THERAPEUTIC APPROACHES TO THE CORRECTION OF COGNITIVE IMPAIRMENT IN PATIENTS WITH HYPERTENSION AND TYPE 2 DIABETES.

OBJECTIVE: The aim: Was to improve the effectiveness of the treatment of cognitive impairment in patients with hypertension and type 2 diabetes. PATIENTS AND METHODS: Materials and methods: 56 patients (11 women and 45 men, average age 61.7 ± 4.3 years) with hypertension II, 2 degree and type 2 diabetes (average severity, subcompensation stage) were examined. 40 patients had moderate CI and 16 had mild CI. After the examination, the patients were divided into two groups and treated accordingly. The control group consisted of 20 healthy individuals. RESULTS: Results: Vascular brain lesions that cause hypertension and diabetes very often lead to impaired cognitive function whose therapeutic correction has received little attention, especially in the pre-operative stages. 56 patients have been examined to study the efficacy and safety a combination of Phenibut and Ipidacrine as an additional therapy to standard basic treatment (antihypertensive and hypoglycemic) for the correction of cognitive dysfunction in patients with comorbidity of hypertension and type 2 diabetes mellitus. CONCLUSION: Conclusions: One month after the beginning of the treatment, an improvement in psycho-emotional state and psychometric parameters was identified, which was manifested by an increase in concentration of attention, memory, psychomotor functions, speech activity together with normalization of blood pressure and metabolic parameters.

Variant of myocardial infarction course in the patient with left ventricular non-compaction.

Non-compacted left ventricle in adults is a rare occurrence, though it is diagnosed even more rarely. As a rule in patients with non-compacted left ventricle (LVNC) other pathologic condition is diagnosed, notably hypertrophic or dilated cardiomyopathy. The majority of LVNC cases are diagnosed in early infancy but currently there are asymptomatic cases detected by means of echocardiographic examination. Real prevalence of LVNC is unknown. According to many authors LVNC occurs in 9.2-9.5% of children with diagnosed cardiomyopathies. The majority of such children do not survive till adulthood because of progressive severe heart failure, fatal arrhythmias and thromboembolisms. This value ranges from 0.014 to 0.05% in adult population. The article presents a clinical case illustrating the stages in establishing the diagnosis of non-compacted left ventricle in a young patient with myocardial infarction and congestive heart failure. Common characteristics of non-compacted left ventricle and connective tissue dysplasia syndrome in the patient suggested etiopathogenetic relationship between these two pathologic states. The basic common characteristic feature of both non-compacted left ventricle and connective tissue dysplasia syndrome proved to be multiple abnormal chords of the left ventricle. The patient was supposed to have some coronary circulation abnormality inherited together with non-compacted left ventricle and connective tissue dysplasia syndrome. Adverse prognosis and high mortality in non-compacted left ventricle require its early recognition and differentiated approach to treatment depending on the severity of the disease and using all modern methods of treatment both conservative and surgical.

Loeffler endocarditis in young woman - a case report.

Loeffler endocarditis is a rare acquired endocardial and myocardial disease characterized by a sharp decrease in the compliance of either or both ventricles with an acute diastolic dysfunction and massive mural thrombosis. This disease is presented in the classification of cardiomyopathies and is a variant of restrictive cardiomyopathy. Today Loeffler endocarditis is considered as a manifestation of hypereosinophilic syndrome with predominant heart involvement. The life-time diagnosis of myocardial injury due to eosinophilic infiltration is rare, or it is diagnosed at the stage of necrotizing endomyocarditis, when the treatment is no longer effective. A number of issues regarding the individual aspects of the pathogenesis of hypereosinophilic syndrome and Loeffler endocarditis are still not fully understood, as well as the long-term prospects for the use of drugs for the treatment of hypereosinophilic syndrome, especially in young and middle-aged persons. Loeffler endocarditis can be suspected in the presence of hypereosinophilia on the background of causeless (unexplainable) hypertrophy of the left ventricle or both ventricles. The article includes a case of the life-time diagnosis of this disease in a young woman with the retrospective analysis of the early stages of the disease, echocardiographic and radiologic imaging at the advanced stage of the disease and quite successful treatment option for this disease.

