Vol 11, No 1 (2020)

Original article
Modern principles of atherogenic dyslipidemia management in special groups of patients
Bubnova M.G., Parnes L.E.
Abstract

Aim. To provide modern view on atherogenic disorders in the blood lipid spectrum, the principles of lipid-lowering therapy prescription in certain groups of patients, the safety issues of statin therapy in patients with chronic liver diseases.

Materials and methods. The data of 55 scientific sources published in the Russian and foreign press in 1988–2020 were analyzed.

Results. It is known that atherogenic dyslipidemia is a key factor in pathogenesis of atherosclerotic cardiovascular diseases. Various disorders in blood lipids and lipoproteins are identified. In this regard, there are certain recommendations for the analysis of lipids and lipoproteins in certain situations. The issues of interpreting extreme deviations from normal values of the blood lipid spectrum are discussed. Patient groups with different levels of the cardiovascular risk, which determines prescription of lipid-lowering therapy, are presented. Statins are the first line of lipid-lowering therapy for both the correction of dyslipidemia and the prevention of cardiovascular complications. The article discusses the tactics of prescribing statins in special groups of patients, their safety issues. It considers promising ways for increasing statins tolerability in patients with chronic liver diseases, primarily with non-alcoholic fatty liver disease, by adding of combined hepatoprotector.

Conclusions. Generally, modern tactics of statins prescription are based on dyslipidemia characteristics and the patient’s cardiovascular risk level. Moreover, statins are clinically effective in special patient groups and have a good tolerability profile.

CardioSomatics. 2020;11(1):6-15
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Influence of metabolic and proinflammatory factors on diastolic heart failure formation in females with essential hypertension
Barsukov A.V., Seidova A.Y., Shcherbakova K.A.
Abstract

Relevance. Diastolic chronic heart failure (CHF) is a characteristic complication of essential hypertension (EH).

Materials and methods. 62 females with EH were examined. The first group (n=47, mean age 51.5±6.2 years) – persons with EH complicated by diastolic CHF, the second group (n=15, 49.8±6.7 years) – persons with uncomplicated EH. The diagnosis of CHF in females of the first group is confirmed by the data of the test with 6-minute walking, increased blood content of the N-terminal precursor of the brain natriuretic peptide, the presence of left atrial dilatation, hypertrophy and disturbed left ventricle (LV) relaxation. The levels of indices of lipid, carbohydrate, purine metabolism, mediators of systemic inflammation (С-reactive protein), tumor necrosis factor alpha (TNF-a), interleukin-6 (IL-6) were studied and a correlation analysis of the whole set of laboratory data with 6-minute walking test results and an integral index of diastolic LV dysfunction (E/e’).

Results. Females with EH complicated initial manifestations of diastolic heart failure, characterized by significantly higher, but the corresponding values of the reference range, the content in blood TNF-a, IL-6 compared with females with uncomplicated EH. In females with hypertension complicated initial manifestations of diastolic heart failure is established significant correlation between blood levels of atherogenic lipids and lipoproteins, glucose, uric acid, CRP, TNF-a, IL-6 on the one hand and indices characterizing reduced tolerance to physical load, diastolic LV dysfunction.

Conclusion. Formation of diastolic heart failure clinical syndrome as well as disturbances of LV relax function in hypertensive females allows participation of metabolic factors and pro-inflammatory pattern.

CardioSomatics. 2020;11(1):16-22
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Left ventricular geometric sportsmen power sports heavyweight with arterial hypertension
Miroshnikov A.B., Smolensky A.V.
Abstract

Aim. To conduct a comparative analysis of the geometry of the left ventricle (LV) at sportsmen heavyweight power sports with hypertension.

Material and methods. We examined 238 representatives of power sports (weightlifting, powerlifting, bodybuilding) with an average body weight of 102.7±6.4 kg and arterial blood pressure at rest: systolic blood pressure – 157.4±5,6, diastolic blood pressure – 91.2±5.3. Along with the examination, all examined athletes underwent: bioimpedansometry, standard resting electrocardiogram, two-fold measurement of blood pressure, transthoracic echocardiography.

Results. A survey of 238 weightlifting athletes of heavy weight categories with arterial hypertension showed an increased fat component in powerlifters (SAT 31.8±3.3%; BMI 34.4±1.3 kg/m2; Fat Mass Index 10.9±1,1 kg/m2; Fat-to-Muscle Ratio 0.5±0.1) and a sufficiently large muscle component: bodybuilding Fat Free Mass Index (FFMI) 26.9±2.1 kg/m2; powerlifting FFMI 23.5±1.6 kg/m2 and weightlifting FFMI 23.7±1.8 kg/m2. The examination also showed a violation of the geometry of the LV. For athlete powerlifters, the following LV parameters were noted: LVMM 270.2±28.7 g; LVMI 123.7±7.9 g/m2; RWTLV 0.46±0.03 sm. For representatives of weightlifting; LVMM 267.8±32.3 g; LVMI 121.4±8.6 g/m2; RWTLV 0.45±0.02 sm. For bodybuilder athletes: LVMM 271.4±18.9 g; LVMI 120.1±6.3 g/m2; RWTLV 0.30±0.01 sm.

