[Bleeding in the appointment of dabigatran in the patients with renal insufficiency caused by coadministration of spironolactone and ACE inhibitors].

It is a case report of bleeding when using dabigatran in patient with renal failure caused by the concurrent use of spironolactone and angiotensin-converting enzyme (ACE) inhibitors. The patient (75 years old) at the decompensation of chronic heart failure in the background of persistent atrial fibrillation was appointed the combination of ACE inhibitors, spironolactone, and dabigatran. 10 days after the start of using spironolactone and dabigatran bleeding was marked with decrease in hemoglobin levels to 69 g/l, creatinine level increases to 3.6 mg/dL (glomerular filtration rate by MDRD 18 ml/min/1,73 m2), and potassium to 5.5 mEq/ l. Against the background of the abolition of drugs normalization of renal function was marked. The question of an increased risk of nephrotoxicity with concurrent use of ACE inhibitors and spironolactone is discussed.

[Postcardiotomy syndrome outside a cardiosurgical clinic].

Postcardiotomy syndrome (PCTS) is an idiopathic inflammatory disease affecting pericardium and pleura; it complicates the postoperative period in cardiosurgery. High efficiency of corticosteroid therapy suggests autoimmune nature of PCTS. As a rule, this condition develops within two weeks after surgery although cases of its delayed onset (after 1 year) were reported too. PCTS may proceed both as an acute disease and as a mild disorder characterized by general inflammation and obscure serositis making difficult its diagnosis. The existence of such "restricted" forms of PCTS is not universally recognized, however glucoocticoids are widely prescribed to patients with this condition.

[Comparison of the efficacy and safety of electrical cardioversion and pharmacological cardioversion with nibentan in patients with persisting atrial fibrillation and flutter].

The aim of the study was to compare the efficacy and safety of pharmacological cardioversion (PC) by nibentan, a class III antiarrhythmic agent, and electrical cardioversion (EC) in patients with persisting atrial fibrillation (AFib) and atrial flutter (AFI) receiving basic antiarrhythmic therapy. Ninety-seven patients with persisting AFib and AFI were included in the trial (45 patients constituted PC group, and 52 constituted EC group). Both groups were comparable according to basic demographic and clinical parameters as well as antiarrhythmic therapy being applied. The results of the study showed that the efficacy of PC did not differ from that of EC (86.7% and 92.3% respectively, p = 0.282). the frequency of arrhythmogenic effect did not differ between the groups either (p = 0.46). One case of non-stable ventricular tachycardia was registered in the PC group. The most significant adverse effect was bradicardia, which was registered more often in the PC group than in EC group (26.7% and 3.8%, respectively, p = 0.001). In conclusion, the efficacy and safety of PC with nibentan in patients with persisting AFib/AFI is comparable with those of EC.

[The clinical features of the course of coronary artery disease in patients with schizophrenia].

Thirty-nine patients suffering from coronary artery disease (CAD) and schizophrenia (main group) and 32 mentally healthy CAD patients (control group) were included in the study. Cardiological examination including complaint and anamnesis analysis, ECG, EchoCG, stress-EchoCG with dobutamine, 24-hour Holter ECG monitoring was performed; coronaroangiography was carried out in 15 patients. Acute circulatory insufficiency, early post-infarction stenocardia, and chronic left ventricular aneurism were found to be more frequent in patients with schizophrenia vs. controls. Certain differences in CAD risk factors between the groups were revealed. Hyperlipidemia and type 2 diabetes were found in 14 (36%) and 1 (3%) patients in the main group vs. 20 (62%) and 6 (19%) patients in the control group (p = 0.03; p = 0.04), respectively. Glucose intolerance was found in no schizophrenia patients, while it was revealed in 5 (16%) controls (p = 0.02). Patients with schizophrenia sought medical aid later than controls. The number of main group patients who sought medical aid during the first hour, the first 4 hours, the first 4 to 12 hours, or the first 12 to 24 hours was 2 (3%), 3 (5%), 16 (27%), and 38 (64%), respectively; in the control groups these numbers were 12 (30%), 21 (54%), 3 (8%), and 3 (8%), respectively (p < 0.001, p < 0.001, p = 0.02, p < 0.001, respectively).

[Teaching methods of the diagnostics and treatment of pulmonary thromboembolism to cardiologists].

The article covers methods of teaching cardiologists diagnostic algorithms and modern schemes of treatment of pulmonary thromboembolism.

