Vol 4, No 2 (2013)

Articles
D.D.Pletnev about mental symptoms in the picture of purely somatic diseases: lessons of history and today
Garganeeva N.P.
Abstract
The article is dedicated to brief statement of priority scientific investigations of the distinguished domestic therapist, Professor Dmitry Dmitriyevich Pletnev, having made significant contribution into development of clinical direction of psychosomatic medicine in Russia. At the level of diagnostic and conclusive possibilities of his time in the beginning of the XXth century, the scientist has grounded those scientific positions which currently are broadly studied in the aspect of co-morbidity of cardiovascular diseases and mental disorders of anxiety-depressive spectrum. D.D.Pletnev, one of the first clinicians-therapists has paid attention to difficulties of differential-diagnostic evaluation of state of somatic patients with psycho-emotional disturbances «depressive affects and neurosis of anxiety». Many papers of the scientist dedicated to study of «mental symptoms in picture of purely somatic diseases», what in the modern medicine is interpreted as various manifestations of neurotic and affective disorders in diseases of inner organs, wrongly forgotten, remain relevant at present as well. As perspective scientific directions, questions of integrative approach to study of interrelationship of pathology of cardiovascular system, anxiety and depressive disorders of neurotic and affective level are discussed.
CardioSomatics. 2013;4(2):5-11
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Arterial hypertension in young men, officers of land forces: psychophysiological peculiarities
Davidovich I.M., Afonaskov O.V.
Abstract
The authors have studied heart rhythm variability at rest and with cognitive loading, types of coronary behavior and reactive and personal anxiety in 86 men of young age, officers of the land forces. 52 of them had hypertensive disease (HD) of I–II stage. 34 men had normal arterial blood pressure. Patients with HD in comparison with normotensive men turned out to have additional risk factors accompanied arterial hypertension. They were hypersympaticotonia, high level of personal anxiety and coronary behavior type A.
CardioSomatics. 2013;4(2):11-15
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Correction of cardiovascular disorders in diabetic patients with depressive simptoms
Kolyadich M.I., Shaposhnik I.I.
Abstract
We studied the influence of mexidol and a-lipoic acid on cardiovascular and affective disorders' severity in patients with diabetes. 14-day administration of mexidol (300 mg/day) and a-lipoic acid (600 mg/day) had a positive impact on depressive guilt dinamics in association with a decrease in QTn-interval duration. Moreover, mexidol decreased patients' propencity to postural hypotension, and alfa-lipoic acid corrected myocardial diastolic function, pulmonary blood flow and circadian glycemia.
CardioSomatics. 2013;4(2):15-19
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Pleiotropic effects of statins at the present stage of their study (focus on atorvastatin). Part III. Mechanisms of the pleiotropy of statins
Aronov D.M.
Abstract
After making a detailed review on the cardiac and non-cardiac pleiotropic effects of statins, the author has attempted to present mechanisms for these effects. The author’s main point is that their non-cardiac pleiotropic effects in diseases of different organs and systems are exposed to statins thanks to the body’s established pathogenic modules that are available in diverse pathologies, including cardiovascular diseases; these are: type 2 diabetes mellitus, obesity, metabolic syndrome, and kidney, liver, and bronchopulmonary system disorders in microbial and viral diseases. In these diseases, the patients are found to have universal pathogenic modules of inflammation, oxidative stress, endothelial dysfunction, hyperangiotensinemia, and inadequate activation of peroxime proliferator-activated receptors. Statins exert an additional positive effect unassociated with their hypolipidemic activity on many of the above pathogenic modules. In most cases, the mechanism of action of statins could be revealed in the above diseases. Special investigations relying on the rules of evidence-based medicine are needed to confirm the found pleiotropic effects.
CardioSomatics. 2013;4(2):20-26
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Optimization of therapy in a patient with coronary heart disease in clinical practice: proven efficacy of the selective If channel inhibitor ivabradine
Bubnova M.G.
Abstract
The paper describes a clinical case of developing coronary heart disease in a young man, by analyzing the specific features of the disease and performed therapy. It discusses the management of this man according to the current recommendations and evidence-based medicine. The paper gives evidence for the importance of controlling heart rate in patients with angina pectoris. The most rational combinations of anti-ischemic agents for clinical application are discussed. Particular emphasis is laid on the selective If channel inhibitor ivabradine and its clinical effects: its good antianginal activity and ability to reduce the risk of cardiovascular events.
CardioSomatics. 2013;4(2):27-36
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Evaluation of patients survival with coronary heart disease after coronary bypass surgery depending on the passage of recovery phase
Efros L.A., Samorodskaya I.V.
