The review provides information about apical hypertrophic cardiomyopathy (HCM), which is a relatively rare phonotype of HCM. Previously, it was believed that apical HCMP has a favorable prognosis, but recent studies have demonstrated an increased risk of fatal arrhythmias and sudden cardiac death, especially among elderly patients, women and those with comorbidities such as arterial hypertension and diabetes mellitus. Patients with apical HCMP complain of chest pain, shortness of breath and palpitations. The diagnosis is based on data from various investigation methods, among which imaging techniques such as echocardiography and cardiac magnetic resonance imaging are crucial. For apical HCMP, a characteristic sign is the identification of the configuration of the left ventricular cavity at the end of the systole resembling to the type "Ace-of-spades". Treatment includes pharmacotherapy using beta-blockers, calcium channel blockers, cardiac myosin inhibitors and surgical interventions. The lack of information on unfavorable prognostic factors, the lack of specific clinical data and the complexity of instrumental diagnosis emphasize the relevance of studying the problem of apical HCMP.

Hypertension and type 2 diabetes mellitus are often combined and mutually enhance the adverse effect on vascular and renal prognosis. Hypertension is present in about 50 % of patients with type 2 diabetes, and diabetes, in turn, is detected in about 20 % of people with hypertension. The risk of developing hypertension in patients with type 2 diabetes is 2-2.5 times higher than in people without diabetes; the presence of hypertension increases the risk of type 2 diabetes by the same number of times. Hypertension and diabetes mutually burden each other: on the one hand, the presence of hypertension significantly increases the likelihood of developing diabetic macro- and microvascular complications (including diabetic nephropathy and retinopathy); on the other hand, type 2 diabetes, as a classic independent cardiovascular risk factor, increases the risk of complications inherent in hypertension by about 2 times Careful treatment of diabetes with maintenance of target values of glycemia for a long time may be associated with a decrease in the likelihood of developing hypertension by 24 % compared with less adequate control of glycemia. Hypertension in type 2 diabetes may have a number of features that distinguish such patients from the general population of people with hypertension. Such features include a higher proportion of isolated systolic hypertension and resistant hypertension, certain types of circadian rhythm disorders of blood pressure (categories “non-dipper” and “night-peaker”), frequent combination with albuminuria, frequent high salt sensitivity and volume-dependent nature of hypertension, and others.

Цель. Проанализировать взаимосвязи картины магнитно-резонансной томографии (МРТ) сердца и органов грудной клетки с парамагнитным контрастным усилением и постковидных наджелудочковых нарушений ритма сердца, у пациентов после перенесенной ковид-ассоциированной пневмонии.

Diabetes mellitus (both type 1 and type 2) is considered one of the risk factors for severe COVID-19 and death from this infection. Past infection with COVID-19 leads to deterioration in the control of existing diabetes mellitus, progression of pre-diabetes to diabetes, an increase in the number of new cases of diabetes and an increase in the proportion of glucocorticoid-induced diabetes, which significantly aggravates the course of post-COVID syndrome for this category of patients. Antihyperglycemic drugs may influence the pathogenesis of COVID-19, which may be of relevance for the treatment of patients with type 2 diabetes mellitus and post-COVID syndrome. The review also presents our own data on the effect of various regimens of oral hypoglycemic agents on post-COVID syndrome in people with type 2 diabetes mellitus. The observation showed that the use of dipeptidyl peptidase-4 inhibitors as part of a treatment strategy in patients with type 2 diabetes mellitus with a past COVID-19 infection was associated with a decrease in the duration and severity of post-COVID symptoms.

Normobaric hypoxic therapy is a therapeutic or prophylactic use of gas hypoxic mixture containing 10% oxygen and 90% nitrogen, alternating with breathing atmospheric air at normal barometric pressure. The use of normobaric hypoxic therapy allows activating and using genetically programmed mechanisms aimed at increasing the nonspecific resistance of the body. The history data, pathogenesis of normobaric hypoxic therapy, the procedure and its effect on the cardiovascular system are described.