Conclusion. Thus, the patterns obtained in relation to the geometry of the heart of athletes of power sports, heavy weight categories with arterial hypertension, can serve as a scientific basis for the formation of some aspects of the preventive program of physical rehabilitation with a priority focus on “risk groups” in such men.

CardioSomatics. 2020;11(1):23-27
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Review
Medical rehabilitation approaches in patients with implanted pacemaker
Iskenderov B.G., Ivanchukova M.G., Berenshtejn N.V.
Abstract

In the following review article, the principles and approaches of medical rehabilitation in patients with implanted pacemakers are discussed. It was shown that total benefit results from cooperation among medical, physical and psychological components of rehabilitation program and optimisation of the mode and parameters of cardiac pacing. Social adaptation of the patients with implantable pacemakers is of paramount importance and should be directed on avoidance of external electromagnetic fields and their influence on pacemaker functions, which in turn may be life-threatening for patient and the staff as well. The indications to diagnostic and treatment regimens including physiotherapeutic procedures should be clearly defined in order to avoid potential influence of electromagnetic interference on cardiac pacemaker. The well-structured medical rehabilitation programs need to be organised in order to improve quality of life and patient′s survival with regard to growing tendency of implantation of cardiac pacemakers.

CardioSomatics. 2020;11(1):28-34
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Heart failure: actual problems of accounting and paying for hospital admissions (agreed position)
Samorodskaya I.V., Larina V.N., Perkhov V.I., Sivtseva M.G.
Abstract

The increase in life expectancy of the population, the more frequent occurrence of heart failure (HF) among the elderly and the increasing costs of its treatment are a significant economic burden for the health of any country. The reasons for the hospitalization of patients with chronic HF (CHF) can be either a worsening condition of the underlying disease, which was complicated by HF, decompensation of HF, the need for implantation of resynchronizing pacemakers and other devices, or heart transplantation. Different reasons for hospitalization require different resources. CHF should be taken into account (coded) as the main final diagnosis in those cases when it is the main reason for hospitalization and the greatest expenses for providing medical care. To plan the volumes and analyze the results of inpatient care for patients with HF, it is necessary to make appropriate additions to the state statistical monitoring forms and to the instructions of the Federal Compulsory Medical Insurance Fund to classify cases of medical care as a specific clinical and statistical group.

CardioSomatics. 2020;11(1):35-38
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Hypertrophic cardiomyopathy: a modern view of the problem
Alieva A.M., Almazova I.I., Reznik E.V., Pinchuk T.V., Baykova I.E., Kislyakov V.A., Svetlakov V.I., Kovtyukh I.V., Korvyakov S.A., Rakhaev A.M., Nikitin I.G.
Abstract

Hypertrophic cardiomyopathy (HCM) is the most common genetic heart disease, with a prevalence of approximately 1 in 500 among the adult cohort. It is a common etiological factor of sudden cardiac death in the young and a common cause of morbidity and mortality in all age groups. HCM is characterized by a complex pathophysiology, which is manifested by a heterogeneous clinical picture. The mechanism of development of this variant of hypertrophy is not fully understood. Currently, only a part of the genetic mutations that correlate with the development of this pathology has been identified. In this regard, the issue of genetic diagnosis of HCM is very relevant, as it will allow us to conduct advanced screening. A very important task is to develop a personalized approach in the conservative and surgical treatment of people suffering from this variant of cardiopathy.

CardioSomatics. 2020;11(1):39-45
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Clinical case
A case of acute myocardial infarction in a patient with congenital atresia of the left coronary artery
Evdokimova A.G., Popov V.V., Shuiskaya O.A., Mikhailova I.S.
Abstract

A clinical example of a rare pathology is presented – a congenital anomaly of the coronary arteries, namely, atresia of the trunk of the left coronary artery in a young patient of 40 years old. This pathology was asymptomatic and was suddenly manifested by the development of acute myocardial infarction in a patient with a single right coronary artery. Clinical, laboratory and instrumental research methods using modern technologies are described in detail. In the article, the authors discuss the genesis of the development of acute coronary syndrome, due to a possible connection with the activation of cytomegalovirus infection.

CardioSomatics. 2020;11(1):46-49
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