Russian Society of Cardiology (RSC), Society of Heart Failure Specialists, Russian Scientific Medical Society of Internists, Association of Cardiovascular Surgeons of Russia Approved by the Research and Practical Council of the Ministry of Health of the Russian Federation
In emergency medicine, standard electrocardiography is a key diagnostic method for circulatory hypoxia in coronary artery disease. Valid electrocardiographic criteria for myocardial ischemia include well-known specific changes in the terminal ventricular complex part. In rare cases, myocardial ischemia can mimic conduction disorders or increased ventricular ectopic activity. TV1≥TV6 phenomenon can also be a "non-obvious" manifestation of ischemic focality.
In the human body, ammonia is produced as a result of the metabolism of nitrogen-containing compounds. An increase in the blood concentration of ammonia above the normal range (21-50 μmol/L) is referred to as hyperammonemia. Ammonia is a toxic compound. Although its blood concentration is relatively low in healthy individuals, even a slight increase can have negative health effects, particularly on the central nervous system. Clinical manifestations vary depending on the degree of ammonia elevation and include irritability, vomiting, ataxia, seizures, and coma. This literature review summarizes current data on the mechanisms of ammonia formation, classification, and pathogenetic mechanisms of hyperammonemia effect on various organ systems. Particular attention is paid to analyzing the effectiveness of therapeutic strategies aimed at reducing blood ammonia concentrations. The importance of early treatment to minimize the risk of irreversible nervous system damage is emphasized.
Introduction . Triptans are first-line medications for acute migraine attacks. Their pharmacological action is due to the selective activation of serotonin 5-HT1B/1D receptors, leading to vasoconstriction of cerebral vessels and pain relief. However, a similar vasoconstrictor effect also occurs in the coronary arteries, which specifies their contraindications in patients with coronary artery disease and prior myocardial infarction (MI). Despite this, in individuals without cardiovascular disease, triptans are traditionally considered safe drugs with an extremely low risk of cardiovascular events. Brief description . This is a clinical case of non-obstructive coronary myocardial infarction complicated by transient third-degree atrioventricular block in a 44-year-old patient with no history of cardiovascular disease or risk factors. Ischemic myocardial injury was verified by contrast-enhanced cardiac magnetic resonance imaging, while coronary angiography revealed intact coronary arteries. Taking into account the temporal association and ruling out of alternative causes, coronary vasospasm was considered the most likely mechanism of MI. No recurrence of symptoms or conduction disorders was observed after zolmitriptan discontinuation. Discussion . This case demonstrates a rare complication of zolmitriptan therapy in a patient with no cardiovascular risk factors. Despite the favorable safety profile of triptans, their use, especially at higher doses, can lead to coronary vasospasm and life-threatening complications.
Introduction . Vitamin K antagonist therapy monitoring using the international normalized ratio (INR) is the standard for patient management after aortic valve replacement. Lupus anticoagulant (LA) can lead to false changes in the INR value depending on the reagent composition, which creates a risk of iatrogenic complications. Brief description . A 61-year-old patient with a history of aortic valve replacement and two episodes of ischemic stroke demonstrated significant INR discrepancies across laboratories, limiting the ability to reliably assess the adequacy of warfarin anticoagulation therapy and its safety profile. Further testing using thromboplastin of different origins (recombinant and rabbit brain tissue) in the INR assay reagent and a mixed assay revealed differences in the assay system sensitivity to the interfering factor. The combination of persistent discrepancies in the mixed assay and consistently higher INR values with recombinant thromboplastin served as indirect evidence of LA influence. INR values obtained using tissue thromboplastin, as less sensitive to LA, were used for subsequent therapy monitoring. Conclusion . This case demonstrates the importance of understanding the influence of preanalytical and analytical factors, particularly LA, on INR results. When unexplained or conflicting results are obtained in patients at high thrombotic risk, a personalized laboratory approach is necessary, including reagent comparison, a mixing test, and additional testing to detect LA. Identifying the interference cause allows for the selection of an appropriate monitoring strategy and the prevention of adverse consequences for the patient.
