Vol 6, No 3 (2015)

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%).

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.

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.

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.

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.