Background. Chest MRI allows diagnosing in the acute period of covid-associated pneumonia (CAP) and assessing the dynamics of treatment. The potential of MRI in postcovid pulmonary arterial hypertension (PAH) study remains unclear. Objective. To examine the chest MRI picture in CAP patients and to quantify the signs of post-COVID PAH. Design and methods. The study included 34 patients who underwent COVID-19 within 3.5–7 months with involvement of the parenchyma of mild severity upon admission of CT1–CT3 according to spiral X-ray CT. All patients underwent chest MRI in ECG- and respiratory-synchronized T1- (T1-WI), T2 (T2-WI) and diffusion-weighted MRI protocols and ultrasound of the heart and large vessels of the chest cavity, with the calculation of systolic pressure in the right ventricle (SPRV). Results. Three groups were distinguished: CT1 (group 1), CT2 (group 2) and CT3 (group 3). The frequency of subsegmental/segmental signs of LA branches thromboembolism was significantly higher in groups CT2 and CT3. LA diameter, SPRV and T1-WI intensity ratio index {Lung/LA} progressively increased from group 1 to group 3. The dependence of SPRV on the {Lung/LA} was fitted using Boltzmann curve (r = 0.92, p < 0.01). Conclusion. Chest MRI in T1- WI allows assessing the degree of post-covid changes in the lung parenchyma thickness and predicting early forms of increased pulmonary arterial pressure and the formation of PAH.

The purpose — to improve the effectiveness of treatment of diabetic foot patients with cardiovascular disorders. Material and methods. 782 patients with diabetic foot (DF) were under observation. 4 groups were identified: group 1 — VAC therapy was used; group 2 — ultrasonic cavitation; group 3 — modern dressings were used for treatment; group 4 — with a standard treatment. Low doses of statins were used (atorvastatin 10–20 mg/day or rosuvastatin 5–10 mg/day) in 213 patients (27.2%) and 89 patients (11.4%) received moderate or high doses of statins (atorvastatin 40–80 mg/day or rosuvastatin 20 mg/day) in combination with ursodeoxycholic acid (UDCA) preparations (750–1750 mg/day). Results. In the low-dose statin subgroup, the rate of low-density lipoprotein cholesterol levels reduction averaged 17.6 (5.6) % of the initial values; triglycerides, respectively, 12.3 (3.5) % of the initial values; that was statistically significantly lower than in the moderate/high dose statin plus UDCA subgroup of 32.9 (5.4) % and 18.7 (3.2) %, respectively, all p<0.001. In group 1, the average duration of hospital stay and the percentage of postoperative complications were statistically significantly lower in patients who received lipid-lowering therapy (28.5 (3.6) days and 8.8 (2.9) %), compared with those who did not receive this treatment (34.0 (2.8) days and 13.1 (2.6) %); p < 0.001. Similar differences in the length of hospital stay and the percentage of postoperative complications, depending on the lipid-lowering therapy, also occurred in groups 2, 3, and 4 (p < 0.001). Conclusions. The use of lipid-lowering therapy, including moderate / high doses of statins in combination with UDCA, contributed to a decrease in the length of hospital stay and a decrease in the incidence of postoperative complications in all groups of patients with DF.

