Vol 6, No 1 (2015)

Articles
Comprehensive medical rehabilitation program after percutaneous coronary intervention for acute myocardial infarction in patients with coronary heart disease and arterial hypertension: efficacy, safety, and the results of remote monitoring
Bubnova M.G., Aronov D.M., Krasnitskiy V.B., Novikova N.K., Matveeva I.F., Ioseliani D.G.
Abstract
Objective. To evaluate the clinical effects and safety of an integrated rehabilitation program, appointed in the early stages of acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) in patients with arterial hypertension (AH), the analysis of the results at 1 year and 5 years.Material and methods. The study included men (n=62), acute myocardial infarction and undergone PCI in the period from 1 to 8 weeks after surgery. After initial clinical and instrumental examination, patients were randomized in 2 groups:basic “O” group (n=31), where patients were engaged in the educational program “School for patients after acute myocardial infarction” (hereinafter - School) with the involvement of controlled physical training (PT) and uncontrolled (at home) FT (FTdom);control “K” group (n=31), where patients were only trained in the School of Education with a recommendation to participate inuncontrolled FTdom. The patients were examined at the time of inclusion, 1.5, 4, 6 and 12 months. After 5 years, a telephone survey of patients in order to assess their clinical status.The Results. According to the results of exercise test (FN) at 6 and 12 months in the “O” significantly increased physical performance indicators: the duration of FN, its threshold power and total work performed. In the group of “K” after PCI, these figures also significantly increased, but to a lesser extent than in trained patients. By the 12th month in the “About” FN duration greater than that seen in the group “K” by 1.7 times (p<0.05), the threshold power made FN and the total amount of physical work performed were 2-fold higher (p<0.05). Efficiency of the heart rate to double product (DP) was significantly increased only in the background controlled by FT by 5,3% (p<0.05) against the lack of its dynamics in untrained. After FT patients noted positive changes in volume terms echocardiography. Also noted a positive increase in cholesterol (TC) high density lipoprotein to 10.8% (p<0.05), while in group “C” had a growth of low-density lipoprotein cholesterol at 12 months of follow-up 13,8% (p<0,05). Patients of group “O” frequency of angina attacks during the year has not changed, whereas in group “C” significantly increased by 77.7% (p<0.05). Participation of patients with hypertension, acute myocardial infarction and PCI in complex rehabilitation program (Education School + FT) resulted in clinical improvement in 18 (58.1%) patients compared with 5 (16.1%) patients in the “K” (p<0.01). The deterioration of the clinical condition occurred only in 7 (22.6%) patients of the “K” in the absence of the dynamics in patients of group “O” (0 patients; p<0.05).Conclusions. The use of a short course of TF in conjunction with the educational program within the School has improved the clinical condition of patients with hypertension and coronary artery disease after PCI in the long-term follow.
CardioSomatics. 2015;6(1):6-11
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Medical psychological and social rehabilitation in patient with myocardial infarction
Baysultanova M.B., Elgarov A.A., Betuganova L.V., Elgarov M.A., Kalmykova M.A.
Abstract
Complex therapy effectiveness in patients with myocardial infarction and chronic heart failure is established; authors monitoring positive influence on medical psychological and social aspects of rehabilitation in post infarction patients is shown, using as monitoring core individual and complex medical psychological educational program.
CardioSomatics. 2015;6(1):12-15
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Chronic heart failure in patients with type 2 diabetes mellitus: prevalence, prognosis
Kakorin S.V., Averkova I.A., Mkrtumyan A.M.
