[Exudative pericarditis with tamponade after COVID-19. Case report].

A description of a COVID-19 patient with the development of exudative pericarditis complicated by cardiac tamponade is provid. A peculiarity of this case is the presence of an underlying disease in the patient (chronic lymphocytic leukemia), which was in remission for 1.5 years after chemotherapy. Another feature of the patient was the relatively small area of lung damage and the hemorrhagic nature of the pericardial effusion, which persisted for a long time. The insignificant activity of inflammatory markers was noteworthy. Possible mechanisms of development and features of the course of exudative pericarditis in the described patient, issues of diagnosis and treatment of this category of patients are discusse.

[Left ventricular dysfunction in patients following high-dose chemotherapy and autologous hematopoietic stem cell transplantation].

AIM: To evaluate the dynamics of LV global longitudinal strain (GLS) and other EchoCG parameters after high-dose chemotherapy (HDCT) and autologous hematopoietic stem cell transplantation (aHSCT). MATERIAL AND METHODS: The risk of LV dysfunction in patients after HDCT followed by aHSCT has not been sufficiently studied. This study included 74 patients with hemoblastosis aged 20 to 65 years who had undergone HDCT followed by aHSCT. All patients had a history of antitumor treatment. EchoCG with assessment of LV GLS and measurements of troponin T and N-terminal pro-brain natriuretic peptide (NT-proBNP) were performed for all patients before and after the treatment. RESULTS: A decrease in GLS by 15 % or more from the baseline was detected in 6 (8.1 %) patients. The decrease in GLS was associated with increased NT-proBNP >125 pg / ml at baseline (odds ratio, 8.667; 95 % confidence interval, 1.419-52.942; p=0.022). CONCLUSION: The decrease in LV GLS in patients after aHSCT was associated with increased NT-proBNP before the intervention.

Comparison of Different Intensity Modes of Neuromuscular Electrical Stimulation in the Rehabilitation of Elderly Patients with Decompensated Chronic Heart Failure.

Aim        To compare effects of neuromuscular electrostimulation (NMES) with various intensity of induced muscle contractions on its tolerance and effect on physical work ability in elderly patients admitted for chronic heart failure (CHF).Material and methods        The study included 22 patients older than 60 years admitted for decompensated CHF. NMES was performed from the 2nd or 3d day of stay in the hospital to the discharge from the hospital. Patients choose the stimulation regimen themselves based on the result of the first session: the high intensity to achieve maximum tolerable muscle contractions (group 1) or the lower intensity to achieve visible/ palpable muscle contractions (group 2). Prior to the onset and after the completion of the training, the 6-min walk test (6MWT) was performed and the general condition of the patient was assessed with a visual analogue scale (VAS).Results   More patients, mostly women, chose the less intensive NMES (14 vs. 8). The groups did not differ in age, comorbidity, and functional condition. Both groups achieved considerable increases in the 6MWT distance (7.3 [5.6; 176] and 9.8 [7.0; 9.9] %, respectively, p>0.05) and VAS scores without a significant difference between the groups. Among the patients who were compliant with continuing NMES after the discharge from the hospital, 69% were patients of the group of the less intensive stimulation.Conclusion            The less intensive NMES (with achieving visible muscle contractions) was characterized by better tolerance and better compliance in elderly patients with decompensated CHF compared to the more intensive NMES (with achieving maximum contractions), but the less intensive NMES was not inferior to the more intensive NMES in effectiveness.

[Cardiovascular magnetic resonance in myocardial infarction with non-obstructive coronary arteries].

AIM: To analyze diagnostic performance of cardiovascular magnetic resonance (CMR) in patients, presented with myocardial infarction with nonobstructed coronary arteries (MINOCA). Materials ant methods. 46 consecutives patients presented with myocardial infarction without evidence of obstructive coronary disease on angiography between January, 1 2018 and October 1, 2019 were included in the study. All patients underwent CMR within 10 days after admission. MRI was performed on 1.5 T Magnetic Resonance Imaging (MRI) using comprehensive protocol (T2-images, Cine-CMR, late gadolinium enhancement (LGE)). RESULTS: CMR revealed myocardial infarction (MI) pattern in 14 patients (30.4%), myocarditis in 12 (26.1%), hypertrophic cardiomyopathy in 6 (13.1%). In 14 patients (30.4%) no LGE was observed. Notably in 2 patients without LGE features of takotsubo syndrome were noted. Mean age was significantly lower in patients with MI versus patient with non-ischemic causes of MINOCA (56.112.3 vs 64.612.8; p=0.04). ST elevation at admission frequency didnt differ between MI and non-ischemic patients (35.7% vs 25.0%; p=0.76). However MI patients had significantly increased troponin level, 0.87 [0.22; 1.85] vs 0.22 [0.07; 0.38]; p=0.008. CMR allowed to establish the prcised clinical diagnosis in 73.9% of the cases. CONCLUSION: Clinical data doesnt allow to differentiate ischemic or non-ischemic causes of MINOCA. However, CMR establish the correct diagnosis in most cases.

[Central sleep apnea in patients with chronic heart failure]. / Tsentral'noe apnoé sna u patsientov s khronicheskoi serdechnoi nedostatochnost'iu.

