Morphofunctional assessment of platelet activity correction in hyperbaric blood oxygenation

100 patients with functional class II-III exertional angina were examined. The subjects underwent a 10-day course of hyperbaric oxygenation (HBO) in the 1.2 ATA mode for 40 minutes, against the background of standard therapy for coronary heart disease (IHD). Before and after HBO, the platelet link of hemostasis and the elastic properties of the platelet membrane were assessed. Assessment of the effect of the HBO course on the functional state of platelets, depending on their aggregation activity, showed that in patients with initially normal platelet aggregation, there is a tendency to a decrease in spontaneous aggregation, in contrast to patients with initial hypoaggregation, HBO promoted a significant increase in spontaneous aggregation. The use of a 10-day course of HBO was accompanied by a reaction of reducing the elasticity of the platelet biomembrane. Key words: aggregation; atomic force microscopy; platelet membrane; hyperbaric oxygenation.

EFFECT OF TRIMETAZIDINE ON HEART PARAMETERS IN PATIENTS AFTER VIRAL PNEUMONIA WITH A TEST WITH A FIXED RESPIRATORY RATE

Статья посвящена оценке динамики традиционных показателей вариабельности ритма сердца (ВРС) на фоне терапии триметазидином у больных с кардиальной патологией после перенесенной коронавирусной пневмонии при использовании методики темпа дыхания. Выполнен анализ анамнестических, клинико-лабораторных и микробиологических показателей 50 лиц мужского пола с диагнозом стабильной стенокардией напряжения II функционального класса, после перенесенной коронавирусной пневмонии с использованием аппаратно-программных комплексов. При использовании пробы с ФТД у пациентов с ИБС после перенесенной коронавирусной пневмонии на фоне терапии триметазидином было выявлено два типа реакции: первый - позитивный достоверный прирост параметров вариабельности ритма сердца, второй - U-образный вид изменения показателей ВРС: снижение при проведении методики в 6 секунд и дальнейший рост при 12 секундах. Клиническая значимость методики ФТД достаточно велика, она позволяет доктору по динамике показателей ВРС: СВВР - показатель средней взвешенной вариации ритмограммы, SDNN - показатель суммарного эффекта вегетативной регуляции кровообращения, рассуждать об адекватности восстановительного периода у постковидных пациентов с ИБС и проводить коррекцию тактики лечения. Триметазидин является эффективным антиангинальным средством в комплексной терапии пациентов со стабильной стенокардией после перенесенной коронавирусной пневмонии. На фоне лечения выявлено уменьшение числа эпизодов, а также времени ишемической депрессии, что несомненного благоприятно для пациента. При исходно низком показателе СВВР добавление триметазидина в комплексную терапию ИБС может свидетельствовать о восстановлении дисбаланса вегетативной нервной системы Purpose: to evaluate the change in heart rate variability (HRV) indicators during treatment with trimetazidine in patients with coronavirus pneumonia after coronavirus pneumonia using a fixed respiratory rate test (FTD). Material and methods. A comparative analysis of anamnestic, clinical, laboratory and microbiological indicators of 50 men with stable exertional angina of II functional class (NYHA FC) after suffering coronavirus pneumonia using hardware and software systems was carried out. Results. When using a test with PTD in patients with coronavirus pneumonia after suffering from coronavirus pneumonia during therapy with trimetazidine, two types of reaction were revealed: the first was a positive significant increase in heart rate variability parameters, the second was a U-shaped type of change in HRV parameters: a decrease in 6-second breathing and further growth with 12-second breathing. Conclusion. The practical significance of the test with FTD is quite large, it allows the doctor, by the type of change in HRV parameters: SDNN - the total effect of autonomic regulation of blood circulation, SVVR - the average weighted variation of the rhythmogram, to talk about the adequacy of the rehabilitation process of postcovid patients with IHD and to correct the treatment tactics. Trimetazidine is an effective antianginal agent in the complex treatment of patients with stable angina pectoris after suffering from coronavirus pneumonia. Against the background of therapy, there is a decrease in the number of episodes, the time of ischemic depression, which is a favorable factor. With an initially low value of SVVR, the addition of trimetazidine to the complex therapy of ischemic heart disease may indicate the restoration of a disturbed vegetative balance

Clinical and anamnestic characteristics of patients with non-ST elevation myocardial infarction after COVID-19

