Features of treatment and rehabilitation of patients suffering from stable coronary heart disease with comorbid background at the outpatient stage

2021 ◽  
Vol 3 ◽  
Author(s):  
D.Yu. Gamayunov ◽  
◽  
V.A. Khaptanova ◽  
A.N. Kalyagin ◽  
N.M. Balabina ◽  
...  

This literature review highlights the relevance of both cardiovascular diseases in general and coronary heart disease in particular. The features of the therapy of coronary heart disease and some comorbid conditions are considered: atrial fibrillation, arterial hypertension, diabetes mellitus, chronic kidney disease, gastrointestinal tract diseases, bronchial patency disorders, iron deficiency anemia, inflammatory diseases of the oral cavity, angle-closure glaucoma, new coronavirus infection COVID-19. Attention is drawn to the paradoxical relationship between cholesterol levels and the risk of cardiovascular complications and death in patients with end – stage CKD. The effect of omeprazole on reflux-induced myocardial ischemia is described. The possibility of using cardioselective beta -blockers in patients with COPD is emphasized. The choice of the form of nitrate release in inflammatory diseases of the oral cavity requires special attention. An urgent problem is the interaction of antiviral drugs and drugs of basic therapy of coronary heart disease in patients with a new coronavirus infection COVID – 19. Thus, patients taking CYP3A4 inhibitors are recommended to use prasugrel. The article examines the effect of comorbidity on the severity of persistent loss of body functions. Attention is drawn to the existing problems of rehabilitation of patients with coronary heart disease at the outpatient stage: patients ignoring non – drug rehabilitation methods, insufficiently attentive attitude to the issue of full – fledged secondary prevention. It is necessary to further improve the algorithms for the tactics of management of comorbid patients with coronary heart disease at the outpatient stage and a more detailed solution to the issue of medical and labor expertise and rehabilitation of this category of patients.

2021 ◽  
pp. 25-32
Author(s):  
E. V. Borisova ◽  
O. D. Ostroumova ◽  
A. P. Pereverzev ◽  
E. E. Pavleeva

Cardiovascular diseases (CVD) are the leading cause of death among adults worldwide, including in the Russian Federation. At the same time, the leading position in the structure of causes of death from CVD is occupied by coronary heart disease (CHD) (16% of the total number of deaths in the world per year). The new clinical guidelines of the Ministry of Health of the Russian Federation for the management of patients with stable coronary heart disease in 2020 identify two main goals of conservative therapy – the elimination of symptoms of the disease and the prevention of cardiovascular complications (CVD). In this connection, when choosing antianginal therapy in patients with stable angina, it is necessary to consider the possibility of using combinations of both first-line and second-line drugs in order to really improve the effectiveness of treatment and achieve the goals set. It is advisable and justified to use more widely 2-line drugs, in particular trimetazidine, at any stage of therapy to enhance the antianginal effectiveness of b-blockers, calcium antagonists and prolonged-acting nitrates, especially in patients with hemodynamic features (arterial hypotension, rhythm and conduction disorders), which is demonstrated in the given clinical example. The effective addition of tremetazidine to the arsenal of traditional antianginal drugs is legislated in practice and is reflected in the new clinical recommendations of the Ministry of Health of the Russian Federation in 2020. The accumulated experience of using trimetazidine allows a pathogenetically sound approach to the treatment of stable CHD, restoring the balance between the need and delivery of oxygen to the heart muscle, and the safety profile expands the possibilities of use in patients with comorbid pathology. 


PLoS ONE ◽  
2017 ◽  
Vol 12 (9) ◽  
pp. e0183791 ◽  
Author(s):  
Mathieu Gayda ◽  
Vincent Gremeaux ◽  
Louis Bherer ◽  
Martin Juneau ◽  
Joffrey Drigny ◽  
...  

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