EDITORIAL
Intima-media thickness (IMT) of carotid arteries is a noninvasive marker of changes in the vascular wall, easily determined by means of duplex scanning of carotid arteries. The article deals with the data of international studies, confirming the importance of IMT as a predictor of coronary heart disease and to identify independent risk factor for cardiovascular events.
ORIGINAL INVESTIGATIONS
Objective — to study relationship of psycho-emotional factors and indicators of intravascular microinflammation and vascular changes in healthy patients.
Materials and methods. To study psycho-emotional status in 239 healthy patients aged 30 to 60 years, markers of inflammation (C-reactive
protein — CRP and cytokines — tumor necrosis factor-α — TNF-α, interleukins — IL-1, -4, - 8) and ultrasonography of the vascular wall of the common carotid artery with the definition of the thickness of intimamedia.
Results. In group with high levels of emotional stress significant increase in the thickness of intima media and increase in plasma concentrations
of markers of vascular mikrovospaleniya — CRP, IL-1, IL-8, TNF-α were showed. These correlation analysis indicated relationship between thickness of intima-media, psychoemotional factors and markers of vascular microinflamation. Calculating odds ratios revealed that thickening of the intima-media process such psycho-emotional disorders like anxiety, depression and fatigue are of great importance.
Conclusion. Otherwise development of latent intravascular inflammation and thickening intima-media complex of common carotid artery is registered inhealthy patients with presence of psycho-emotional disorders (depression, anxiety, fatigue).
Objective — to study prevention of cardio-cerebral complications of metabolic syndrome on the basis of mathematical methods of forecasting.
Subjects and methods. A discriminant analysis of clinical and instrumental data of patients with MS.
Results of this study allow the early (prenosological) stages of the metabolic syndrome using the linear discriminant equations to predict the
development of myocardial infarction up to 89.3 %, stroke — up to 87.8 %.
Conclusion. The diagnostic and treatment algorithms developed based on the stratification of cardiovascular risk index, allow us to give sound recommendations for targeted prevention of cardio-cerebral complications.
Objective — to study features of severe chronic obstructive pulmonary disease (COPD) aggravation.
Materials and methods. We examined 1969 patients with acute severe COPD who were hospitalized in the intensive care unit with progressive
respiratory insufficiency, and depression of his own expectoration during the period from 2004 to 2011, chest radiography, electrocardiography,
pulse oximetry, blood gas study, bronchoscopy were performed in all patients on admission.
Results. In many patients, there was a significant deterioration in expectoration, up to complete suppression. This made it difficult to identify the two major symptoms of the classic triad of exacerbation (increased bronchial secretions and increase of pyogenesis). However, during fiberoptic scope examination massive obstruction of the lower parts was revealed on the level of tracheobronchial tree by bronchial secretion, which had purulent or muco-purulent character.
Conclusion. Severe rapid increasing obstruction of the lower respiratory tract by bronchial secretion in inefficient natural expectoration should be considered as an equivalent of COPD exacerbation.
Objective — studying dyssynchrony characteristics and evaluation correction effectiveness in patients with chronic heart failure (CHF) of ischemic origin.
Materials and methods. The study included 125 patients with chronic heart failure of ischemic etiology, 28 of them — with coronary heart disease (CHD) who had undergone aorto-and / or mammarokoronary bypass and / or percutaneous coronary intervention, 42 — with coronary artery disease and postinfarction cardiosclerosis, 32 — with arrhythmic variant of coronary artery disease, 23 — with stable angina without evidence of arrhythmia. Among included patients, biventricular pacemakers were implanted for 17 patients. All patients underwent echocardiography with determination of the parameters of dyssynchrony.
Results and conclusion. Among patients with CHF ischemic symptoms dyssynchrony was diagnosed in 36 (28.8 %) cases. Statistically significant association between patients with cardiac arrhythmias and dyssynchrony was determined. At the same time the incidence of dyssynchrony was not associated with various forms of ischemic heart disease, and did not depend on the anamnesis of cardiac surgery. Dependence of the frequency of occurrence of dyssynchrony on the severity of CHF was revealed. Patients selected for implantation of biventricular pacemakers, especially in view of echocardiographic signs of dyssynchrony had significant improvement after providing cardiac resynchronization therapy. Effect of the treatment does not depend on the atrial fibrillation rhythm presence.
Objective — to identify the relationship between the individual profile of functional hemispheric asymmetry (IPFA) and lateralization of the Parkinson's disease (PD) debut, as well as assess of their impact on anxiety and depressive disorders and quality of life of patients.
Materials and methods. 70 patients with PD (28 men and 42 women, average age 63,1 ± 8,1 years) with disease duration 48 [36, 72] months (Me [25 %; 75 %]) were included. We used Hoehn and Yahr, UPDRS, EuroQol, PDQ-39 scales, scale of anxiety and Spielberger–Hanin Hamilton Depression. IPFA was determined using the protocol survey of 48 jobs during the period of inclusion of patients in the study.
Results. In patients with right-sided IPFA right-sided debut of PD was more common (p < 0.05) and in patients with mixed IPFA — leftsided
(p < 0.05) PD debut. There were no significant differences in levels of reactive, personal anxiety and depression at different IPFA depending
on the side of PD debut (p > 0.05) received. Quality of life scale PDQ-39 showed worse results in patients with right-in right IPFA debut in comparison with those in patients with left debut (p < 0.05). Quality of life by EuroQol-II scale was higher in patients with rightsided IPFA with the left debut of PD than in patients with right-debut (p < 0.05), and in patients with mixed IPFA with right debut compared to patients with left debut (p < 0.05).