Aim. To study clinical, medical history and paraclinical characteristics of patients with non-ST elevation myocardial infarction (NSTEMI) after coronavirus disease 2019 (COVID-19).Material and methods. The study included 209 patients with NSTEMI who were admitted to the Demikhov City Clinical Hospital (Moscow). The patients were divided into 2 groups: the experimental one (n=104) — those after COVID-19, the control one (n=105) — those without history of COVID-19. All patients underwent routine diagnostic investigations in accordance with current standards and clinical guidelines.Results. The mean age of patients in the experimental group was 61,8±12,2 years, while in the control one — 69,0±13,0 years (p<0,0001). Myocardial infarction developed 49 days [34.0; 82.0] after COVID-19. Prior exertional angina was observed in 76,9% of patients in the experimental group and in 88,6% in the control one (χ2 =4,97; p=0,0258). The level of C-reactive protein in the experimental group was 19,2 mg/l [4,9; 53,0], and in the control one — 5,6 mg/l [0,4; 21,8] (p=0,0007). The average troponin I level in the experimental group was 2,7 ng/ml [1,3; 8,0], while in the control one — 1,8 ng/ml [0,8; 3,5] (p=0,0091).Conclusion. Patients with NSTEMI after COVID-19 were significantly younger compared to patients without a history of COVID-19. They had less common exertional angina prior to MI, while C-reactive protein and troponin I levels were significantly higher than in the control group. In addition, in NSTEMI patients after COVID-19, the estimated pulmonary artery systolic pressure was significantly higher compared to patients without a history of COVID-19.

Case Report: Extrinsic Compression of the Left Main Coronary Artery by a Giant Sinus of Valsalva Aneurysm

Sinus of Valsalva aneurysm (SoVA) is an uncommon clinical entity, which is present in roughly 0. 09% of the general population. The cause can either be acquired or congenital. Clinically the SoVA of unruptured status are rarely captured or even diagnosed due to atypical clinical presentations. Here, we present a rare case of exertional angina pectoris and recurrent syncope due to an extrinsically compressed left coronary artery by a giant SoVA in a 50-year-old female patient. This SoVA was successfully repaired by the surgical exclusion and the patient was still doing well after 2 years of follow-up.

Cardioprotective effects of alendronate bisphosphonate in patients with ischemic heart disease associated with type 2 diabetes mellitus and osteoporosis

Introduction. Diabetes mellitus, cardiovascular diseases and osteoporosis are linked by common pathophysiological mechanisms.Objective. To evaluate the effect of alendronate bisphosphonate on cardiovascular outcomes in comorbid patients with ischemic heart disease (CHD) associated with type 2 diabetes mellitus (type 2 diabetes) and osteoporosis during a two-year follow-up.Materials and methods. A total of 112 women with comorbid pathology including osteoporosis, coronary artery disease, and type 2 diabetes were examined. The patients' condition was assessed at baseline and prospectively for 24 months with a combined endpoint assessment, including: mortality, readmission for cardiovascular diseases, the development of myocardial infarction (MI), stroke, atrial fibrillation. Women were divided into groups: group 1 (n = 59) included patients who received basic therapy for IHD and type 2 diabetes, group 2 (n = 53) included patients who, in addition to basic therapy for coronary artery disease and diabetes Type 2 was prescribed alendronic acid preparation.Results and discussion. According to the results of two-year follow-up, the patients were divided into two subgroups: patients with a favorable (n = 61) and unfavorable course of coronary artery disease (n = 51). At the same time, during prospective observation, the following was assessed: the frequency of hospitalizations for cardiovascular diseases, the dynamics of the functional class (FC) of exertional angina, the development of MI, stroke, atrial fibrillation, and mortality. A significant association of alendronate therapy with a favorable course of ischemic heart disease (OR = 0.26; 95% CI = 0.18-0.57; p = 0.008), a decrease in the risk of MI (OR = 0.32; 95% CI = 0.11-0.87; p = 0.018) and worsening of FC of exertional angina (OR = 0.4; 95% CI = 0.17-0.91; p = 0.014).Conclusion. Long-term (24 months) use of alendronate is an effective and safe method for the treatment of associated cardiovascular pathology, represented by coronary artery disease, type 2 diabetes and osteoporosis in postmenopausal women, reducing the risk of MI, worsening of FC of exertional angina. These results suggest a more aggressive prescription of alendronate for osteoporotic patients at very high cardiovascular risk.

