[Peculiarities of pregnancy management after multiple stenting of coronary arteries].

This paper describes the strategy for pregnancy and labour management in women with the history of myocardial infarction after multiple stenting of coronary arteries using stents with cytostatic coating. The authors discuss a broad range of diseases underlying coronary lesions in young pregnant women receiving antiaggregation therapy. Neither multiple stenting nor intake of aspirin and ticlopid provoked teratogenic effect.

[A newly diagnosed intraventricular septal defect in a pregnant woman presenting with pulmonary hypertension].

This clinical description of pregnancy follow-up and labour management in women with severe pulmonary hypertension caused by an interventricular septum defect is intended to familiarize practicing physicians with the methods for maintaining pregnancy and ensuring spontaneous delivery despite the said pathology. Indispensable conditions for the attainment of these goals include thorough clinical and laboratory control, comprehensive analysis of possible complications, efficacious epidural anesthesia, and correct choice of medicines.

[Pregnancy management and spontaneous labor in heart diseases: present-day solution to the dilemma].

AIM: to study cardiac rhythm variability (CRV), to optimize pregnancy management tactics and to choose a delivery procedure. SUBJECTS AND METHODS: Ninety-six 19-to-37 year-old (mean age 28.3 +/- 9.4 years) women at 35-39 weeks gestational age were examined. All the women were diagnosed as having congenital or acquired (rheumatic) heart disease. Their hemodynamics and CRV were analyzed according to the type of hemodynamic overload, for which purpose three patient groups were formed: 1) volume overload; 2) pressure overload; and 3) combined overload. A control group comprised 40 healthy pregnant women. Before and 2-3 days after delivery, all the women underwent 24-hour Holter cardiac rhythm monitoring with the estimation of the temporary and spectral parameters of CRV. RESULTS: In antepartum heart diseases accompanied by volume overload, there was a tendency for total CRV (SDNN 95.4 +/- 15.8 msec versus 125.5 +/- 17.8 msec in the controls) to decrease and for sympathetic activity to significantly increase (SDANN 65.7 +/- 13.7 and 109.9 +/- 14.7 msec, respectively; p < 0.05). When pressure overload (a moderate gradient) developed, the temporary parameters of total CRV, sympathetic and parasympathetic activities did not differ from those in the control group. Heart diseases attended by pressure overload and a high gradient were characterized by a significant reduction in total CRV (100.5 +/- 24.6 msec; p < 0.05) as compared with those in patients having a moderate pressure gradient, with a declining trend for total spectrum power, Group 3 patients showed a reduction in all the indices reflecting the temporary and spectral characteristics, suggesting a considerable rise in sympathetic activity and a decrease in total autonomic spectrum power. CONCLUSION: Based on SRV studies, indications for prolonged pregnancy and spontaneous or, in some cases, surgical delivery can be assessed in pregnant women with heart diseases.

[Kawasaki disease in an adult European].

A case of Kawasaki disease is reported with manifestations of autoimmune vasculitis and predominant affection of coronary arteries. The relevant literature review describes major symptoms of this pathology and risk factors of its atypical forms. It is emphasized that rare occurrence of Kawasaki disease among non-mongoloid subjects should not make the general practitioner les suspicious of this condition.

[Heart disease and pregnancy: grounds for confidence in the safe outcome].

Indications for prolongation of pregnancy and spontaneous delivery in women with congenital and acquired heart disease are proposed based on original observations and literature data. Special attention is given to risk factors of an undesirable outcome of pregnancy for mothers with high functional class cardiac insufficiency, high blood pressure gradient, and severe pulmonary hypertension with mitral valve and aortic stenosis.

[Optimization of antihypertensive therapy in pregnant women using 24-hour arterial pressure monitoring].

The purpose of the investigation was to study peculiarities in the parameters of 24-hour arterial pressure monitoring (APM) in pregnant women with various extragenital and obstetric pathologies to define indications to administration and optimization of hypotensive therapy. The results of 24-hour APM of 558 pregnant women with a suspected arterial hypertension (AH) of different origins were matched with peculiarities of pregnancy and its outcome (gestosis, an abortion due to AH complications, serious obstetric complications such as intrauterine fetal death or detachment of placenta). The control group consisted of 41 women without cardiovascular diseases or any complications during pregnancy. The analysis of the results made it possible to offer a classification of 24-hour curves of systolic and diastolic arterial pressure and heart rate based on relations between these parameters. This classification is convenient for clinical application and makes it possible not only to define indications to hypotensive therapy, but also to recommend certain pharmacological group of hypotensive preparations in each particular case. Prognostication of the development of severe gestosis or serious obstetric complications.

[Supraventricular paroxysmal tachycardias during pregnancy: the therapeutic tactics and prognosis].

The paper contains recommendations on treatment of supraventricular paroxysmal tachycardias (SVPT) during pregnancy. The recommendations are based on contemporary literature data and authors" own data. SVPT in postural syndrome are shown to be benign and to demand no continuous antiarrhythmic therapy, while tachycardiac attacks are terminated by vagal tests and adenosine application. Relapsing and steady forms of SVPT with a high heart rate are accompanied by subjective symptoms and require preventive antiarrhythmic therapy, which should be conducted considering risk/benefit ratio. According to the authors, sotalol is the most effective and safe pharmaceutical.

[Principles of rehabilitation in major occupational diseases].

The article deals with personal experience and literature data, basing recommendations on rehabilitation of patients with occupational diseases. Rehabilitation measures include better work conditions, job placement of individuals in whom the disease was not caused by etiology factor, rehabilitation through medical and nonmedical measures.

[The ECG-phenomenon of ST segment elevation: the reasons for it and its clinical significance].

The authors adduce a detailed analysis of the reasons for ST segment elevation, which is found in patients with various pathologic conditions and in some normal individuals, basing this analysis on their own experience and literature data. The authors pay special attention to differential ECG-diagnostics of ST elevation, which plays the most significant part in practice.

[Pathogenesis, clinical picture, and diagnosis of myopericarditides]. / Patogenez, osobennosti kliniki i diagnostiki mioperikarditov.

Basing on own data and literature survey the authors analyze clinical course of viral myopericarditides. Special emphasis is made on evolution of electrocardiographical signs in which four stages are distinguished. It is noted that incidence of hemorrhagic myopericarditides probably of viral nature is increasing. The paper contains recommendations on treatment of patients with myopericarditis. The disease has favorable prognosis. However prognosis of diffuse myopericarditis remains unfavorable and its rational treatment - insufficiently established.

[Significance of the system of atrial natriuretic peptides in heart failure and hypertension]. / Znachenie sistemy predserdnykh natriureticheskikh peptidov pri serdechnoi nedostatochnosti i arterial'noi gipertenzii.

This literature review presents current information on mechanisms of realization and action of natriuretic peptides in heart failure and hypertension. Significant role in degradation of natriuretic peptides belongs to neutral endopeptidase. Basing on theoretical and experimental data novel class of drugs - inhibitors of neutral endopeptidase - has been developed. The paper contains discussion of first results of the use of drugs from this class for the treatment of chronic heart failure.

[Atrial natriuretic peptides reception and physiological effects]. / Predserdnye natriiureticheskie peptidy: osobennosti retseptsii i fiziologicheskie éffekty.

The review presents current data on production, release and reception of natriuretic peptides (NUP) with special focus on NUP effects on blood circulation, urination in arterial hypertension and cardiac failure; analyses interaction between NUP and renin-angiotensin-aldosterone system, effects of new drugs influencing these systems.