Arterial hypertension is one of the most significant modifiable risk factors for stroke. The article provides a clinical example of using a fixed combination of amlodipine + ramipril in real clinical practice in a patient suffering from arterial hypertension, occurring with dyslipidemia, hyperuricoemia, microalbuminuria. High antihypertensive activity of a fixed combination of amlodipine + ramipril was shown. A literature review of the beneficial effect of amlodipine and lisinopril on the risk of stroke, as well as the beneficial effect of this combination of drugs on the course of chronic kidney disease developing in patients with arterial hypertension, is presented.

Objective. To identify clinical and functional correlations in patients with myocardial infarction against the background of the chronic obstructive pulmonary disease with various phenotypes.

Materials and methods. 188 patients were examined, from which the following groups were formed: control group – 50 patients, group 1–50 patients with myocardial infarction (MI), group 2–25 patients with MI against the background of the chronic obstructive pulmonary disease (COPD) with emphysematous phenotype, group 3–20 patients with MI + COPD with chronic bronchitis phenotype, group 4–22 patients with MI + COPD with mixed phenotype and group 5–21 patients with MI + COPD with the phenotype with eosinophilia and bronchial asthma. Clinical examination of patients included assessment of complaints, medical history and history of life. Spirography on apparatus SP-100 Schiller (Switzerland) was used for the assessment of respiratory function. Echocardiography was performed on Acuson-Sequoia 512 echo scanner (Siemens). Statistical analyses were performed using Statistica 12.0 (Stat Soft).

Results. The highest frequency of symptoms such as chest pain, nausea/vomiting, fatigue, tachycardia, cough with sputum was observed among patients with MI + COPD with chronic bronchitis phenotype. In this group of patients, the level of systolic blood pressure in the pulmonary artery and the left ventricular ejection fraction were the lowest.

Conclusion. Chronic bronchitis phenotype of COPD in patients with MI is the most prognostically unfavorable. It is associated with the severity of clinical manifestations, with signs of pulmonary hypertension and dysfunction of the left heart, that makes necessary to take into account the phenotypes of COPD in the care of patients with MI against the background of COPD and the allocation of chronic bronchitis phenotype as a criterion for an unfavorable prognosis of MI.

Chronic fatigue syndrome (CFS) is a state of constant, impairing quality of life, fatigue, lasting more than 6 months, inexplicable by any of coexisting patient’s pathological conditions. The prevalence of CFS in the world is approximately 2 % of the population (120–140 mln inhabitants of Earth). The etiology of CFS is unknown. Several theories of development of CFS have been proposed (immune, infectious, endocrine, metabolic, neurological, psychiatric), however, none of them fully explains the clinical manifestations of CFS. There is no specific treatment for this condition. This article presents the clinical case of a patient B 45 years old with CFS, who received treatment with regular physical exercises, diet (limiting consumption of coffee and caffeine-containing products, alcohol, salt intake to less than 5 g per day, an increase in the consumption of plant foods and products containing potassium, calcium, magnesium), as well as intake of Mildronat, a positive dynamics was observed, manifested by an increase in productivity at work, decrease in fatigue, a decrease in the daily variability of blood pressure and a decrease in heart rate at rest.

Hereditary genetic X-linked disease Fabry’s disease belongs to the group of lysosomal accumulation diseases and is caused by mutations in the GLA gene and is characterized by a decrease in functional activity or complete absence of the enzyme α-galactosidase A. This pathology belongs to the group of orphan diseases. Mutation of the GLA gene leads to the formation of defective forms of the enzyme α-galactosidase A, which contributes to the violation of the catabolism of glycosphingolipids, their further accumulation in the lysosomes of various cell cultures, and the development of lysosomal cell dysfunction. The prevalence of Fabry disease is about 1 in 117,000 live-born boys. According to screening studies in newborns, this figure can be about 1 in 3,100 and affects to the same extent representatives of all ethnic groups. Fabri’s disease has become actively studied in Russia, but more than 5,000 people (according to estimates) remain undiagnosed. In the first place among the causes of death in Fabry’s disease is heart disease, in particular left ventricular hypertrophy with the subsequent development of diastolic dysfunction and heart failure. Heart rhythm disorders are often observed. Early diagnosis of Fabri disease will lead to the appointment of genotype-specific enzyme replacement therapy and reduce the risk of cardiovascular complications.