Echocardiographic changes and quality of life after surgical unroofing of myocardial bridges

Objective To examine the echocardiographic changes and quality of life (QoL) after surgical unroofing of myocardial bridges (MBs) involving the left anterior descending (LAD) coronary artery compared with optimal medical therapy (OMT). Methods Twenty-two patients (median age, 24 years; interquartile range, 16–40 years) with MBs of the LAD artery and exertional angina from 2018 to 2019 were retrospectively analyzed. Twelve patients underwent OMT and 10 underwent surgery. Both groups underwent clinical and echocardiographic examinations during hospitalization and follow-up (mean, 1.0 ± 0.8 years). QoL was assessed with the Seattle Angina Questionnaire, short version (SAQ-7). Results Surgery resulted in significantly better QoL than OMT, with a significant improvement in left ventricular global longitudinal strain (GLS) [mean (standard error): 19% (0.19) to 22% (0.34) and 19% (0.15) to 20% (0.24), respectively; delta-change (delta-GLS) of 0.15 vs. 0.067]. In the univariate and multivariable analyses, delta-GLS was positively correlated with the SAQ-7 score and MB length (rho = 0.64 and 0.71, respectively), with a significant interaction between MB length and surgical treatment (beta coefficient, 1.95; 95% confidence interval, 0.14–3.77). Conclusions MB unroofing surgery provided benefits in terms of QoL and left ventricular GLS improvement compared with 1 year of OMT.

Early invasive tactics for treatment of patients with various forms of unstable angina

The paper presents immediate and long-term results of early invasive treatment tactics in 467 patients with various forms of unstable angina (UA), including 129 patients with unstable rest angina, 225 patients with unstable exertional angina, and 93 patients with a new onset angina. Percutaneous coronary interventions on a symptom-affected artery at a single procedure were performed in 213 cases (48%), indications for coronary artery bypass grafting were identified in 182 patients (41%), and only in 52 cases (11%) the treatment was limited to medicinal therapy. Coronary angiography performed in the initial 12–48 hours makes it possible to identify the indications to myocardial revascularization, to avoid inconsistencies in the choice of optimal treatment tactics and non-invasive risk assessment.

Refractory Dyspnea in a Patient with End-Stage Idiopathic Pulmonary Fibrosis (Palliative Care unit Case Study)

Treating dyspnea in patients with idiopathic pulmonary fibrosis is a challenge. The foreign experience of using low doses of opioids to relieve dyspnea in patients with progressing diseases is controversial among Russian specialists. The presented clinical case is an 83-year-old patient with idiopathic pulmonary fibrosis in the terminal stage and refractory dyspnea, progressive respiratory failure of II - III degrees, and concomitant exertional angina II FC and organic anxiety disorder. The patient was offered low-dose morphine injections (2 mg 5 times a day subcutaneously) to relieve the shortness of breath. The patient, who had not previously received opioids, and his relatives gave prior consent to the use of morphine. Within a week from the moment of hospitalization, the general and psycho-emotional state of the patient improved, dyspnea decreased, and night sleep was partially normalized. However, а week later, being in a severe but relatively stable condition, the patient died from a massive nosebleed. Shown, that the traditional approach to reducing dyspnea and the associated agitation in patients with interstitial lung disease is the use of corticosteroids and psychotropic therapeutics in increasing doses. The use of low doses of opioids to relieve dyspnea in patients with non-cancer disease meets many organizational, medical, and psychological barriers. At the same time, this therapy is recognized as successful and safe in the foreign palliative practice. Overcoming the existing barriers based on the evidence from clinical trials, as well as the domestic and foreign clinical practice of the safe use of low doses of opioids would expand the arsenal of effective treatments for refractory dyspnea.

Frequency, intensity and duration of routine rehabilitation exercises practiced by patients with coronary artery disease

This article is designed to determine frequency, intensity and duration of routine rehabilitation exercises practiced by patients with coronary artery disease (CAD). Living a sedentary lifestyle along with unhealthy diet can also contribute to this disease. Cardiac rehabilitation is considered to play key role to prevent from these circumstances. Objective: To determine frequency, intensity and duration of routine rehabilitation exercises practiced by patients with coronary artery disease. Methodology: Cross-sectional descriptive study was conducted in Hospitals of Lahore. The research was completed within 5 months after the approval of synopsis from February – June 2019. Patients having unstable angina, exertional angina, and multiple organ failure will be excluded. The data was collected from 186 participants (105 males and 81 females) by using interview based questionnaire. Descriptive statistics including percentages, mean and frequency distribution were calculated for each variable. Results: The study included 105 males (56.5%) and 81 females (43.5%) showing that most of subjects with age ranges 52-62 years (n = 72), standard deviation (SD = 56.34), were affected with cardiac incident. It was noted that 117 subjects (62.9%) practiced brisk walking as their routine rehabilitation exercise with frequency of 57 subjects performed 3 times per week and 117 subjects with duration of 10-20 minutes. Continuous...