Background. The increase in the number of cardiac surgeries has also led to a growth in cases of infective endocarditis of prosthetic valves and intracardiac devices. Both endocarditis are associated with difficulties in diagnosis, treatment and poor prognosis, which makes it relevant to analyze the clinical manifestations of these forms of endocarditis, especially in comparison with the results of other studies.Objective. To identify the features of clinical manifestations of infective endocarditis of prosthetic valves and endocarditis of intracardiac devices.Materials and methods. We analyzed clinical manifestations, laboratory, echocardiographic data and their dynamics during therapy in patients with infective endocarditis localized on the prosthesis (37 patients) or electrodes in the heart (15 patients). In the comparison group there were 21 patients with IE of the native valve.Results. Older patients were observed in the infective endocarditis group of valve prostheses and intracardiac devices. In all forms of infective endocarditis, the most common symptoms were fever, weakness and malaise; laboratory indicators included accelerated ESR and leukocytosis, and increased CRP. Manifestations of heart failure were more often observed in the group of prosthetic endocarditis (59.4%), in the group of native valve endocarditis in 40% of cases, in the group of electrode endocarditis less often – in 20% of cases. The most common causative agent of infective endocarditis was Staphylococcus aureus. We analyzed diseases and previous operations of infective endocarditis, as well as the time of onset of symptoms.Conclusion. The type of prosthesis and its location do not exclude the possibility of endocarditis. In patients with electrode endocarditis, the infection was localized in 2/3 of cases only on the electrode, in 1/3 of cases – on the electrode and the tricuspid valve. For instrumental diagnosis of prosthetic and electrode endocarditis, transesophageal echocardiography was more informative. Conservative treatment was successful in 75% of patients with prosthetic infective endocarditis, and with electrode infective endocarditis, surgical intervention was required in 53.3%.

Hypertrophic cardiomyopathy (HCM) is a genetically determined disease associated with the presence of mutations in the genes encoding the synthesis of myocardial contractile proteins. The presence of obstruction in the LVL is a powerful predictor of adverse outcomes and serves as an indication for surgical treatment. One of the frequent “masks” that patients with HCMP come with is “acute coronary syndrome” or “heart defect”. Patient O., 43 years old, maintained a good tolerance to physical exertion for a long time. Has 2 children. Pregnancies proceeded without pathology from the cardiovascular system. Mild arterial hypertension was registered after the second birth. In August 2017, the patient was hospitalized with a diagnosis of ACS, diagnostic coronary angiography was performed: the coronary arteries are not changed. During auscultation, systolic noise was heard over the precardial region. Previously, noises were detected. On an echocardiogram, an obstructive variant of HCMP with a gradient of 150 mmHg was diagnosed. Given the high gradient of LVL obstruction, the patient underwent selective alcohol ablation. After alcohol ablation, there was a high gradient in VTLJ – 96 mmHg. Cardialgia and shortness of breath persisted. No cardiac arrhythmias were recorded. In August 2019, the patient underwent an extended myoectomy with good effect. At control examinations a year after myoectomy: the pressure gradient on the AoC is 13 mmHg, VTLJ is 11 mmHg. This example illustrates the need to include HCMP in the circle of differential diagnosis when examining a young patient with chest pain, especially in combination with heart murmurs. Echocardiography with Doppler examination is a simple and affordable diagnostic method. The alcohol septal ablation performed was ineffective, and the extended myoectomy had a good hemodynamic and clinical effect and may be the method of choice of therapy in these patients. The peculiarity of this case is the manifestation of the disease at the age of 43, during two pregnancies without clinical manifestations of pathology of the cardiovascular system.

The article presents a case of intravital diagnosis of a rare heart disease, isolated primary amyloidosis. The clinical onset of the disease was heart failure (HF) that was resistant to treatment; chemotherapy was ineffective and was poorly tolerated by the patient. The diagnostics was based on a combination of refractory HF and changes in echocardiography data (atrial dilatation, small size of the left ventricular cavity, interventricular septal hypertrophy with the presence of hyperechoic inclusions of the “granular fluorescence” type), and changes detected by contrast-enhanced cardiac magnetic resonance imaging. The diagnosis of amyloidosis was confirmed by results of pathohistological examination of the material obtained during autopsy.