Conclusion. With the debut of PD in leading limb and preferential involvement of the dominant hemisphere poorer quality of life was observed. IPFA and clinical asymmetry did not affect on the level of anxiety and depressive disorders, which were revealed in more than two
thirds of patients with PD.
LECTION
CASE REPORT
POEMS-syndrome (P — polyneuropathy, O — organomegaly, E — endocrinopathy, M — M-protein, S — skin) in 64-year old patient is
described in the article. The clinical picture was marked by such symptoms, as polyneuropathy, multiple myeloma, organomegaly (hepatosplenomegaly), endocrinopathy (diabetes), skin changes (redness and induration of the dermis in the neck), fever, hypoproteinemia, edema, weight loss, thrombocytosis. Bone-destructive syndrome was absent. In myelogram 18 % of the cells with signs of some plasmatic anaplasia were found. In blood, low level of paraprotein secretion Aλ, increased β2-microglobulin was fixed. A course of therapy with prednisolone and alkeranom was accompanied by slight positive effect. However, a second course was interrupted in the third day due to worsening of concomitant cardiac disease (ischemic heart disease in combination with hypertension). Last episode of recurrent of pulmonary edema occurred fatal. Autopsy study was not conducted. This observation illustrates the need for more rigorous examination (myelogram, immunochemical study of blood and urine) in the presence of clinical signs of POEMS-syndrome for the timely diagnosis of the underlying disease and its treatment.
Clinical case of a patient with idiopathic pulmonary hypertension, an algorithm for the diagnosis and management of patients with this pathology
are presented in the paper.
REVIEW
Modern recommendations for the migraine attack treatment and it's prophylaxis are analyzed in this review. Established, that acetylsalicylic acid, diclofenac potassium, ibuprofen, naproxen, paracetamol, metamizol and their combination with caffeine are drugs of the first choice for migraine attack treatment. Metoclopramide and domperidone are used to reduce nausea and vomiting. Also triptans are high effective drugs for migraine attack treatment. Metoprolol, propranolol, flunarizine, valproic acid can be used for migraine prophylaxis. Drugs of the second choice are: amitriptyline, venlafaxine, naproxen and bisoprolol.
PHARMACOTHERAPY
Objective — to study therapeutic equivalence (efficacy, safety and tolerability) and hemorheological activity of original clopidogrel and its
generic in patients of high cardiovascular risk.
Materials and methods. 50 patients with stable angina pectoris were randomized into 2 groups of consecutive 2-week treatment by original
(plavix) and generic (plagril) clopidogrel and vice versa. ADP-induced platelet aggregation was measured at baseline and after treatment by
each of the drugs. Physical examination and adverse events were evaluated at visits.
Results. After the first treatment period a significant decrease of platelet aggregation was determined in both groups. After switching to another
drug the decrease continued but not significantly in both groups. There were registered no adverse events associated with antiplatelet therapy.
Conclusion. Equal antiplatelet activity established for plavix and plagril demonstrates their therapeutic equivalence.
Objective — to assess influence of the combined therapy on a functional condition endothelium, the central haemodynamics and geometry of heart in patients with hypertensive disease.
Subjects and methods. The volume of supervision has made 40 patients with arterial hypertension grade II hypertension, moderate — high
risk. Patients of the first group received the combined therapy lisinopril — 20 mg and hydrochlortiazid — 12.5 mg (iruzid — “Belupo”, Croatia), patients of the second group — therapy trandolapril and verapamil (tarka — “Ebbot”, Germany) — 2 and 180 mg accordingly.
Results. The combined therapy trandolapril and verapamil renders more expressed antihypertension effect, than lisinopril and hydrochlortiazid.
Appointment of the combined therapy promoted normalization morphofunctional heart indicators: in group of tarka ejection fraction
(EF) has authentically increased by 4.34 % (р = 0,02), the thickness to a back wall of the left ventricle has decreased for 5.8 % (р = 0,03) in group of iruzid. Also in both groups optimization functional a condition endothelium vessels as on level desquamation endotheliocytes, a function indicator endothelium and on a level of a factor of Willebrand was marked. Authentically more expressed positive influence on endothelium tarka in comparison with iruzid has been noticed.
Conclusion. At comparison of combinations fat-soluble ACE inhibitor with verapamil (tarka) and water-soluble ACE inhibitor in a combination with hydrochlortiazid (iruzid) the insignificant superiority of the first combination over the second for level of positive influence on endothelium of vessels has been revealed, more expressed antihypertensive effect and ability authentically to increase EF.
CLINICAL CASES AWARDS FROM THE YOUNG CARDIOLOGISTS' WORKING GROUP
Clinical case of a patient with acute myocarditis with suspected toxic etiology, which developed under the mask of an acute coronary syndromeegment elevation ST is presented.
Difficulties of diagnosis of the causes of cardiac decompensation failure in patients with severe chronic heart disease and implantable antiarrhythmic
devices is demonstrated in this clinical case.
Correction of potential risk factors is essential for effective therapy for cardiovascular diseases. This clinical case demonstrates negative impact of non-corrected risk factors — obstructive sleep apnea — in occurrence and further progression of cardiovascular disease.
ISSN 2412-8775 (Online)