Platelet-to-hemoglobin ratio (PHR = platelets ×10 9 /L/hemoglobin g/L) is a laboratory marker proposed in 2019-2020 that combines prothrombotic potential and anemia grade in a single indicator. The aim of this study is to systematize existing data on the pathophysiological basis, calculation methodology, and prognostic value of PHR for adverse cardiovascular outcomes and in-hospital mortality. In addition, we assessed its potential in thrombotic and bleeding risk stratification in patients receiving antithrombotic therapy. This review analyzes the results of clinical trials of PHR in patients undergoing percutaneous coronary intervention, acute coronary syndrome, ST-segment elevation myocardial infarction, pulmonary embolism, ischemic stroke, as well as in vascular surgery and nephrology. The paper shows that elevated PHR is independently associated with an increase in all-cause and cardiovascular mortality and the risk of other adverse outcomes. The limitations of this marker and areas for further research are discussed.
This review compares the following various methods for aortic stiffness assessment: catheter-based, magnetic resonance imaging, applanation tonometry, and carotid and femoral artery Doppler ultrasound. Literature data indicate that ultrasound measurement of carotid-femoral pulse wave velocity is the most accessible method in clinical practice for diagnosing preclinical aortic lesions in hypertension. The methodology of this study is discussed.
Aim . To determine the potential of using acoustic speech signal analysis parameters and speech biomarkers in the diagnosis and monitoring of cardiovascular diseases. Material and methods . A search was conducted in accordance with the requirements and guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in the PubMed, Google Scholar, ClinicalTrials, CyberLeninka, and eLibrary databases. The review included 14 original studies that analyzed the voice parameters of patients with cardiovascular diseases (heart failure (HF), pulmonary hypertension (PH), and coronary artery disease (CAD)). Static acoustic features and dynamic changes during therapy were examined. Parameters were compared between patients and healthy controls, as well as before and after treatment. Results . Studies examining changes in speech signal parameters in patients with HF have shown that speech indices and acoustic features differ during decompensation compared to discharge. Outpatient studies have noted independent associations with speech rate in patients with HF and/or PH. In studies examining the diagnosis of CAD, voice biomarkers are associated with coronary atherosclerosis based on coronary angiography and with incident coronary events during follow-up. Conclusion . The current systematic review demonstrated that acoustic speech analysis and the resulting voice biomarkers represent available tools for remote monitoring of cardiovascular diseases. However, for implementation into routine practice, multicenter studies and standardization of speech signal analysis methods are necessary. Its validation could form the basis for remote screening and diagnosis, as well as dynamic follow-up monitoring of patients with cardiovascular diseases.
Cardiac arrhythmias significantly specify morbidity and mortality, but viral factors are traditionally considered primarily through the lens of acute myocarditis. Meanwhile, persistent herpesvirus infections (Epstein-Barr virus, cytomegalovirus, human herpesvirus 6, and herpes simplex virus) can create an arrhythmogenic substrate without overt inflammatory myocardial injury. The review aim was to summarise epidemiological, clinical and genetic data on virus-associated arrhythmias with a focus on herpesviruses, non-myocarditic pathways of arrhythmogenesis and immune-response variability driven by the human leukocyte antigen (HLA) complex. We summarise studies in adults and children demonstrating associations of chronic and reactivated infections with supraventricular and ventricular arrhythmias, atrial fibrillation (AF), conduction disturbances and vascular complications. We discuss the roles of autonomic dysregulation, inflammation, endothelial dysfunction, microvascular ischaemia and genetic variants (HLA and non-HLA) that modify virus-associated cardiac risk and patient risk stratification.