Clinical examples of left ventricular non-compaction in adults.

INTRODUCTION: isolated left ventricular non-compaction (LVNC) is a heart disease with rather distinct morphologic and clinical manifestations. Available in the literature information about LVNC considering multiple left ventricle abnormal chords (LVAC) as one of its criterion motivated us to review the results obtained in the study of young patients with this pathology. The aim of the research was to demonstrate different clinical variants of left ventricular non-compaction course in adult patients and to clarify some pathogenetic aspects of this pathology. Materials and metods: comprehensive examination of 28 patients with multiple LVAC, 12 patients with LVNC and dilated idiopathic cardiomyopathy aged 16-36 was performed. RESULTS: according to the results of our research, 16 of 28 patients with multiple LVAC of left ventricle had ejection fraction more than 55%, in 6 patients this index range was 50-54%, in 6 it was 45-49%. Multiple LVAC were found to be associated with significantly greater clinical, phenotypic, structural and hemodynamic changes when compared both to control and solitary LVAC of any location (р<0.05). There were 12 young patients with multiple LVAC and ejection faction 22-41%. The detailed analysis of echocardiographic data in dynamics revealed other criteria of LVNC in all the patients. The data obtained suggest the relationship between pathogenetic mechanisms of heart pathology development in patients with connective tissue dysplasia syndrome and in patients with LVNС. Echocardiographic evidences of multiple LVAC designate the necessity of targeted search of left ventricular non-compacted signs and timely detection of left ventricular dilation.

Clinical examples of left ventricular non-compaction in adults.

INTRODUCTION: isolated left ventricular non-compaction (LVNC) is a heart disease with rather distinct morphologic and clinical manifestations. Available in the literature information about LVNC considering multiple left ventricle abnormal chords (LVAC) as one of its criterion motivated us to review the results obtained in the study of young patients with this pathology. The aim of the research was to demonstrate different clinical variants of left ventricular non-compaction course in adult patients and to clarify some pathogenetic aspects of this pathology. Materials and metods: comprehensive examination of 28 patients with multiple LVAC, 12 patients with LVNC and dilated idiopathic cardiomyopathy aged 16-36 was performed. RESULTS: according to the results of our research, 16 of 28 patients with multiple LVAC of left ventricle had ejection fraction more than 55%, in 6 patients this index range was 50-54%, in 6 it was 45-49%. Multiple LVAC were found to be associated with significantly greater clinical, phenotypic, structural and hemodynamic changes when compared both to control and solitary LVAC of any location (р<0.05). There were 12 young patients with multiple LVAC and ejection faction 22-41%. The detailed analysis of echocardiographic data in dynamics revealed other criteria of LVNC in all the patients. The data obtained suggest the relationship between pathogenetic mechanisms of heart pathology development in patients with connective tissue dysplasia syndrome and in patients with LVNС. Echocardiographic evidences of multiple LVAC designate the necessity of targeted search of left ventricular non-compacted signs and timely detection of left ventricular dilation.

Efficiency of ranolazine in the patient with microvascular angina, atrial fibrillation and migraine.

Microvascular angina (MVA) is rather a common form of stable ischemic coronary disease (CAD) as that such diagnosis is made in 20-30% of patients who previously underwent coronary angiography. The disease occurs three times more frequently in women than in men irrespective of age. Most of these patients are 45-60 years old. According to available data, the long-term outcome in patients with MVA is comparable with that in general population. MVA characterizes great variability of its course and low response to conventional antianginal therapy. However, patients with MVA experience chest pain, which in most cases tend to strengthen and increase the number of pain episodes, significantly deteriorating the quality of life of these patients. In view of this, the problem of antianginal drugs which can be used in addition to standard therapy remains to be solved. The major role in MVA development plays the decreased coronary flow reserve resulting from evident endothelial dysfunction of small coronary arteries. Ranolazine is a new original antianginal drug which improves left ventricular diastolic filling by selective inhibition of late sodium current leading to more effective coronary vessel filling in diastole. The article presents the case of the successful administration of ranolazine in a woman with MVA and persistent atrial fibrillation.