[The place of acetylsalicylic acid in the modern cardiovascular pharmacotherapy].

Acetylsalicylic acid (ASA) is effective antiplatelet agent in many groups of patients with cardiovascular disorders. Efficacy and safety of ASA was confirmed in many trials and meta-analyses. But the optimal dose of ASA in different conditions is still uncertain. ASA is effective in all forms of coronary heart disease. Most prominent effect is observed in patients with acute coronary syndrome without ST elevation and with myocardial infarction. Also, ASA is a necessary component of therapy in patients before and after coronary angioplasty and stenting. ASA plays important role in the management of patients with peripheral arterial disease. Today, ASA is the only antiplatelet drug recommended for the treatment of ischemic stroke. Also, ASA is effective as a method of secondary prophylaxis after ischemic stroke or transitory ischemic attack. As a method of primary prophylaxis, ASA is indicated for patients with annual risk of coronary events 1.5% and more. But, if the annual risk of coronary events is less than 1%, prophylactic treatment with ASA is contraindicated. Thus, ASA must be prescribed to all patients with high risk of cardiovascular complications, if contraindications are absent.

[Effectiveness and safety of clopidogrel bisulfate in complex therapy of patients with acute coronary syndrome with ST segment elevation].

UNLABELLED: Efficacy of clopidogrel in acute myocardial infarction (AMI) was studied only in two trials. However efficacy and safety of loading dose of this drug and its long-term effectiveness were not studied in these trials. AIM: To assess effects of clopidogrel loading dose and long term therapy in addition to standard treatment on death, re-infarction, recurrence of angina and bleedings rate in patients with ST segment elevation acute coronary syndrome. METHODS: Patients (n=107) with AMI who met the criteria for thrombolytic therapy (TLT) were assigned randomly into either clopidogrel group A (n=51) or conventional therapy group B (n=56). Group A received loading dose of clopidogrel (300 mg) in addition to conventional therapy (TLT, aspirin, statin, ACE inhibitor and beta-blocker). Group B received only conventional therapy. The follow-up was 6 months after inclusion during which patients in group A continued to receive clopidogrel (75 mg/day after Day 2 of the study). Primary endpoint included death, re-infarction, recurrence of angina and bleedings. In addition, changes of ST segment after TLT and local contractility were assessed. RESULTS: During 30 days of follow-up rates of primary endpoint were 2.0 and 41.1% in groups A and B, respectively (p=0.003). Subgroup analyses showed that this difference depended on the rate of angina recurrence (2.4 and 36.1% in groups A and B, respectively, p=0.002). These differences were maintained during all follow-up period. Odds ratios for clopidogrel were 0.235 for primary endpoint (95% CI 0.104-0.528, p=0.0003), 0.078 for angina recurrence (95% CI 0.022-0.279, p=0,0001). No significant differences were obtained for mortality, re-infarction and bleeding rate. TLT in group A was more effective. ST depression 90 min after TLT was 86.23+/-4.38 and 61.00+/-6.97% (p=0.010), reperfusion arrhythmia rate - 72.6+/-3.27 and 33.9+/-2.78% (p=0.005) in groups A and B, respectively. CONCLUSION: The use of clopidogrel in addition to standard therapy for AMI is safe and effective. Long-term clopidogrel treatment decreases angina recurrence rate.

[HIV-associated cardiomyopathy].

Dilated cardiomyopathy (DCMP) is a non-coronary heart disease, which leads to the severe degenerative changes and destruction of cardiomyocytes, heart chamber dilatation, systolic and diastolic myocardial dysfunction, steady heart failure progression, disability, and high mortality. HIV is considered to be one of the possible causes of DCMP. Heart involvement in AIDS influences prognosis by lowering survival rate. The number of HIV-infected patients grows in our country; thus, the number of patients with various AIDS manifestations is going to grow, too. In this article the authors adduce the observation of DCMP development in a HIV-infected patient.

[Idiopathyc progressive disorder of atrioventricular conductivity].

Atrioventricular (AV) blockades are classified into congenital and acquired ones. Conductive system fibrosis or sclerosis and coronary heart disease are the most frequent reasons for disturbances in AV conductivity. Congenital AV conductivity disorder may be associated with an isolated lesion of the AV conductive system or with other congenital diseases of the heart. The author describes a case of AV conductivity disorder which has been progressing for many years.