Introduction . The problem of neurogenic bradycardia among young adults is socially significant, as it is associated with the need for surgical treatment, the only option for which has long been pacemaker implantation. Cardioneuroablation is a new method that has demonstrated its efficacy and safety in the treatment of neurogenic bradycardia. Brief description . This article presents a case of successful treatment of neurogenic binodal disease in a young patient after pacemaker extraction due to an infectious complication. Cardioneuroablation improved sinoatrial and atrioventricular node automaticity and eliminated clinical symptoms associated with bradycardia. Follow-up demonstrated a sustained effect lasting up to 3 months, with improved quality of life and no need for pacemaker reimplantation. Discussion . The potential to eliminate vagotonic effects on the cardiac conduction system through destruction of the parasympathetic atrial ganglionic plexuses underlies the cardioneuroablation method. According to several studies, the achieved improvement in the functional state of the sinoatrial and atrioventricular nodes is sustainable during long-term follow-up. The alternative of eliminating bradycardia without pacemaker implantation allows for the avoidance of unnecessary infectious complications while improving the patient’s quality of life and clinical status. Conclusion . This case clearly demonstrates the importance of diagnosing the autonomic causes of cardiac conduction system dysfunction in young patients and the potential for their elimination using cardioneuroablation, which makes it possible to avoid pacemaker implantation and the risk of related complications.
Aim . To analyze the relevant literature on the significance of prediabetes in the development of cardiovascular diseases (CVD) and related events. Material and methods . This article was prepared using materials from peer-reviewed articles published in PubMed, eLIBRARY.RU, CyberLeninka, and other research platforms from 2016 to 2024. Results . In 2023, prediabetes was not included in the list of conditions discussed in the updated European guidelines on diabetes and CVD. However, prediabetes is a target for the primary prevention of type 2 diabetes (T2D). At this stage of carbohydrate metabolism disorders, a close association with various cardiovascular risk factors is observed, and overall, the risk of CVD increases compared to normoglycemia. Vascular inflammation, endothelial dysfunction, and insulin resistance play a significant role in the development of CVD in prediabetes. Conclusion . Prediabetes is a target for the primary prevention of T2D. However, at the stage of carbohydrate metabolism disorders, a close association with various cardiovascular risk factors is observed, and overall, the risk of CVD increases compared to individuals with normoglycemia. Given the predicted increase in prediabetes risk worldwide, we believe it is necessary to include this condition in adult screening programs and implement comprehensive measures to reduce CVD and other noncommunicable diseases.
Introduction . Coronary artery disease (CAD) remains one of the leading causes of mortality and disability worldwide. Despite advances in cardiology, a significant proportion of patients with progressive coronary atherosclerosis require multiple surgical and endovascular interventions. Long-term mortality after percutaneous coronary intervention (PCI) remains high. Successful management of these patients requires not only the choice of interventional tactics but also effective secondary prevention, the key element of which is achieving target low-density lipoprotein cholesterol (LDL-C) levels. Brief description . A 73-year-old patient with a long-standing history of CAD, hypertension, multiple risk factors, and multiple episodes of stent restenosis and thrombosis after coronary artery bypass grafting and a series of PCIs in 2013-2018. Due to identified resistance to clopidogrel, antiplatelet therapy was escalated with ticagrelor, which enabled control of thrombotic events. Despite therapy with rosuvastatin 20 mg and ezetimibe 10 mg, LDL-C levels remained elevated (3,02 mmol/L), which did not meet the target value of <1,0 mmol/L for extreme-risk patients. In February 2023, treatment with inclisiran was initiated. After two years (six drug administrations), LDL-C was reduced to 0,83 mmol/L, corresponding to a 72,5% reduction from baseline, with no rehospitalizations for ischemic events. Discussion . This case demonstrates not only the importance of identifying clopidogrel resistance in restenosis but also the efficacy of inclisiran as a long-term lipid management option in patients with CAD, dyslipidemia, and intolerance to high doses of statins.
Introduction . This paper presents the results of surgical treatment of a left ventricular pseudoaneurysm in a 75-year-old female patient after bioprosthetic mitral valve replacement. Brief description . This life-threatening condition is extremely rare after heart surgery and is not part of the routine practice of cardiac surgeons. Discussion . Surgical treatment is the only radical option for saving this category of patients, although it is associated with a high risk. The aim was to demonstrate the successful surgical treatment of a left ventricular pseudoaneurysm in an elderly patient.