The presented contains the discussion about the role of echocardiography in management of patients with hypertrophic cardiomyopathy (HCM). The article provides general information about the role of echocardiography in the diagnosis of the disease, clarification of the specific etiology of hypertrophy and differential diagnosis with secondary hypertrophy and phenocopies of HCMP. The features of right and left ventricular (LV) hypertrophy, determination of its predominant localization, phenotype, and conventionally used parameters for assessing myocardial hypertrophy, including the maximum LV wall thickness, LV myocardial mass and LV myocardial mass index, are discussed in detail. Knowledge of phenotypic variants helps to diagnose HCMP, to differentiated approach the management of patients and to choose the optimal treatment strategy. Special attention is paid to the assessment of the structure and function of the mitral valve (MV), the subvalvular apparatus and the phenomenon of systolic anterior motion of the MV responsible for the development of obstruction of the LV outflow tract. The previously existing opinion that cardiac abnormality in HCMP is limited only by hypertrophy of ventricular myocardium has recently undergone changes. Approximately 60% of patients with HCMP have at least one MV anomaly as a direct consequence of genetic mutations. The most common abnormalities that can be detected with echocardiography include elongation of the valvular leaflets and chords, prolapse of the valvular leaflets, hypertrophy, disposition and change in the number of papillary muscles. The importance and significance of assessing LV systolic and diastolic functions using echocardiography is emphasized. The role of transesophageal echocardiography in visualization of hypertrophy features of the MV structure and in the perioperative period during surgical correction of hypertrophied septum and valvular defects is also discussed.

Despite the achievements of modern cardiology, the cardiovascular morbidity and mortality in most countries of the world remains high, which motivates the wider use of additional (alternative) preventive and therapeutic approaches, one of which is hypoxytherapy. Over several decades of using this method, a large amount of data has been accumulated that allows us to state the beneficial effect of various hypoxytherapy regimens on the clinical course of cardiovascular diseases and can potentially improve prognosis of them. The use of hypoxytherapy is associated with an improvement in blood pressure circadian rhythm, flow-dependent vasodilation, an insulin resistance decrease, a vascular wall stiffness redaction, an improvement in blood rheology, endothelial function and nitric oxide system, a decrease of proinflammatory and prothrombotic cytokines levels. A number of modern experts consider hypoxytherapy as an affordable and perspective method of prevention and treatment of cardiovascular disease, effectively supporting traditional non-drug and drug-based approaches. Contemporary data indicate serious future perspectives for an expanded study of the hypoxytherapy possibilities in cardiac patients, including through the State research programmes. This review is devoted to the discussion of the physiological effects of hypoxytherapy, the possibilities of its application in cardiological practice, including with the analysis of own data, as well as precautions during its implementation.

This literature review is devoted to the issues of non-drug and drug treatment of arterial hypertension in people with type 2 diabetes mellitus. Type 2 diabetes mellitus is the cause of severe disabling complications and a significant factor in increasing mortality. Arterial hypertension and diabetes mellitus are often combined and mutually burden each other’s course. Arterial hypertension increases the risk of formation and the rate of progression of micro- and macrovascular complications of diabetes. The presence of diabetes mellitus increases the risk of complications of hypertension by about 2 times. Achievement and stable maintenance of target blood pressure levels in people with diabetes and hypertension is one of the most important components of improving the prognosis. To do this, it is important to follow the recommendations for lifestyle changes, as well as the use of antihypertensive drugs. The article presents general issues of epidemiology and principles of determining the target level of blood pressure in different groups of patients. The issues of lifestyle changes and the choice of tactics for prescribing medications are discussed in detail, a brief description of the main groups of antihypertensive drugs is given.