Abstract
In a retrospective study based on the register of patients with coronary heart disease after coronary artery bypass grafting clinical and functional characteristics and long-term survival in 2398 men, age 54,8±6,3 were analized, depending on the passage of the recovery phase from 2000 to 2009. The results showed that people of pre-retirement age were sent to the sanatorium therapy stage (72,5%) with a mild coronary and myocardial insufficiency. Mortality in the long-term period of 1 year to 10 years in the group after sanatorium therapy stage was 7,9%, whereas among patients who have not undergone sanatorium rehabilitation mortality rate was higher – 8,4%. Analysis of survival by Kaplan-Meier method of patients after sanatorium rehabilitation revealed that 3, 5 and 10-year survival rate was significantly higher than in those that did not pass the sanatorium stage of treatment. Two tests – Gehan's Wilcoxon Test (p=0,01835), Cox-Mantel Test (p=0,02820) – confirmed the accuracy of the comparison groups.
CardioSomatics. 2013;4(2):37-42
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Cliniko-experimental research of trimetazidine efficiency at the myocardium ischemia
Romashchenko O.V.
Abstract
The randomized controllable clinical research of Trimetazidine (Preductal MB) efficiency was spent at 95 patients with a stable angina pectoris. There were revealed the authentic increase in 2 times of treatment’s clinical efficiency in patients, who in addition to basic therapy appointed Trimetazidine for the account of more expressed antianginal effect and increase of physical working capacity. Additional appointment of Trimetazidine at a myocardium ischemia promoted the reduction of energy deficiency and tissue hypoxia. Last position has proved to be true according to experimental data: at rats males of line Vistar at experimental IHD the introduction of Trimetazidine led to increase of recycling of carbohydrates with the power purposes in a cardiac muscle that was accompanied by signs of stabilisation of cardiomyocytes’ membranes and reduction of degree of tissue hypoxia.
CardioSomatics. 2013;4(2):43-47
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The optimization of the drug therapy in patients with resistant hypertension (clinical analysis)
Rodionov A.V.
Abstract
The article (case history) discusses the strategy of management of the patient with resistant hypertension and comorbidity (diabetes, gout) according to current clinical guidelines.
CardioSomatics. 2013;4(2):47-52
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Salt and hypertension. Possibilities of the non-drug prevention of hypertension by dietary correction in an organized population of 25-to-49-year-old men and women for 3 years
Molchanova O.V., Britov A.N., Andreeva G.F.
Abstract
There is much evidence for a relation between sodium intake and blood pressure (BP). The aim of this study was to investigate the efficiency of a BP reduction when sodium was limited in men and women with high normal BP. Three-year dietary intervention significantly lowered systolic and diastolic BP (SBP and DBP) in the men and women from the intervention group (p<0,05) as compared to those in the control group that showed natural BP changes and a significant increase in BP during the 3-year period (p<0,05). Furthermore, there was a significant weight loss in the intervention group as compared to the control one. In the long-term follow-up, lower salt consumption significantly reduces SBP and DBP in the men and women with high normal BP as compared with the control group.
CardioSomatics. 2013;4(2):52-57
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Comparative analysis of the efficiency of the selective b-blocker nebivolol and the angiotensin II receptor blocker valsartan in men with hypertension, metabolic syndrome, and erectile dysfunction
Nedogoda S.V., Salasyuk A.S., Barykina I.N., Ledyaeva A.A., Tsoma V.V., Chumachek E.V.
Abstract
Objective: to evaluate the antihypertensive efficacy and effect of nebivolol and valsartan on metabolic parameters and erective function in patients with hypertension, metabolic syndrome, and erectile dysfunction. Subjects and methods. A 12-week randomized, blind, controlled, parallel-group, comparative (nebivolol versus valsartan) trial enrolled 40 patients with hypertension, metabolic syndrome, and erectile dysfunction. Results. There were no significant differences between the drugs in their antihypertensive efficiency. Nebivolol exerted a more pronounced positive effect on cardioand angioprotection and lipid and carbohydrate metabolic parameters. It had no negative effect on metabolic parameters. Therapy with nebivolol versus valsartan produced a pronounced positive effect on blood androgen levels and erectile function. Moreover, the quality-of-life indicators also showed a significant improvement in the nebivolol group. Evaluation of the tolerability and adverse reactions of the drugs demonstrated no side effects in both groups.
CardioSomatics. 2013;4(2):57-66
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Hypoglycaemia as predictor of cardiovascular accidents
Doskina E.V., Tankhilevich B.M.
Abstract
Diabetes mellitus type 2 is not only a chronic disease, but also refers to a group of constantly progressing pathologies. Regardless of the level of development of medicine and used therapeutic approaches, mortality from cardio-vascular complications of diabetes exceeds the figures of the General population. According to the results of Veterans Affairs Diabetes Trial it was revealed that severe hypoglycemia are predictors for the development of myocardial infarction and acute disturbance of cerebral blood circulation. Pledge of successful treatment of patients with type 2 diabetes is the adequate choice of target values of glycemia and maintaining it by means of a combination of curative (observance of dietary recommendations, reception of hypoglycemic drugs, etc.) and not drug-induced (by which primarily active self-monitoring of blood glucose) activities.
