No 2 (2015)
CLINICAL GUIDELINES
ORIGINAL PAPERS
33-35 332
Abstract
Purpose of this study was examination of the features of coronary vessels in patients with rheumatoid arthritis (RA) using CT angiography. Materials and Methods: results of CT angiographic studies of 60 patients with varying degrees of coronary vessels pathology were retrospectively analyzed. 27 of them had a history of RA. The control group included 33 patients who had no medical history and clinical symptoms of rheumatic disease. The degree of calcification of the coronary arteries was calculated according to the Agatston degree. Processing of the results was carried out on Excel and Statistica 6.0. Results: The study found that coronary calcification in the control group patients averaged 289, and in patients with RA 305 HU (p <0.05). In addition, the dependence of the Agatston degree, patient's age, smoking and diabetes history was revealed. Conclusions: comparing to the control group coronary calcification was higher in patients with rheumatoid arthritis. A direct correlation between the value of the calcification index and RA activity, as well as risk factors such as age, smoking, and diabetes was revealed.
37-40 409
Abstract
The aim of the study was to assess associations between myocardial electrical instability estimates (heart rhythm turbulence, T- wave microvolt alternation, QT dispersion) and structural and functional changes in heart in the settings of IHD with ventricular premature beats. Eighty two subjects with exertional angina (NYHA FC II-III) and Lown Grade 3-5 class ventricular arrhythmia were examined. Controls included 28 pts. with chronic IHD with no arrhythmias. Heart rhythm turbulence, T- wave alternation and QT dispersion were defined based on 12-lead ECG data with record duration of 5 minutes using Intecard-7 apparatus. All patients underwent common clinical examination, 60-lead electrocardiogram (ECTG-60), ECG daily monitoring test (SMECG) (Cardian, Belarus), bicycle ergometric test, short ECG recording vagal sympathetic balance was estimated (using Briz Program Package and SMECG). IHF subjects who had Lown Grade III-V class ventricular arrhythmia had a higher frequency of heart rhythm turbulence disturbance, higher T microvolt alternation estimates and QT dispersion. Close relationship between myocardial electrical instability parameters (heart rhythm turbulence, T microvolt alternation and QT dispersion) and myocardial ischemic signs, LVEF, and heart rhythm variability in chronic IHD have been identified.
T. V. Martynyuk,
Z. H. Dadacheva,
V. M. Paramonov,
O. A. Arkhipova,
S. N. Nakonechnikov,
I. Ye. Chazova
42-49 919
Abstract
The key component of the pathogenesis of pulmonary hypertension (PH) is endothelial dysfunction with imbalance between vasodilators and vasoconstrictors and activation of the blood coagulation system. Randomized trials showed a beneficial effect of phosphodiesterase type 5 (PDE-5) inhibitors on vascular remodelling and vasodilatation in pulmonary arterial hypertension (PAH). Sildenafil is the only PDE-5 inhibitor that is officially approved by Pharmacological Commitee in our country. PDE-5 inhibitors by blocking the breakdown of cyclic guanosinemonophosphate (cGMP) resulted in prolongation of the action of vasoactive mediators including nitric oxide (NO) that cause vasodilation and antiproliferation in the lung. Sildenafil demonstrated the efficacy in uncontrolled clinical studies in pts with idiopathic pulmonary hypertension, PAH due to systemic connective tissue disease, congenital heart defects, with pulmonary embolism. 25-75mg at doses 2-3 times a day in patients with improved pulmonary hemodynamics, exercise tolerance. Basis for the authorization of this drug in the setting of PAH was a large randomized, placebo-controlled trial in which different doses of sildenafil were assessed in 278 patients presenting with idiopathic PAH, PAH related to connective tissue disease or congenital systemic to pulmonary shunts surgically corrected. After three months of treatment significant hemodynamic and functional class improvements were noted in every sildenafil group as compared to placebo. An approved dose is 20 mg three times a day, but in clinical practice often higher doses of 40-80 mg to 3 times per day are in need. Stable long-term efficacy of Sildenafil was observed with the dose of 80 mg 3 times a day in SUPER-2 trial. PACES trial demonstrated the efficacy of sildenafil in combination with intravenous epoprostenol.
51-55 411
Abstract
Authors brought historical way of cardiac rehabilitation as sciences. There was described evolution terms and intensity of physical rehabilitation since XVIII century and so far. The separate attention was paid on social importance of cardiac rehabilitation and on its influence on resistant and temporary disability. There was provided not only historical review of cardiac rehabilitation status in countries of Western Europe and the USA but also data about cardiac rehabilitation in the USSR. In USSR in the 90th years of the XX century scientifically based program of physical rehabilitation and after myocardial infarction was created. Separate attention was paid on formation of cardiac rehabilitation in Republic of Belarus taking into account changes of organizational model rehabilitation help and also new medical, diagnostic and cardiosurgical technologies have been developed. Scientific researches in the field of cardiac rehabilitation have started in Republic of Belarus since 80th years of the XX century. Authors described newly created rehabilitation classification of patients after myocardial infarction and percutaneous coronary intervention. They studied the influence of thrombolytic therapy, percutaneous coronary intervention and developed rehabilitation programs on outcomes in patients after myocardial infarction. Significant effect of developed program of cardiac rehabilitation revealed by authors dictate the necessity of development and widespread similar rehabilitation programs for all categories of cardiac patients.
57-61 366
Abstract
This review examines the possibility of personalized pharmacotherapy with statins, based on the genotype of the individual patient. Identification of polymorphism of genes, responsible for the metabolism of the liver CYP3A5, CYP2C9 and transport of statins into the liver SLCO1B1, BCRP allows differentiated approach to their appointment and choice. This will not only increase the effectiveness of statins, but also to avoid serious side effects, primarily statin-induced myopathy and toxic hepatitis.
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ISSN 2225-1685 (Print)
ISSN 2305-0748 (Online)
ISSN 2305-0748 (Online)