Ischemic cardiopathy is a clinical morphological variant of IHD. It occurs due to chronic ischemia of the myocardial sites. It is characterized by the angiosclerosis of the vessels of the microvasculature, cardiosclerosis, dilatation and eccentric hypertrophy of the left ventricle, progressive heart failure.

Review of current trends in the usage of high sensitive troponins (hsсTn) in cardiology and emergency medicine. The special attention is given to analytical characteristics of different hscTn tests and algorithms of their serial measurements using for diagnostics of different types of myocardial infarctions, non-ischemic myocardial injury, stable and unstable angina, heart failure, cardiomyopathy takotsubo; myocardities, endocardities, and pericardities. Also it is reviewed the usage of hscTn testing for evaluation of cardiac injuries in patients with sepsis, pneumonia, renal pathologies, stroke, in critical and hospitalized patients, in outpatients and in general population.

A patient with acute coronary syndrome requires not only urgent hospitalization, continuous medical observation, but also medical and diagnostic measures that meet standard standards.

Purpose of the study. Аnalysis of the management of patients with acute coronary syndrome with ST segments elevation in the prehospital phase.

Materials and methods. Analysis of emergency medical care patients with acute coronary syndrome with ST-segment elevation in 2017. In the study group, men (126 people) and women (119 people).

Results. The average time of arrival of the team is 14 minutes, the total time of patient care is 28.9 minutes (excluding time for delivery to the hospital). The time from the call to the moment of delivery to the emergency department is 53 minutes. Analysis of drug therapy revealed that the frequency of nitrates was 88.8 %, antiplatelet therapy – 88.2 %, narcotic analgesics – 82.3 %, anticoagulants – 67.3 %, β-blockers – 18.7 %, oxygen therapy – 36.3 %, antiarrhythmic drugs – 6.4 %, fibrinolytic therapy was performed in 54.3 % of patients.

Conclusions. А patient with acute coronary syndrome with ST elevation segments in the prehospital hospital provided sufficient medical care in accordance with clinical guidelines. A low percentage of thrombolytic therapy is associated with the presence of absolute contraindications for the patient.

The widespread prevalence of myocardial infarction and the frequency of complications in the form of atrial fibrillation, makes it relevant to study its pathogenesis and effect on hemodynamics, significantly aggravating the patient’s condition, leading to a deterioration in hemodynamic parameters and the appearance of recurrent myocardial ischemia. At present, a large amount of data has been accumulated on the causes, electrophysiological mechanisms, and hemodynamic consequences of the development of atrial fibrillation during myocardial infarction. This circumstance necessitates both further study of the features of the development and course of atrial fibrillation, and the search for new approaches in organizing and optimizing the treatment of this complication. It is necessary to study in detail the structure of anxiety-depressive disorders, the state of the elastotonic properties of the vascular wall, endothelial function and heart remodeling in patients with myocardial infarction with various forms of atrial fibrillation.

Acute gastrointestinal injury develops in more than half of all patients in the intensive care unit, regardless of the underlying pathology. Determining the stage of acute gastrointestinal injury is necessary to choose the appropriate strategy of intensive therapy, leading to the fast gastrointestinal function recovery. The described strategy of intensive therapy, certain approaches to enteral therapy allow to improve prognosis and to reduce the duration of the disease among patients with severe gastrointestinal injury.

The article presents the clinical results of the first use of the hydrogel Burnshield and the dressings Burnshield made of polyurethane in the treatment of burn wounds of the I–II degrees at the first medical care. The aim of the work was to study the effectiveness of the use of the Burnshield hydrogel and dressings with this hydrogel in burn patients at the first aid stage. We had an analysis analgesic and cooling effect of the Burnshield hydrogel, its effect on the healing rate of burn wounds, the antiseptic effectiveness and its influence on the formation of scar tissue (according to the Vancouver scale). We saw a good result and recommend using hydrogel in first aid due to the pronounced analgesic, cooling effect. Hydrogel spray is convenient to use in a large number of patients, does not require special skills, is used with a friend or for yourself.