Expanding the indications for surgery of congenital heart defects (CHD) with pulmonary arterial hypertension (PAH) in the era of specific pulmonary vasodilators has generated considerable interest and controversy. This systematic review (10 studies, 351 patients) analyzed the impact of PAH-specific therapy (treat-and- repair approach) on the indications and outcomes of curative treatment of CHD with pre- and post-tricuspid shunts. An expansion of the indications for curative treatment of CHD was demonstrated after mono- and/or combination therapy with PAH-specific therapy using virtually all drugs registered in the Russian Federation. However, the results in the groups with pre- and post-tricuspid shunts differed significantly. For pre-tricuspid defects, the treat, repair, and treat approach was justified in carefully selected patients with an increase in pulmonary vascular resistance borderline for curative treatment. For post-tricuspid defects, this strategy was justified in young children and only in some older patients with a border-line increase in resistance. Routine use of the treat and repair approach is inappropriate. Treat, repair, and treat situations followed by regret about the treatment performed should be avoided.
Introduction . Timely diagnosis of life-threatening ventricular arrhythmias (VAs) is important for prescribing treatment to prevent sudden cardiac death Brief description . In the presented case, the history and multiple 24-hour electrocardiographic (ECG) monitoring data of a 26-year-old female patient with VAs in the form of frequent premature ventricular contractions and nonsustained episodes of multidirectional accelerated ventricular rhythm, nonsustained episodes of ventricular tachycardia were assessed. Physical examination was not assessed due to retrospective assessment after the patient’s death. The case study was carried out using the patient’s outpatient records from birth to 26 years, extracts from the medical history, and also based on ECG monitoring data. From the age of 14 years until the moment of fatal ventricular fibrillation, repeated studies were carried out — electrocardiography, ECG monitoring, echocardiography, as well as cardiac magnetic resonance imaging. The patient was examined in medical facilities at the regional and federal levels, received the recommended combination therapy with an antiarrhythmic effect achieved, confirmed by regular ECG monitoring. However, despite the therapy, the patient experienced ventricular fibrillation, which was recorded during 24-hour ECG monitoring on the day of death. Assessment of medication adherence is not applicable in this case due to the known outcome. Discussion . Clinical follow-up demonstrates the relevance of the prevention of sudden cardiac death in patients with diagnosed VAs, as well as the need for more frequent 24-hour ECG monitorings for the timely detection of fatal tachycardias (ventricular tachycardia, ventricular fibrillation) and determination of indications for a cardioverter-defibrillator implantation.
Introduction . The differential diagnosis of hypertrophic cardiomyopathy (HCM) requires the ruling out phenocopies. Noonan syndrome with multiple lentigines (NSML) is a rare genetic disorder with an autosomal dominant inheritance pattern, classified as a RASopathies. In 85% of cases, NSML is caused by mutations in the PTPN11 gene, which encodes the key enzyme in the RAS pathway, protein tyrosine phosphatase SHP2. The remaining cases are associated with mutations in the RAF1 and BRAF genes. Like other RASopathies, NSML presents with a phenotypic triad of facial dysmorphism, cardiopathy, and growth retardation. Distinctive features of NSML include cutaneous manifestations in the form of lentigines (90%) and a high (up to 80%) incidence of HCM phenocopy. Brief description . We described a familial case of NSML caused by the Thr468Met mutation in the PTPN11 gene. The proband was a 38-year-old woman with a long-term history of HCM. Facial dysmorphism was mild, and multiple lentigines were not associated with the disease. Left ventricular hypertrophy was concentric, with a maximum myocardial thickness of 34,5 mm. The disease course was complicated by presyncope due to ventricular tachycardia episodes. All of the patient’s children inherited NSML, had a typical facial phenotype, lentigo, and a phenocopy of HCM. In addition to HCM phenocopy, the patient’s eldest son and youngest daughter had pulmonary artery stenosis of varying severity. Discussion . Diagnosis of NSML in the proband was difficult due to a decrease in the severity of external signs with age and poor awareness among cardiologists of the external syndrome manifestations. This case demonstrates the variability of cardiac pathology within families and the importance of family screening and monitoring of family members for the timely diagnosis of cardiac pathology.
