Vol 6, No 3 (2015)

Articles
The clinical efficacy of a comprehensive program of rehabilitation after coronary artery bypass grafting in patients with coronary artery disease under outpatient department cardio rehabilitation - III stage of rehabilitation
Aronov D.M., Ioseliani D.G., Bubnova M.G., Krasnitskiy V.B., Novikova N.K.
Abstract
Purpose of the study. Evaluate the clinical efficacy of early poststationary rehabilitation of persons with coronary heart disease (CHD) who underwent coronary artery bypass grafting (CABG) in a cardiac rehabilitation outpatient department (III stage cardiorehabilitation). Material and methods. The study included men (n=36) suffering from coronary artery disease and had undergone CABG after 3-8 weeks after surgery (an average of 7.8±1.6 weeks). Patients were randomized into two groups: the main group where patients are involved in the educational program "School for patients undergoing CABG" (hereinafter - the "School"), controlled and uncontrolled (at home) physical training (PT) - the control group, where patients were only training in the educational "School" with a recommendation to participate in an uncontrolled PT under the house. Classes in education "School" held 1 time per week, lasting 60-80 minutes, for 5 weeks; controlled PT - 3 times per week for up to 60 minutes in the groups for 4 months. The total duration of the observation - 1 year. Patients underwent instrumental tests - electrocardiogram rest, echocardiography, bicycle stress test, laboratory tests of blood - lipid and lipoprotein, glucose, fibrinogen, a survey by questionnaire of motor activity, nutrition, quality of life, HADS (Hospital Anxiety and Depression Scale). Results. After a 4-month course of the PT there was a significant indicator of physical performance. The duration of exercise at the end of the course PT increased from baseline by 32.6% (p<0.05) while preserving the effect of the 12th month. In patients who did not train after CABG, but held an educational "School", exercises were observed increase in the duration of the 12th month of monitoring and to a lesser extent (9.8%); р<0.05; p<0.05. The threshold power of exercises in trained patients increased significantly after 4 months (by 35.2% from baseline; p<0.05) with the increase of the effect to the 6th (by 53.9% from baseline; p<0.05) and 12th month (49.5% of the original); р<0,05; p<0.05. In the absence of physical rehabilitation after CABG tolerance to exercises in patients did not change. Patients held PT, 4 and 12 months there was a slight increase in the ejection fraction of the left ventricle (LV) and the LV stroke volume with a decrease in LV end-systolic volume. The absence of PT in the program of rehabilitation of persons after CABG did not prevent the increase in the concentration of total cholesterol (by 10.2%; p<0,05) and low density lipoprotein cholesterol (by 15.6%; p<0,05) for the 12th month, which was not observed in trained patients. Under the influence of PT in patients improves the quality of life as opposed to those not participating in the training. In general, serious cardiovascular complications in 3 times less common among those involved in a comprehensive program of rehabilitation "PT + "School" (at 11.1%) than in patients who only attend educational "School" (39.2%).
CardioSomatics. 2015;6(3):6-14
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Dynamics and correlation anxious-depressive, cognitive disorders and quality of life of patients undergoing coronary artery bypass grafting
Chugunova Y.V., Chumakova G.A., Demenko T.N.
Abstract
Neuropsychological complications can appear at patients after coronary artery bypass surgery (CABG) and significantly worsen their quality of life (QoL). The purpose of this research was to study neuropsychological patients’ status before and after CABG and its effect on patients’ QOL. Materials and methods: 90 men were included in this study. Neuropsychological status was evaluated with the use of Zung Self-Rating Depression Scale, Russian version; State-Trait Anxiety Inventory; the Short Form General Health Survey (SF-36); hardware-software complex “Status PF”. Results. There were lower cognitive performances among patients with depression symptoms then among those without those before CABG. 2 weeks after CABG patients with depression symptoms had significantly lower cognitive performances such as mechanical, sense and image memory volume, “finding numerals” test, “induction” and “abstraction” tests, and number of mistakes in complex visual-motor reaction as compared with patients without depression symptoms. Neurodynamics performance was worse in patients with high trait anxiety (HTA) then it was in those with moderate trait anxiety (MTA) before CABG. Also patients with HTA had lower cognitive performances 2 weeks and 6 months after CABG. Patients with depression or HTA had significantly lower QoL levels then patients without depression or MTA before and after surgery. Thus, severe cognitive performances are exposed among patients with depression and high anxiety before and after CABG. Depression and anxiety negatively influence on patients’ QoL before and after surgery.
CardioSomatics. 2015;6(3):15-21
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Drug therapy of patients with myocardial infarction as the most important component of a polyclinic stage of cardiorehabilitation
Garganeeva A.A., Kuzheleva E.A., Efimova E.V., Tukish O.V.
