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The case of a 81-year-old male with atrial fibrillation, associated with severe aortic stenosis (AS) is outlined. A peculiarity of the clinical portrait of AS is a long asymptomatic period with a significantly varying duration. After the appearance of the first clinical manifestations of the disease (shortness of breath on exercise, fainting) the risk of sudden death rises sharply, and the average life expectancy is 2-3 years. The development of atrial fibrillation (AF) leads to a serious impairment of the clinical condition due to loss of the contribution of atrial systole to the filling of the left ventricle (LV). Concentric hypertrophy of the LV, which at the first stage is an important adaptation mechanism compensatingfor a high intracavitary pressure, later leads to a relative reduction of the coronary blood flow and to limitation of the coronary vasodilatation reserve. So patient was referred for transcatheter aortic valve implantation. He had also a history of coronary artery disease with earlier percutaneous coronary intervention. Then, he was started on a triple antithrombotic therapy therapy. The triple antithrombotic therapy caused gastrointestinal bleeding (Mallory-Weiss syndrome). Considering the difficulties in the rational choice of anticoagulant therapy and high risks of adverse reactions, the patient underwent endovascular occlusion of the left atrial appendage.

Modern pathogenetic therapy of idiopathic pulmonary arterial hypertension (IPAH), a severe life-threatening cardiovascular disease of unknown etiology, leads to a positive clinical effect due to reverse remodeling of the vessels of the microvasculature of the lungs. Highly effective drugs of specific therapy that act on the main targets of pathogenesis have now been introduced into clinical practice.

The presented clinical case of a patient with diagnosed in 2014 IPAH with an initial functional class III according to the WHO classification demonstrates high long-term efficacy and safety of specific therapy based on the use of the soluble guanylate cyclase stimulator riociguat for 5 years after replacing previous therapy with sildenafil with further implementation of the strategy of sequential combination therapy due to the addition of ambrisentan and selexipag.

According to international epidemiological studies, the total number of reported cases of cardiovascular diseases (CVD) almost doubled from 1990 to 2019, reaching 523 million and the number of deaths from CVD in 2019 increased by more than 1.5 times (18,6 million). Coronary artery disease (CAD) and stroke are the main contributors to these unfavorable trends. The number of registered cases of coronary heart disease in 2019 amounted to 197 million, and the number of deaths caused by coronary artery disease exceeded half of all registered cases of cardiovascular death (9,14 million). Patients with stable angina are the majority of patients with CAD. Despite the existing modern methods of treating angina pectoris, patients with chronic coronary artery disease continue to suffer from anginal pain, which significantly reduces exercise tolerance and worsens their quality of life. In clinical practice, the severity and frequency of angina pectoris in patients remain underestimated by doctors, and drug therapy is not corrected in a timely manner, and the possibilities of combined antianginal therapy are not used. Trimetazidine, as an antianginal drug that acts on the metabolism of ischemic myocardial cells (influence on the ischemic cascade, by reducing cellular acidosis and increasing ATP content), is effective and safety for the treatment of angina pectoris, regardless of the mechanism that caused ischemia as monotherapy and in the combination, primarily with beta-blockers.

The aim of the work is to evaluate the planarity of the QRS loop and its relationship with systolic dysfunction of the left ventricle in patients in the subacute period of myocardial infarction (MI).

Materials and methods. The ECG of 265 patients with a diagnosis of acute myocardial infarction were analyzed. The control group consisted of 55 healthy individuals. The planarity index was calculated as the ratio of the area of the QRS loop projection onto the plane (the polar vector of the QRS loop) and the true area of the QRS loop in space using a synthesized vectorcardiogram.

Results. In patients with MI, the planarity index was significantly lower than in healthy individuals: 0,87 [0,71; 0,94] and 0,96 [0,93; 0,97], respectively, p < 0,0001. Weak but significant correlations between the planarity index and the left ventricular ejection fraction (LVEF, r = 0,41, p < 0,001) and with the number of affected segments of the left ventricle according to echocardiography (r = −0,43, p < 0,001) were found. In patients with MI, the planarity index was lower in the presence of pulmonary edema in the acute period of MI (0,68 [0,54; 0,86]; without pulmonary edema 0,88 [0,76; 0,94], p < 0,001), and in the presence of a history of chronic heart failure (0,79 [0,61; 0,88]; without chronic heart failure 0,88 [0,75; 0,94], p = 0,007). In patients with MI of both anterior and inferior localization, the planarity index was significantly lower with LV EF < 50% compared with LV EF ≥ 50%. The planarity index was significantly lower in anterior MI than in inferior MI. Conclusion. In patients in the subacute period of MI, there is a decrease in the QRS loop planarity index, which correlates with the volume of myocardial damage, a decrease in LV EF, and the presence of acute and chronic heart failure. The QRS loop planarity index was significantly lower in anterior MI than in inferior MI.