Abstract
The article presents a literature review of prevalence, prognosis and treatment of overt tactics of chronic heart failure (CHF) in patients with type 2 diabetes mellitus (T2DM). Diabetes and heart failure acquire the status of the epidemic of the XXI century and require health care costs for prevention and treatment of these diseases. Application of modern pharmacological preparations and instrumental treatment of cardiovascular disease (CVD) increases life expectancy and improves the quality of life of patients with CHF as with normal carbohydrate metabolism (UO), and with type 2 diabetes. However, the risk of cardiovascular mortality (CAS) in patients with type 2 diabetes, compared to having a normal carbohydrate metabolism remains unchanged. The rapidly growing population of patients with type 2 diabetes will soon change this in recent years to improve representation treatment prognosis of cardiovascular disease. Violation of myocardial remodeling in type 2 diabetes is caused by a combination of factors associated with diabetic cardiomyopathy. Reduction of the metabolic activity of cardiomyocytes insufficient glucose transport into cells, endothelial dysfunction, diabetic macro and microangiopathy myocardial fibrosis leading to disruption of filling the left ventricle (LV) and the development of chronic heart failure.Insulin resistance (IR) and compensatory hyperinsulinemia (GI) play a key role in the pathogenesis of type 2 diabetes. With effective treatment of chronic heart failure by cardiologists in patients with type 2 diabetes, affecting therapy with insulin resistance should be mandatory.
CardioSomatics. 2015;6(1):16-23
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The clinical efficacy of a fixed combination of angiotensin receptor blockers valsartan II with a calcium antagonist amlodipine - drug Exforge® smokers patients with cardiovascular disease and chronic obstructive pulmonary disease
Bubnova M.G., Aronov D.M., Sulim Y.N., Vygodin V.A.
Abstract
The Aim. A study of the clinical efficacy and safety of a fixed combination of valsartan (ARB) with amlodipine (AK), appointed as part of the standard therapy of hypertension and coronary heart disease smoking patients with chronic obstructive pulmonary disease. Material. The study included 36 men aged 40 to 65 years. All patients were treated with statins, aspirin, selective b-blockers; 16.7% of patients received diuretics, and 19.4% - long-acting nitrates. After randomization, patients were divided into 2 groups: group 1 (n=18, mean age 55.8±5.9 years) in addition to those receiving treatment angiotensin-converting enzyme (ACE) and group 2 (n=18, average age 58.0±4.9 years) - combined preparation Eksforzh® (amlodipine 5-10/160 mg valsartan). Study duration - 4 months.Methods. In a study clinical examination wasconducted, bicycle stress test (HEM-test), echocardiography (echocardiography), daily monitoring of blood pressure (BP), spirometry, determination of the concentration of lipids and lipoproteins, glucose, fibrinogen, uric acid, creatinine with calculation of glomerular filtration rate by MDRD.Used questionnaires: Hospital Anxiety and Depression Scale (HADS), St George's Hospital (SGRQ) and quality of life (QOL) SF-36. The Results. The appointment of the drug to patients Eksforzh® accompanied by a significant reduction in levels of “office” in systolic blood pressure at 39.2±9.7 mm Hg. Art. ( p <0.001), diastolic blood pressure of 16.9±5.7 mm Hg. Art. ( p <0.001) and pulse pressure to 22.2±5.9 mm Hg. Art. ( p <0.001) versus no such favorable dynamics in patients of group 1. On therapy with Eksforzh® all 18 patients achieved target BP<140/90 mm Hg. Art. At the same time on therapy with Eksforzh® positive changes in circadian BP profile.After 4 months of taking the drug Eksforzh® in patients with comorbidity observed favorable growth of the basic parameters of physical performance: an increase in the duration of exercise performed (FN) for HEM-sample (22.2%, p <0.01), the power threshold FN (on 23.6%, p <0.01), lengthening the time before the onset of an attack of angina pectoris (8.6%, p <0.05) and ischemia (8.3%, p <0.05). In contrast, patients in group 1 receiving ACE inhibitors, there was a decrease in the duration of the FN (10.2%, p <0.05) and time (29%, p <0.05) to the development of angina attack.In patients in group 2 positive changes were found in the structural and functional parameters of the heart according to echocardiography due to lower average pressure in the pulmonary artery. While taking the drug Eksforzh® the improvement of respiratory function parameters was shown, as well as indicators of psychological status and quality of life against the negative dynamics of these parameters in patients in group 1. Conclusion. Combined preparation Eksforzh® should be considered as a first choice in patients with concomitant cardiovascular and bronchopulmonary diseases due to its high clinical efficacy and good tolerability.
