diseases. A high frequency of cardiovascular pathology in these patients requires the search for cardiovascular risk factors. The aim of the study was to determine the cardiovascular risk factors in renal transplant recipients in the early postoperative period in the dialysis and early postoperative period.
Endothelial dysfunction in chronic obstructive pulmonary diseasesM.V. Sholkava, E.A. Dotsenko
Endothelial dysfunction is considered as one of the links between pulmonary and cardiovascular diseases. To evaluate the dynamics of endothelial function in patients with dyslipidemia and chronic obstructive pulmonary diseases, receiving atorvastatin.
In vivo calcium compounds accumulation in allograftsM.M. Shchatsinka, S.V. Spirydonau, V.A. Adzintsou, A.S. Smirnova, О.А. Yudina, Y.P. Ostrovsky
To assess calcium deposition in standard and decellularized aortic allografts in animals, to evaluate calcium accumulation dynamics in standard aortic allografts in humans.
Tonsilogenic cardiomyopathy: unsolved issues in diagnosis and treatmentA. S. Vaidzelevich, Zh. V. Kolyadich, N. P. Mitkovskaya
High prevalence of chronic tonsillitis among the population makes it possible to call this disease socially significant. Due to the polymorphism of this pathology, as well as a high risk of occurrence and development of metatonsilogenic diseases and complications, doctors of various specialties (otorhinolaryngologists, cardiologists, rheumatologists, immunologists, therapists) deal with the problem of chronic tonsillitis, which indicates a multidisciplinary nature of chronic tonsillitis. This article outlines the general concepts of chronic tonsillitis (classification, etiology, pathogenesis mechanisms, treatment tactics, tonsilogenic disorders). Attention is focused on the study of tonsillogenic lesions of the heart (tonsillogenic cardiomyopathy), the mechanisms of their development and diagnostic methods. From the review it follows that tonsillectomy is the only effective method of treatment, as well as prevention of the development of metatonsilogenic complications of chronic tonsillitis.
Pathogenetic basis of treatment strategies for patients with decompensated chronic heart failureD.S. Gerasimionak, D.V. Pilipchuk, N.P. Mitkovskaya
The article deals with the problem of chronic heart failure (CHF) and its effect on renal function. The basic mechanisms of cardiorenal relationships are discussed. Information about modern pathogenetic tactics of CHF treatment concerning the renal effects is presented. The article describes research data related to the treatment of congestive heart failure resistant to diuretic drugs with the use of auxiliary equipment for dehydration.
Differential diagnosis of vegetative crises and panic attacksE.G. Koroleva
This article discusses the relationship between such terms as “vegetative crises” and “panic attacks”, their clinical picture, mental disorders with them, issues of diagnosis and, accordingly, approaches to treatment. One of the important activities of the Department of Vegetative Pathology under the guidance of the famous professor A.M. Wayne was the study of vegetative crises, which gradually became known by many as panic attacks. As far as the terms “vegetative crises” and “panic attacks” are equivalent, what do they have in common and how do they differ? What is the proportion of mental disorders with them? So far, in general practice there are no exact diagnostic criteria for these concepts. In this regard, it is often unclear what specialists should be engaged in them. In this regard, the purpose of this review is to conduct a more accurate differential diagnosis of these clinical forms, which manifestations unite them and whether they should be considered as independent disorders requiring different therapeutic approaches.
Coordination and control of interregional cardiovascular care: an experience in Ontario, CanadaDr. Patrick Tiffy MD FRCP
The manuscript presents the experience of increasing the availability of diagnostic and invasive therapeutic procedures for the heart using the example of The Ontario model for Cardiac Care / CorHealth Network with the aim of maintaining and improving medical care for a large population or a specific geographical region. Throughout Ontario, new PCI centers have been set up, and new medical protocols have been introduced for patients with UTI, which will improve access to specialist care.