Cheyne-Stokes respiration (CSR) is a form of sleep-disordered breathing seen in approximately half of patients with chronic heart failure and low left ventricular ejection fraction. The authors describe clinical features of CSR, mortality rate, treatment variants. Effects of continuous positive airway pressure (CPAP), bi-level ventilation, adaptive servoventilation (ASV) in patients with CSR and chronic heart failure are discussed. Diuretic acetazolamide is one more therapeutic option for CSR. It improves central sleep apnea and related daytime symptoms in patients with heart failure.

Heart valve injury due to radiation therapy.

RELEVANCE: Radiation therapy (RT) plays an important role in oncology, improving the immediate and long-term results of treatment of a number of tumors. One of the most significant complications of RT are lesions of the heart valves. OBJECTIVE: To study the variants of valve damage that occur in patients who received radiation therapy for cancer. PATIENTS AND METHODS: A group of patients who, during the period from 1978 to 2002, underwent chemo-radiation therapy (CRT) for Hodgkin's lymphoma (LH) of 2-4 stages with damage to the intrathoracic lymph nodes: 71 patients, 60 of whom did not go to the cardiologist and were invited to be examined, 11 were hospitalized due to clinically significant cardiovascular pathology (CHF, myocardial infarction, angina pectoris, valvular defect, AV block). The study methods included: standard clinical and laboratory examination, spirometry, 24­hour ECG monitoring, echocardiography, in some patients single-photon myocardial emission tomoscintigraphy (SPECT), and CT scan of the chest organs. In 60 patients, a stress test on an ECG-controlled treadmill was performed, in 18 patients - a maximum stress test on a treadmill with a gas analysis - ergospirometry. RESULTS AND DISCUSSION: Valve pathology was detected in 49.3 % of cases, most often (in 46.5 %) mitral regurgitation (MR) occurred, primarily due to MR of the 1 st degree, which had no clinical significance. Pathology of the aortic valve (12.7 % of patients) was represented mainly by mild regurgitation (11.3 %). Aortic stenosis was diagnosed in 4.2 % of patients. In the studied cohort of patients, predominantly non-severe valve lesions were detected. In addition, examples of patients with clinically significant valve valvular lesions are presented.

Functional Diagnostic Methods in Cardiac Prognosis in Major Abdominal Surgery in Patients with Heart Disease or Over 65 Years Old.

PURPOSE OF THE STUDY: Evaluation of the value of the results of the use of cardiac functional examination methods for the stratification of the risk of developing cardiovascular complications in planned abdominal surgical interventions in patients over 65 years of age or with cardiac pathology. MATERIALS AND METHODS: The study included 179 patients over 65 years of age or with a history of heart disease who underwent elective abdominal surgery. The median age was 70 years. During the operation and for 30 days after it, cardiac complications were recorded: severe (myocardial infarction, stroke, death from cardiovascular disease), others (strokes of exertional angina, ischemic dynamics of the ST segment on the electrocardiogram - ECG - rest, paroxysmal fibrillation / flutter atrial). All patients underwent basic examination - examination, anamnesis, ECG, blood test, assessment of respiratory function, ECG monitoring. Additionally, echocardiography (EchoCG) and ergospirometry (ESM) were performed. RESULTS: In 30 (16.8 %) patients, various MTRs were detected: 6 (3.4 %) of fatal myocardial infarctions, 2 (1.1 %) of fatal strokes; 3 (1.7 %) cases of sudden cardiac death, angina attacks were recorded in 4 (2.2 %) patients, 7 (3.9 %) had ischemic ECG dynamics, 11 (6.1 %) had fibrillation episodes or atrial flutter. Chronic obstructive pulmonary disease, intervention on the colon, blood hemoglobin level <100 g / l, serum creatinine >103 µmol / l, presence of any pathological changes in the resting ECG were associated with the development of SSO; according to EchoCG - VTI (linear velocity integral) in the outflow tract of the left ventricle (LV) <21.5 cm, volume of the left atrium> 57 ml, global LV myocardial deformity is less than 18 %, increase in heart rate (HR) at the 1st minute load test> 27 %, peak oxygen consumption at ESM <15.8 ml / kg / min. The optimal plan for preoperative examination in men is to perform a basic model, and for women it is advisable to combine a basic examination with an ESM or an assessment of the degree of myocardial deformity using the speckle-tracking method for EchoCG. CONCLUSION: The risk of perioperative MTS during planned abdominal operations in patients older than 65 years or with a history of heart disease is relatively high - 16.8 %. When assessing the risk associated with the operation, it is advisable to additionally conduct echocardiography with VTI assessment in the LV outflow tract and myocardial deformity indicators, as well as ESM with the determination of HR increase in the 1st minute of the test and peak oxygen consumption.

[Impact of radiotherapy and chemotherapy for malignancies of the head and neck on thyroidal function and structure].

Thyroid lesions after radiation and chemotherapy include thyroid tumors and thyroiditis, which occur in violation of its function, as well as secondary hypothyroidism due to damage to the pituitary region. Hereinafter, we will use the term 'chemoradiotherapy', since in the treatment of malignant neoplasms, schemes are most often used that include both radiation exposure and drug treatment, and it is almost impossible to single out the influence of each of these components individually.