Background. The state of the aorta is a key factor in the prognosis of the patient’s life, since the distension of the ascending aorta in systole determines the blood supply to the myocardium in diastole. Paramagnetic contrast-enhanced MRI provides a reliable assessment of pathological neoangiogenesis, however, in fact, studies of the aorta are performed descriptively, without calculating mechanical strength and extensibility. Objective. To develop and clinically test on the patients with atherosclerotic lesions and myocarditis a method for quantitative assessment of extensibility and mechanical elasticity of the aortic wall.Design and methods. Were examined 12 patients with acute myocardial infarction with ST segment elevation, as a control group 11 patients without clinical and instrumental signs of atherosclerosis of large arteries and aorta. All underwent MRI of the chest and heart with paramagnetic contrast enhancement (PMCE) and ECG synchronization. The indices of aortic distensibility, distensibility normalized to pulse BP, Young’s modulus of the aortic wall, systolic distension of the ascending aorta (mL), index of strengthening of the aortic wall in PMCE were calculated.Results. Ascending aortic distensibility decreased in patients with myocarditis and acute infarction. Young’s modulus and distensibility of the ascending aorta significantly correlated with the value of the aortic wall enhancement index in PMCE. Myocardial damage in acute infarction and myocarditis was noted with a decrease in systolic expansion of the ascending aorta below 10 ml due to its reduced elasticity.Conclusion. There is a relationship between pathological accumulation of a paramagnet in the wall of the ascending aorta, a decrease in its elasticity, a decrease in the volume of systolic aortic dilation, and the development of hypoperfusion myocardial damage. Magnetic resonance elastometry of the aortic wall makes it possible to assess violations of aortic distensibility and predict the development of ischemic damage in the myocardium of the left ventricle.

The purpose — to compare the efficacy and safety of the use of two regimens for the use of renin-angiotensin system blockers — valsartan / sacubitril (V/C) and losartan in patients with diabetes mellitus (DM) type 2 in combination with chronic heart failure (HF) and low ejection fraction (EF) of the left ventricle (LV). Material and methods. We observed 46 patients with type 2 diabetes. All these patients had previously suffered from myocardial infarction and had clinical manifestations of chronic HF class II-III with LV EF < 40%. All patients were recommended lifestyle changes, they received adequate hypoglycemic and organ-protective therapy. Two groups were distinguished: group A (16 patients, taking V/C at an initial dose of 100 mg/day, followed by titration to 400 mg/day) and group B (30 patients, taking losartan at an initial dose of 50 mg/day, with titration up to 150 mg/day). In the course of treatment and after 11 months, clinical and laboratory studies were performed, in dynamics, echocardiography with tissue Doppler, ultrasound of the brachiocephalic arteries, and a test with reactive hyperemia were performed. Results. During treatment in group A, compared with group B, a more significant positive dynamics of clinical manifestations and the following studied parameters were noted: HOMA-IR and ΔHOMA-B indices, glycated hemoglobin levels, chronic HF class, LV EF, left atrial volume index, ratio of early diastolic velocity of transmitral blood flow to early diastolic velocity of the mitral valve ring, carotid intima-media complex thickness, and indexbrachial arteries resistivity; all changes are significant. Conclusions. Combined neurohumoral blockade using V/S compared with losartan in patients with DM type 2 and chronic HF with low LV EF helped to have more positive changes in clinical-laboratory and instrumental indicators.

Cirrhosis is one of the major health problems worldwide; and ascites is often its first and foremost manifestation. Despite the advances in modern hepatology, the presence of ascites is associated with a poor prognosis and high mortality. The aim of the study was to analyse data on the efficacy and safety of ascites treatment options, taking into account the pathophysiology of the condition. The analysis of literature and international guidelines on ascites management showed that cirrhotic ascites is treated with medication or surgery that interfere with pathogenetic mechanisms underlying the condition. Treatment of uncomplicated ascites depends on the severity of clinical manifestations. Patients with grade 1 ascites do not require treatment. Therapy for grade 2–3 ascites is aimed at reducing sodium intake and promoting its excretion with diuretics. The effect of diuretics should be assessed by daily monitoring of body weight. Close monitoring of serum creatinine and electrolyte levels is necessary to avoid severe electrolyte imbalance and mitigate the risk of diuretic-associated acute kidney injury. Another medical option to increase diuresis is the use of vasoconstrictors. Large volume paracentesis is the treatment of choice for patients with grade 3 ascites and refractory ascites. The most dangerous complication of paracentesis is circulatory dysfunction, which is prevented by limiting the volume of fluid removed to 5–6 liters per procedure and using plasma substitutes. If paracentesis is ineffective, new minimally invasive methods of treatment should be considered: transjugular intrahepatic portosystemic shunting and automated low-flow ascitic fluid removal system. However, given the poor prognosis, all patients with refractory ascites should be considered candidates for liver transplantation, which is currently the only effective treatment. The efficacy and safety of therapy may be enhanced by a personalised approach to choosing the treatment for ascites in cirrhosis, as well as further investigation of means to mitigate adverse reactions to medication and minimally invasive surgery.