Shortness of breath, a subjective feeling of lack of air, is one of the most common complaints that patients present to a general practitoner or any other primary care doctor. The range of pathological conditions and diseases accompanied by shortness of breath is diverse and often poses a difficult diagnostic task for the doctor. These conditions may include such life-threatening pathologies as myocardial infarction or pulmonary embolism on the one hand, and conditions that are relatively “harmless” from a prognostic point of view, such as hyperventilation syndrome and detraining, on the other. The more experienced a doctor is, the wider this range will be. However, certain stereotypes are usually triggered in the management of such patients in the routine practice and the pathology that the general practitioner faces most often, prevails. Our clinical example clearly shows how the present cardiovascular condition (hypertension) masks other signs, and the shortness of breath is easily explained by a complication of hypertension - heart failure. Nevertheless, this case turned out to be more complicated. This clinical example shows the main problems of differential diagnosis of shortness of breath in the practice of a general practitioner or a family doctor. This case emphasizes that a multidisciplinary approach should be applied to the diagnosis and treatment of patients with dyspnea.

Aim. To reveal the peculiarities of clinical manifestations of infectious endocarditis in injection drug addicts.Material and methods. Clinical, laboratory, echocardiographic manifestations of infectious endocarditis in 40 injecting drug addicts and in 21 patients of control group were analysed. Among injection drug users there were 22 men aged 40,0±2,9 years and 18 women aged 29,5±2,3 years. The history of the disease, clinical manifestations, laboratory markers of inflammation, the results of bacteriological blood tests, and the dynamics of the state during therapy were analyzed. Echocardiography at admission to hospital and at the end of treatment was carried out on a Vivid E-9 apparatus using transthoracic and transesophageal probes. The electrocardiogram was recorded in 12 standard leads. All patients underwent an x-ray examination of thoracic organs or multispiral pulmonary tomography, ultrasound of the liver and spleen. Statistical analysis of the research results was conducted using Statistica 7.0, Microsoft Office Excel.Results. We determined significantly younger age of patients in the group of injection drug users (p<0,05). The most frequently detected manifestation of infective endocarditis in both groups was fever. According to echocardiography data, tricuspid valve isolated localization of endocarditis was found in 90%. Radiographically, 8,2% of drug-dependent patients had signs of pneumonia (often bilateral multisegmental), regarded as a manifestation of the thromboembolic syndrome by vegetation particles. Splenomegaly (75%) was detected in the majority of drug addicts, less often — hepatomegaly (47,5%). Manifestations of chronic heart failure were detected only in 12,5% of patients who use drugs, the kidneys were less involved in the process. An association of infective endocarditis with HIV infection (72,5%) and hepatitis C was detected in 97,5% of patients.Conclusion. Knowing of the infective endocarditis features in drug addicts makes it possible to improve the approaches to the diagnostics in earlier periods of its progression and thus makes the treatment of these patients more promising.

Cardiac amyloidosis - the disease which is characterized by deposition of insoluble protein amyloid in intercellular space is one of the most severe implications of systemic amyloidosis. Primary cardiac amyloidosis possesses a wide range of clinical implications that complicates well-timed diagnostics and, respectively, treatment. The long latent current and the adverse forecast do extremely important diagnostics of cardiac amyloidosis at early stages of a disease. The modern concept of pathogenesis and morphology of an amyloidosis is covered in article, the clinical options of a current, diagnostic methods of dysfunction of heart including bio- and immunochemical blood analysis and urine, a complex of tool methods of a research and «the gold standard» of verification of deposits of amyloid - a biopsy of various organs and tissues are described.

In the article, a case presented of primary amyloidosis of the heart and pericardium, with severe resistant heart failure. That kind of case witnesses that diagnostics and management of patients with this disease, is a complicated issue in cardiology practice. That is related to its rarity, absence of key simptoms in clinical practice and delayed diagnostics with lack of expected efficacy of modern treatment.

Clinical presentation of myxomas is diverse, so it is not easy to diagnose this pathology even with available modern instrumental methods. With its “natural” course this pathology is associated with poor outcome, most patients die in several years from the first clinical signs onset.

Proof of clinical equivalence of generic and original dugs - the way to lessen cost of therapy of patients while providing comparable clinical effects. We present in this paper results of 1 year follow-up of 115 patients receiving Egithromb or Plavics after coronary artery stenting. Comparable clinical efficacy and safety of Egithromb and Plavics has been established.