A myocardial bridge (MB) is a congenital variant of coronary anatomy in which a patch of muscular tissue overlies a coronary artery segment. In some cases, MB can cause systolic compression of the underlying coronary artery. MB is traditionally considered a benign condition. However, according to the literature, patients with MB and no obstructive coronary artery disease have an increased risk of adverse cardiovascular events. Currently, there are no official clinical guidelines or expert consensus regulating the evaluation and treatment strategy for patients with symptomatic MB. The study aim is to summarize current data on the diagnosis and treatment of patients with symptomatic myocardial bridges (MBs), identify indications for endovascular revascularization, and describe key principles of safe and effective coronary artery stenting within the MB.
This article analyzes a following common terminological error in diagnostic practice: using the morphological definition of transmural myocardial infarction based on echocardiographic data indicating myocardial akinesia areas in cases where the R wave is retained (even after its regression), the pathological Q wave is absent, and ST segment elevation is absent on the initial electrocardiogram. This article examines the reasons why akinesia cannot serve as direct evidence of transmurality and substantiates the need for more accurate verification of myocardial damage depth.
Aim . Based on a single-center clinical experience, to evaluate the procedural features and outcomes of ultrasound-assisted catheter-directed thrombolysis using the EkoSonic system (EKOS, Boston Scientific, USA) in patients with pulmonary embolism (PE), primarily intermediate-high and high-risk. Material and methods . We retrospectively analyzed a total of 19 patients with PE hospitalized at the Davydovsky City Clinical Hospital (Moscow) in 2025-2026. They underwent ultrasound-assisted catheter-directed thrombolysis using the EKOS system. The diagnosis of PE was confirmed using multislice computed tomography pulmonary angiography. There were following inclusion criteria: Pulmonary Embolism Severity Index (PESI) score ≥III and/or a Simplified Pulmonary Embolism Severity Index (sPESI) score ≥1, combined with right ventricular dysfunction and elevated cardiac biomarkers. Treatment efficacy was determined by changes in clinical and echocardiographic parameters. Safety was assessed by the incidence of bleeding events, recurrent PE, and in-hospital mortality. Results . Ultrasound-assisted catheter-directed thrombolysis resulted in a significant reduction in right heart overload in all patients. Right ventricle to left ventricle basal diameter ratio decreased from 1,1±0,2 to 0,9±0,1 (p=0,001), pulmonary artery systolic pressure — from 56,9±9,8 to 42,4±9,1 mm Hg (p<0,001), right ventricle basal diameter — from 46,2±6,6 to 40,8±4,6 mm (p<0,001). Along with the echocardiographic changes, an improvement in the clinical condition of patients was observed with a mMRC dyspnea score decrease from 3,0 [3,0; 3,5] to 1,0 [1,0; 2,0] (p<0,001). The duration of ultrasound-assisted catheter-directed thrombolysis was 8,0 [8,0; 8,0] h with a total alteplase dose of 15,5±3,9 mg. During the hospital stay, no deaths, recurrent PE, or major or clinically significant minor bleeding events were recorded. Conclusion . The experience demonstrates the EKOS system safety in selected patients with PE, primarily at intermediate-high and high risk, and allows us to highlight key aspects of patient selection, procedure implementation, and perioperative management.
Russian Society of Cardiology (RSC) With the participation of: the Association of Cardiovascular Surgeons of Russia (ASSH), the Russian Scientific Medical Society of Internists, the All-Russian Scientific and Practical Society of Epidemiologists, Microbiologists and Parasitologists, the Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy, the Russian Society of Nuclear Medicine, the All-Russian Scientific Society of Specialists in Clinical Electrophysiology, Arrhythmology and Pacing (VNOA) Approved by the Research and Practical Council of the Ministry of Health of the Russian Federation (04.12.2025)