Abstract
Myocardial infarction (MI) is one of the most common causes of temporary incapacity, disability and mortality in the adult population of developed countries. Despite a trend in recent years to reduce mortality from cardiovascular disease, the indicator remains high in Russia. One of the main conditions to improve immediate and long-term prognosis of patients after MI, is to conduct a comprehensive cardio-rehabilitation, which is an important component of drug therapy. The article presents the characteristics of drug therapy and its influence on the course of post-MI at 5-year follow-up on the basis of "Register of acute MI". As a result of the frequency, VEN-analysis revealed no significant differences in the main groups of drugs prescribed in different periods after acute MI. At the same time it found that patients with unfavorable course of postinfarction period, significantly more often treated with inadequate doses of b-blockers, who were appointed at hospital discharge and then titrated with the annual and 5-year follow-up. The lower frequency of the appointment of vital medicines (based on VEN-analysis) was detected in patients with unfavorable course of postinfarction period as the baseline, and after a year, and 5 years after MI. Installed features of drug use have an impact on the clinical course of postinfarction period and the development of negative cardiovascular events.
CardioSomatics. 2015;6(3):22-26
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Adaptation to hypoxia and ischemic preconditioning: pathophysiologic and clinical aspects of cardioprotection in patients with coronary disease
Liamina N.P., Kotelnikova E.V., Karpova E.S., Biziaeva E.A., Liamina S.V.
Abstract
Research of cardioprotection and endogenous methods of nonspecific myocardial protection - adaptation to hypoxia and ischemic preconditioning grows rapidly nowadays. In cardiovascular patients the use of cell mechanisms based on adaptation to hypoxia, and the phenomenon of ischemic preconditioning is a perspective and promising approach to solve the problem of myocardium protection in ischemic injury. In consequence of basic and clinical research in intracellular functional and methabolic mechanisms of adaptation to hypoxia and ischemia there is a real opportunity of widespread use of data on the mechanisms of adaptation syndrome formation in clinical practice, as well as to develop new research-based effective health technologies in medical rehabilitation programs in cardiovascular patients.
CardioSomatics. 2015;6(3):27-32
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Biochemical predictors of coronary atherosclerosis in patients with metabolic disorders
Surkichin E.M., Shuvaev I.P., Asymbekova E.U., Matskeplishvili S.T.
Abstract
Metabolic syndrome represents a combination of different major risk factors of cardiovascular diseases and is mainly related to impaired insulin sensitivity in biological tissues. Common understanding of pathogenesis and relationship of different pathological conditions within metabolic syndrome is still missing. New data on endocrine function of adipose tissue suggests that development and progression of atherosclerosis in this situation may be related to adipokines dysbalance. This study investigates correlation of leptin and adiponectin with clinical and laboratory changes in patients with metabolic disorders.
CardioSomatics. 2015;6(3):33-37
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Radiofrequency ablation and antiarrhythmic therapy in the treatment of patients with paroxysmal and persistent atrial fibrillation: clinical effects
Bubnova M.G., Aronov D.M., Makhinova M.M.
Abstract
The purpose of this article is to discuss the issues related to the treatment of patients with paroxysmal and persistent atrial fibrillation (AF). The article discusses the indications for patients with radiofrequency catheter (RFC) ablation of the mouths of the pulmonary veins and based on the results of randomized clinical trials analyzed the clinical effects of this procedure, depending on the type of AF. The article discusses the initiation of antiarrhythmic therapy and the duration of its application after RFC.
CardioSomatics. 2015;6(3):38-47
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Acetylsalicylic acid therapy in patients undergoing planned surgery
Altarev S.S., Barbarash O.L.
Abstract
In a review, we described risks and benefits of surgery performed while continuing aspirin therapy in perioperative period. Aspirin therapy is associated with mild increase in surgery related bleeding risk. On the other hand, aspirin therapy leads to significant decrease of mortality and perioperative cardiovascular risk in most cases.
CardioSomatics. 2015;6(3):48-57
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Modern approaches to the treatment and long-term management of arterial hypertension in clinical practice. Pharmacological and clinical characteristics of angiotensin II receptor blockers: focus on azilsartan medoxomil. Part II
Bubnova M.G.
Abstract
The article discusses the problem of the use for the treatment of hypertension combination therapy. Advantages of application as a component of chlorthalidone therapy are discussed. Proofs of its effectiveness in lowering both blood pressure and risk of cardiovascular events compared with hydrochlorothiazide are stated. Anti-hypertensive effectiveness of one of the last appeared on the pharmacological market of receptor-blockers like angiotensin II azilsartan medoxomil in combination with chlorthalidone is discussed as well.
CardioSomatics. 2015;6(3):58-69
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Clinical case of rheumatoid arthritis with antiphospholipid antibody syndrome
Arabidze G.G., Shapchenko A.V., Muslimova O.V., Larina O.Y., Sorokoletov A.M.
Abstract
The article presents a clinical case of development of secondary antiphospholipid syndrome (APS) with early active rheumatoid polyarthritis, complication in the form of acute deep vein thrombosis of forearm on the left and chronic left vein thrombosis of the lower extremity. Patient treatment with methotrexate has developed an infectious complication and resulting in the need to go to therapy of leflunomide. This therapy have positive effect. In a survey of the patient revealed a rare form of adrenal pheochromocytoma confirmed by computed tomography and measurements of plasma normetanephrine, but not accompanied an increase of blood pressure. This article discusses the modern classification of APS, pathogenesis, clinical and laboratory diagnostic criteria, methods of therapy as rheumatoid arthritis, and APS.
CardioSomatics. 2015;6(3):70-78
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