Evolving views on antithrombotic therapy in acute coronary syndrome
A.S. Rudoy
The review article presents current data on one of the key issues of modern cardiology - the duration of dual antiplatelet therapy in patients with acute coronary syndrome, including postcoronary angioplasty. The analysis of current clinical recommendations (including ESC-2017 for dual antiplatelet therapy and acute coronary syndrome with ST segment elevation) was carried out, the results of recent clinical studies and meta-analyzes were high-lighted. Given the dilemma of balancing the risks of thrombotic events and complications of bleeding in these patients, a scale for assessing the risks of ischemic and hemorrhagic events, formed on the basis of the results of the DAPT and PRECISE-DAPT studies, is presented.
2018 Том 2, №2
Antiarrhythmic therapy: harm and benefit
D. P. Salivonchik
The widespre ad use of antiarrhythmic therapy for common rhythm and conduction disorders led to the registration of pro-rhythmogenic manifestations of these ECG preparations with the form a tion of stable ventricular tachyarrhythmias and, consequently, fata loutcomes. Conducting randomized studies allowed changing the strategy and tactics in the treatment of arrhythmias and stratifying the benefit and harm of antiarrhyth mic therapy before treatment as well as the likelihood of sudden cardiac death. Control of risk factors, optimal drug therapy, stratification of the risk of sudden death, revascularization, catheter ablation, implantation of cardioverter-defibrillators can reduce deaths from ventricular arrhythmias and the need for antiarrhythmic therapy.
2018 Том 2, №2
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.
2018 Том 2, №1
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.
2018 Том 2, №1
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.
2018 Том 2, №1
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.
2018 Том 2, №1
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.
2018 Том 2, №1
Interventional Cardiology: from History to Reality
A.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.
2017 Том 1, №1
Anemia in Cardiovascular Diseases
S.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.
2017 Том 1, №1
Current Treatment of Massive Pulmonary Thromboembolism
T.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.
2017 Том 1, №1

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