The presented article contains the clinical observation of bradycardia development in 64-year-old patient with chronic kidney disease who was in ambulatory treatment at the hemodialysis department. During electrocardiogram recording an arrhythmia was detected as a junctional rhythm. The specific changes on electrocardiogram, presence of risk factors, and data of additional collection of history disease allowed purposing the development of dangerous condition — hyperkalemia. The diagnosis was confirmed after detection of the serum potassium level. This case illustrates the necessity to consider the possibility of hyperkalemia in patients with chronic kidney diseases including those who undergoing hemodialysis treatment. Relevant clinical manifestations and changes on the electrocardiogram require the urgent assessment of the serum potassium level for timely and adequate correction of the electrolyte disorder.

Одной из важнейших задач вузовского образования является формирование у студентов как субъектов будущей профессиональной деятельности способности и готовности к саморазвитию на протяжении всего жизненного пути. Эффективность адаптации студентов первого курса к образовательному процессу – важнейшая предпосылка успешной профессиональной подготовки. Основным требованием к психической организации первокурсника в период его адаптации к требованиям вузовских реалий является необходимость обладать способностью существовать в изменившейся среде, способность к самосовершенствованию и саморазвитию, готовность не столько формально подстраиваться под изменившиеся условия обучения, сколько выступать субъектом этих изменений. В качестве их базисного механизма выступает флексибильность как системное, интегральное качество личности, которое обеспечивает ей необходимую базу для оценивания себя и ситуации и полноценной переработки системы отношений на основе вновь образовавшейся реальности.

The presented review concerns aortic regurgitation which occupies a significant place in the structure of valvular heart disease. The detailed anatomic and physiologic description of the aortic valve is provided. The characteristics of sinotubular, ventricular-aortic junctions, and virtual aortic annulus are presented. There are data about prevalence of aortic regurgitation on the basis of results of population studies, indicating the increase in incidence of aortic regurgitation among individuals older 70–74 years. The detailed etiologic structure of this valvular pathology is described with specifying of the most common causes of both aortic disease and aortic cusps alterations. In particular, there are some aortic diseases, resulting in acute aortic regurgitation, including acute aortic dissection and paravalvular regurgitation in incompetence of the prosthetic aortic valve; in chronic one – idiopathic dilation of the aortic root, inherited connective tissue dysplasias (Ehlers–Danlos, Marfan, and Loeys–Dietz syndromes), bicuspid aortic valve, aortitis of various origin, seronegative arthropathies (reactive, psoriatic arthritis, ankylosing spondylitis) etc. Infective endocarditis and traumatic exposure are commonly responsible for development of acute regurgitation due to aortic cusps abnormalities. Chronic aortic regurgitation as a consequence valve defects occurs in rheumatic heart disease, degenerative changes, congenital anomalies, systemic connective tissue diseases (systemic lupus erythematosus, rheumatoid arthritis), non-specific aortoarteritis, etc. The special attention is paid to pathophysiologic features of acute and chronic aortic regurgitation in the review. Acute aortic regurgitation is characterized by sudden increase in end-diastolic volume and due to the noncompliant left ventricle of normal size, it undergoes abrupt exposure a significant pre-load and after-load which results in decrease of left ventricle systolic function and stroke volume despite on relative preservation of contractile function of myocardium. In contrast to acute aortic regurgitation it is remarkable in its chronic form slow, progressive influence by increased overload of the left ventricle with possibility to adapt driven by its gradual dilation and hypertrophy.