CardioSomatics. 2015;6(1):24-35
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Statin therapy and atherosclerosis stabilization in carotid arteries
Luginova Z.G., Koshurnikova M.V., Solovieva E.Y., Balakhonova T.V., Susekov A.V.
Abstract
Atherosclerosis and it’s clinical implications (myocardial infarction, stroke, intermittent lameness) is a serious medico-social problem in Russia. Statins (or HMG-CoA reductase inhibitors) are the first-choice agents to prevent cardiovascular disease events. The paper presents the results of early regression studies and modern regression studies using MRI imaging concerning the regression or stabilization atherosclerosis and rationale and baseline characteristics of russian regression study “FREGAT”.
CardioSomatics. 2015;6(1):36-45
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Phenotype receptor gene mutations in low-density lipoprotein in patients with familial hypercholesterolemia in Karelia
Korneva V.A., Bogoslovskaya T.Y., Kuznetsova T.Y., Mandelshtam M.Y., Vasilev V.B.
Abstract
Familial hypercholesterolemia (FHC) - hereditary dyslipidemia, which is based on mutations in the gene for low-density lipoprotein receptor.However, there is variability in the clinical manifestations of the disease difficult to assess individual risk.Materials and methods. Under our supervision for 10 years were 109 patients with FHC, 17 mutation in the receptor density lipoprotein. FHC diagnosis established by the criteria of the British leadership Simon Broom. To search for mutations in low-density lipoprotein receptor was performed automated fluorescent SSCP-analysis of exons of the gene analysis of restriction fragment length polymorphism and the direct sequencing of DNA on a gel sequencer ALFExpress-2 (Amersham Biosciences) using the program ALFwin Sequence Analyzer.The Results. We analyzed five clinical cases of patients with genetically confirmed diagnosis of FHC. Shows a wide phenotypic variability FHC: the possibility of early debut of coronary heart disease, coronary tropism for the pool some patients and cerebral - others, the possibility of a long asymptomatic disease.Conclusion. The absence of clinical manifestations of atherosclerosis and wide phenotypic variability at FHC require targeted screening for FHC, at least among patients with coronary heart disease in order to timely and adequate preventive measures, especially in cases where the mutation is set low density lipoprotein receptor.
CardioSomatics. 2015;6(1):46-49
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Multiple myeloma with monoclonal immunoglobulin A exhibiting and hypercholesterolemia: case report and literature review
Livandovskii U.A., Rybina O.B.
Abstract
Multiple myeloma with monoclonal immunoglobulin (Ig) A exhibiting is a type of the classic multiple myeloma, occurring every fifth patient. This type of disorder is associated with hypercholesterolemia that is refractory to the conventional therapy with anti-hyperlipidemic agents.This article presents a case of a patient B., 72 years old, whose disease debuted with high numbers of ESR and hypercholesterolemia. Ig Ak was identified by immunochemical analysis. Patient was diagnosed as having stage IA IgAk type multiple myeloma, diffuse lobular shape, with hyperlipidemia. Positive effect sustained after three courses of chemotherapy: level of IgA eventually subsided, and lipid metabolism returned to normal values.
CardioSomatics. 2015;6(1):50-52
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Results of clinical studies PLATO and place of ticagrelor in the treatment of acute coronary syndrome
Erlih A.D.
Abstract
This article provides an analysis of the results of a large international randomized clinical trial PLATO, in which to learn a new antiplatelet ticagrelor compared with clopidogrel in addition to aspirin in patients with acute coronary syndrome (ACS). Material contains a description of the study design, the main results concerning the efficacy and safety of ticagrelor. In addition, the material presented those parts of modern clinical practice guidelines, which describes the location of ticagrelor in the treatment of ACS and which are modified according to a PLATO study.
