Vol 12, No 3 (2021)

Aim. To identify different pathogenetic variants of myocardial infarction type 2 (MI-2).

Material and methods. Reviewed 4168 cases of MI admitted in multidisciplinary hospital for 10 years. 353 patients met the criteria for MI-2 without signs of coronary atherothrombosis (CA). In the study group, the features of clinical and laboratory-instrumental manifestations were evaluated.

Results. Cases of IM-2 were subdivided into 4 clinical-pathogenic variants (CPV): 1-CPV developed due an increasing in myocardial oxygen demand; 2-CPV, arising from a decrease in the supply of oxygen; 3-CPV associated with local coronary circulation disorder; 4-CPV developed due to the combined oxygen-energy imbalance. In 72 (20.4%) cases, 1-CPV was detected, caused by a hypertensive crisis and/or tachyarrhythmias; 2-CPV observed in 73 (20.68%) patients with hypotension, anemia, microvascular dysfunction, respiratory failure; 3-CPV caused by spasm and embolism of CA was detected in 47 (13.31%) cases; in 161 (45.61%) patients, IM-2 is associated with increased myocardial oxygen demand with reduced oxygen delivery. The gender and risk factors in groups are comparable. The average age of 1-CPV- and 3-CPV-patients was less and amounted to 65.7 and 56.5 versus 70.2 and 73.8 years in the 2-CPV and 4-CPV. Typical clinical and laboratory-instrumental signs of MI were common for patients with 1-CPV and 3-CPV, while 2-CPV and 4-CPV more often had chronic severe pathology, multivessel coronary disorder, and the clinical presentation and ischemic signs were less common.

Conclusion. Clinical manifestations and results of examination of patients with MI-2 depend on the mechanism of its development.

Aim. To assess the effect of physical rehabilitation on dynamics of oxygen and lactate status indicators in “inotrope-dependent” patients with stable chronic heart failure (CHF) of III–IV functional class (FC).

Material and methods. A randomized prospective study included 120 men, aged 18–65, hospitalized at Almazov National Medical Research Centre due to CHF III–IV FC, left ventricular ejection fraction (LVEF) ≤30%; with blood pressure (BP)≥90/60 mm Hg. Patients who received dobutamine or dopamine for ≥2 weeks were randomized into 3 groups: 1st – participating in the program of physical training (PPT), 2nd – not participating; 3rd group – patients without inotropic support participating in PPT.

Results. Oxygen extraction ratio (O₂ER) at rest was increased, while central venous oxygen saturation (ScvO₂) was decreased in all groups at baseline, after 3 and 6 months. Initially, at rest, central venous blood lactate (lactate) was normal in all groups. By the 6th month, lactate in group 2 became higher than in group 1 (p=0.005) and group 3 (p=0.008). Initially, after 3 and 6 months, at peak of exercise in groups 1 and 3, lactate and O₂ER increased, and ScvO₂ decreased without development of life-threatening adverse events. By the 6th month, in groups 1 and 3, the distance of 6-minute walk test increased: p=0.004 and p<0.00001 and the strength of hand muscles increased: p=0.01 and p=0.005.

Conclusion. In patients with CHF III–IV FC at rest, regardless of participation in PPT and inotropic therapy, there were comparable disturbances of oxygen status, characterized by decreased level of ScvO₂ and increased level of O₂ER, in the absence of decrease in arterial blood saturation. At peak of aerobic exercise of mild and moderate intensity in patients with advanced CHF, regardless of inotropic support, there was a comparable increase in the level of lactate and O₂ER, as well as a decrease in ScvO₂, which was not accompanied by life-threatening adverse events. The participation of “inotrope-dependent” patients in PPT is associated with decrease in blood lactate at rest, which, along with increase in hand muscle strength and exercise tolerance, may indicate an improvement in condition of muscle tissue.

A major problem in arrhythmology is supraventricular arrhythmias – atrial fibrillation. Remodeling of the myocardium and the formation of fibrosis zones are the cause of cardiac arrhythmias. Violations of the extracellular framework of myocardiocytes with the formation of zones of sclerotically altered areas lead to violations of the pulse from the sinoatrial node. The inflammatory reaction, which results in fibrosis, has been repeatedly confirmed by the results of histological examination of lung vein and myocardial tissue samples in patients with rhythm disorders – atrial fibrillation. The paper considers the possibility of determining in the blood of patients with atrial fibrillation a highly sensitive C-reactive protein, widely used in clinical practice, as an indicator of the activity of sluggish inflammation in the myocardium with simultaneous determination of the level of vitamin D (25-OH), known, among other things, for its anti-inflammatory effects. The data of the pilot study are presented.

In modern medical practice, the treatment of cancer is one of the most pressing issues. Many of the drugs used in the treatment of cancer have a toxic effect on the cardiovascular system of patients. The main clinical manifestations of cardiotoxicity are ischemic heart damage, rhythm disturbances, thrombosis, angina, asymptomatic changes in the electrocardiogram, and others. Side effects can develop both during the treatment period and months after the end of the course of chemotherapy. This is especially important for patients with concomitant cardiac or vascular pathology, since the severity of developing side effects can lead to disability or death of cancer survivors. The article discusses the data on the frequency of detection of the negative effect of pyrimidine, purine and folic acid antagonists on the cardiovascular system of cancer patients, the mechanisms of cardiotoxic effects of drugs in such patients, the possibilities of preventing heart damage and correcting for already developed lesions. The aim of this work is to collect, compare and systematize the available disparate data on the cardiotoxic effects of antitumor drugs of the antimetabolite group. An important condition for saving and preserving the quality of life of cancer patients is the identification of cardiovascular pathologies at the stage of preparation for chemotherapy, which can be facilitated by the active cooperation of oncologists and cardiologists. The search for information was carried out on the bases of scientific medical publications (eLibrary.ru, PubMed) taking into account the clinical recommendations for the treatment of malignant neoplasms.