CardioSomatics. 2013;4(2):67-71
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Effects of different doses of rosuvastatin on blood lipids and lipoproteins, endothelial function, and cerebral blood flow in patients with hyperlipidemia and cerebral ischemic stroke-complicated hypertension
Bubnova M.G., Semenova E.G., Aronov D.M., Batysheva T.T.
Abstract
Objective: to study the dose-dependent effect of rosuvastatin on blood lipids and lipoproteins (LP), endothelial functional activity, coagulation, and safety parameters in patients with hyperlipidemia (HLP) and hypertension after cerebral ischemic stroke (CIS). Subjects and method. The trial included 34 patients (mean age 59,4±7,4 years) with types IIa or IIb HLP and CIS-complicated hypertension. The patients were randomized to 2 groups: 1) rosuvastatin 10 mg and 2) rosuvastatin 20 mg. The trial lasted 12 weeks. The dose of rosuvastatin remained unchanged throughout the trial. The authors evaluated the impact of therapy on the blood concentration of lipids, LP, fibrinogen, end products of nitric oxide (NO) metabolism, and endothelin-1 (ET-1), cerebral blood flow by great cerebral artery Doppler ultrasound data, as well as the parameters reflecting the safety of the therapy. Results. After 12-week therapy with rosuvastatin 10 and 20 mg, there was a significant decrease in the level of cholesterol by 30 and 35%, low-density lipoprotein (LDL) cholesterol by 40 and 45%, and triglycerides by 18 and 26%, respectively. Increasing the dose of rosuvastatin was attended by a significant rise (by 18%) in the number of patients with target LDL cholesterol levels. Rosuvastatin therapy caused no changes in the high baseline level of fibrinogen. At the same time, at the rosuvastatin doses of 10 and 20 mg, the concentrations of end products of NO metabolism increased by 14,3 and 12,4%, respectively. The vasoprotective effect of rosuvastatin 20 mg showed itself just at therapy week 6. Significantly decreased ET-1 levels were found when rosuvastatin was given in a dose of 10 mg; this was directly related to the baseline concentration of ET-1. In the patients who had an ET-1 level of >0,51 fmol/ml, its drop was 22,5% (p<0,05). Some improvement of cerebral blood flow velocities in the internal carotid artery and in the V2/V3-segments of the vertebral artery might be expected in post-CIS patients taking the average dose (20 mg) of rosuvastatin. It should be remarked that the test doses of rosuvastatin are well tolerated and cause no adverse reactions. Conclusion. The antiatherogenic and pleiotropic effects of the two rosuvastatin doses 10 and 20 mg were shown in the post-CIS patients with HLP and hypertension. The pleiotropic activity of rosuvastatin, such as an increase in NO bioavailability and a reduction in ET-1 concentrations, was manifested when both the starting (10 mg) and average (20 mg) doses of rozuvastatin were used. At the same time, rosuvastatin showed dose-depended effects in lowering LDL cholesterol levels, enhancing NO bioavailability, and improving cerebral blood flow velocities.
CardioSomatics. 2013;4(2):72-80
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Treatment for cardiac arrhythmias in pregnancy: Efficiency and safety
Bunin Y.A.
Abstract
Pregnancy with its physiological neurohumoral and hemodynamic changes may cause new-onset cardiac arrhythmia or worsen existing arrhythmias. It is important to single out the arrhythmias in pregnant women, which pose no risk for mother or fetus and therefore are not a contraindication to vaginal delivery and occasionally need no medical treatment. On the other hand, the arrhythmias, that impair hemodynamics and those that are referred to as the so-called potentially malignant and malignant cardiac arrhythmias, require specific pharmacotherapy and, in a number of cases, invasive treatments. Arrhythmias pharmacotherapeutic challenges in pregnant women are determined by that many antiarrhythmic agents may be harmful to the fetus and that the results of controlled trials of this problem are few and conflicting. The paper covers the current areas and some disputable issues of medical and surgical treatments for a wide spectrum of supraventricular and ventricular arrhythmias in pregnant women and gives practical recommendations for the use of different classes of antiarrhythmic agents in them to stop and prevent cardiac arrhythmias depending on their fetal safety and the pattern of maternal cardiovascular and concomitant diseases.
CardioSomatics. 2013;4(2):81-91
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Klinicheskiy sluchay: appenditsit i serdtse
Parnes E.Y.
Abstract
CardioSomatics. 2013;4(2):91-93
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Pis'mo v redaktsiyu
Ipatov A.V.
Abstract
CardioSomatics. 2013;4(2):94
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