CardioSomatics. 2015;6(1):53-59
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Strategy and tactics of emergency treatment of atrial fibrillation: a modern approach to the problem
Bunin Y.A.
Abstract
Atrial fibrillation (AF) is the most common tachyarrhythmiac detection which in the general population is 1.0-2.0%. It is the cause of 20% of all strokes, associated with an increase in mortality and the risk of chronic heart failure. Paroxysms are often accompanied by deterioration of the patient's hemodynamic instability, requiring emergency medical care.The article presents a modern view on strategy and tactics cupping AF indication for pharmacological cardioversion and cardioversion. As the basis of the material made by the international guidelines on the management of patients with atrial fibrillation, as well as data from a number of modern-controlled studies and own clinical experience treating arrhythmias.However, the article dealt with some of the controversial issues of emergency treatment of AF and expresses the point of view of the author on a number of studies in this area arrhythmology.
CardioSomatics. 2015;6(1):60-64
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Blocker, angiotensin II receptor olmesartan to interrupt cardiovascular continuum: vesselsand cardioprotective, anti-atherosclerotic and metabolic pleiotropic effects (part 2)
Bubnova M.G.
Abstract
The article provides an overview of pleiotropic activity and clinical efficacy of one of the representatives of the class of angiotensin receptor blockers II - olmesartan medoxomil. Analyzed is a wide range of established in experimental and clinical studies and vasoconstriction, cardioprotective, anti-atherogenic, anti-inflammatory and other effects of olmesartan medoxomil. Given clinical studies evaluating anti-atherosclerotic effects of this drug.
CardioSomatics. 2015;6(1):65-74
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The role of calcium antagonists in the treatment of cardiovascular disease: Focus on diltiazem
Baryshnikova G.A., Chorbinskaya S.A., Stepanova I.I.
Abstract
The article deals with the use of calcium antagonists (CA) with a focus on diltiazem for the treatment of hypertension, angina pectoris, and cardiac arrhythmias, for secondary prevention of coronary heart disease, to evaluate their cardiac, angiography, nephroprotective effect, the ability to prevent the development of left ventricular hypertrophy. The problems of tolerability and safety of CA in short and prolonged action.
CardioSomatics. 2015;6(1):76-82
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Vserossiyskaya nauchno-prakticheskaya konferentsiya«Neinfektsionnye zabolevaniya i zdorov'e naseleniya Rossii» (v ramkakh Natsional'nogo goda bor'bys serdechno-sosudistymi zabolevaniyami)30-letie provedeniya 1-y Mezhdunarodnoy konferentsii po profilakticheskoy kardiologii
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Abstract
CardioSomatics. 2015;6(1):83-84
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XI Rossiyskaya nauchno-prakticheskaya konferentsiya RosOKR s mezhdunarodnym uchastiem «Reabilitatsiya i vtorichnaya profilaktika v kardiologii»
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Abstract
Приглашаем Вас принять участие в объединенной XI Российской научно-практической конференции Российского общества кардиосоматической реабилитации и вторичной профилактики с международным участием «Реабилитация и вторичная профилактика в кардиологии», которая состоится 23-24 апреля 2015 г. в Москве.
CardioSomatics. 2015;6(1):85
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Issledovanie PEGASUS-TIMI 54 prodemonstrirovalo, chto dolgosrochnoe ispol'zovanie preparata tikagrelor v terapii patsientov, perenesshikh infarkt miokarda bolee goda nazad, privodit k snizheniyu chastoty tromboticheskikh oslozhneniy
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Abstract
14 марта 2015 г. компания «АстраЗенека» представила в полном объеме результаты крупномасштабного исследования PEGASUS-TIMI 54, в рамках которого проводилась оценка применения препарата тикагрелор в комбинации с низкими дозами ацетилсалициловой кислоты (АСК) по сравнению с плацебо в комбинации с низкими дозировками АСК для вторичной профилактики атеротромботических осложнений у пациентов, перенесших инфаркт миокарда в течение 1-3 лет до включения в исследование.
CardioSomatics. 2015;6(1):86
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