Overdose with angiotensin converting enzyme (ACE) inhibitors, especially in combination with other cardiovascular drugs, is limited by a small number of publications. A serious problem is an overdose with combined drugs with a fixed dose and poisoning with several drugs at the same time. ACE inhibitors poisoning has serious complications and can lead to a fatal outcome. Acute ACE inhibitors poisoning comes out in disorders of hemocirculation, where one of the predisposing mechanisms of decompensation of blood circulation is the failure of cardiomyocytes, the pathogenesis of which is not fully studied. Therefore, the currently used the methods of cardio- and hemodynamic disorders correction which are currently used do not always give a positive effect. The review highlights the difficulties of clinical and functional diagnosis and treatment of overdose with ACE inhibitors, combined drugs with a fixed dose, as well as poisoning with several drugs.

The study analysed the level of troponin I (Tn) in the blood in patients with coronary artery disease after coronary artery bypass grafting in comparison with patients after aortic valve replacement surgery. The dynamics of troponin in the early postoperative period was studied, a parallelism was established between the occurrence of complications after surgery and the degree of myocardial damage. A new method has been developed for assessing the degree of intraoperative myocardial damage and the risk of complications using the «index of myocardial damage», the Tn level is determined twice after the operation, in the period up to 6 hours – Tn early and 12–24 hours later – Tn late, the index is calculated as the ratio of Tn late one to Tn early one. A correlation analysis of the «index» with other laboratory parameters was carried out, as a result of which no significant correlations were found, which indicates the absence of duplication and the significance of the developed indicator for assessing myocardial damage after cardiac surgery.

The aim of the study. To analyze the indicators of hemostasis with adherence to treatment in patients operated on for mitral valve prosthetics with mechanical bicuspid prostheses in dynamics after 6, 12 and 60 months.

Materials and methods. The study included 260 patients who underwent surgery for prosthetics with mechanical prostheses. Patients’ adherence to treatment was assessed using the Morisky – Green test. The following hemostasis parameters were analyzed: international normalized ratio (INR), activated partial thromboplastin time (APTT), D-dimer, fibrinogen and soluble fibrin-monomer complexes.

Results of the study and conclusion. At all stages of the postoperative period, the hemostasis indicators of compliant patients corresponded to the reference values for people receiving anticoagulants, in non-compliant patients, these indicators did not reach the recommended values for patients on anticoagulant therapy. The presence of correlations between compliance and hemostasis indicators is evidenced by the results of correlation analysis. In most cases, the maximum strength of the relationship between compliance and hemostasis indicators was observed after 12 months of follow-up. A noticeable strength of interrelations was traced between compliance and levels of APTT, INR and fibrinogen.

The alternative use of local hemostatic agents based on chitosan is the gentlest method of stopping bleeding, with minimal damaging effect on tissues, in comparison with the imposition of a hemostatic tourniquet or a pressure bandage.

Goal. To evaluate the effectiveness of temporary stopping of external bleeding with the help of local hemostatic agents based on chitosan in powder and bandage forms and to determine the expediency of their use by visiting ambulance teams.

Materials and methods. Specialists of the field teams of Ambulance and Medical Emergency Care Station n. a. A. S. Puchkov (Moscow, Russia) used local hemostatic agents based on chitosan in the form of a powder, a bandage in comparison with traditional hemostatic agents (a hemostatic tourniquet to stop arterial bleeding and a pressure bandage). The criteria for hemostasis were the absence of wetting of the pressure bandage and the absence of the need for a hemostatic tourniquet.

Results. 103 patients were included in the main group, and 106 patients with arterial and venous bleeding from wounds of various localization were included in the control group. The age of patients in the compared groups ranged from 18 to 94 years. When using hemostatic powder and bandage, primary hemostasis was achieved in 99 patients in 96.1 % of cases, compared with the control group in 76 patients in 67.9 % of cases.

Conclusions. Simplicity and ease of use, the speed of stopping bleeding and achieving results, as well as the absence of the need for special skills among specialists in the use of hemostatic agents, improved the quality of emergency medical care for patients with bleeding and allowed them to be recommended as a dressing for emergency medical care.

Edematous syndrome is most common among patients of older age groups and indicates pathology on the part of such organ systems as cardiovascular, genitourinary, musculoskeletal, lymphatic, endocrine. The causes of edema are diverse, and the tactics of further management due to incorrect justification can lead to serious consequences.

The purpose of this study. To study the prevalence and differential diagnostic features of edematous syndrome based on the analysis of current scientific publications containing information on this topic.

Results. The development of edematous syndrome is caused by a number of factors, the main of which are: hydrodynamic factor, osmotic factor, oncotic pressure, membranogenic factor. Despite the fact that edematous syndrome is associated with many diseases, it has specific differential diagnostic signs for each pathology.

Conclusions. Edema is a visible objective symptom and is a root cause factor of various diseases, such as glomerulonephritis, thrombophlebitis, filariasis, cirrhosis, chronic heart failure, shock, allergic, inflammatory conditions and many others. However, with the help of specific clinical features of the symptoms of this syndrome, it is possible to make a differential diagnosis and determine the underlying disease that led to the formation of edematous syndrome.

The main purpose of the following article is to highlight one of the most pressing and poorly studied issues both for cardiology and endocrinology – treatment and prognosis for patients with severe coronary pathology and subclinical hypothyroidism (SH). Pathophysiological mechanisms of type 2 myocardial infarction (MI) development with SH as a background and hormone replacement therapy issues are considered. SH is a modifiable risk factor (RF) for cardiovascular diseases (CVD) and mortality that does not depend on traditional cardiovascular RF. SH is associated with high risk of developing coronary artery disease, MI, heart failure, and CVD mortality. SH incidence of morbidity increases with age, usually the course is oligo- or asymptomatic. SH leads to a number of pathological conditions that cause an imbalance between the myocardial oxygen demand and delivery with a possible development of type 2 MI. Clinical case of type 2 MI development in a patient with severe coronary atherosclerosis and SH is presented. The key point of type 2 MI development mechanism is insufficient oxygen (O2) supply to cardiomyocytes due to multivessel coronary artery atherosclerotic stenosis and sharp increase in O2 demand as a result of cardiomyocyte hypertrophy. Older patients with severe cardiac pathology and SH should refrain from treatment with levothyroxine or start treatment after myocardial revascularization, selecting the dose of the drug individually.

Point-of-care lung ultrasound either standalone or in a combination with other ultrasound techniques is a useful diagnostic method for patients with different respiratory disorders. Nowadays lung ultrasound helps to identify emergency conditions, such as acute respiratory distress syndrome, pneumothorax, cardiac arrest, acute respiratory failure, pneumonia. Moreover, a semi-quantitative evaluation of pulmonary congestion can be performed to determine the severity of interstitial syndrome and COVID‑19 associated pneumonia. In this review the basic semiotics of ultrasound are described, as well as the role of point-of-care lung ultrasound in various respiratory disorders.

The article presents the immediate results of treatment of patients with acute myocardial infarction complicated by cardiogenic shock. Outcomes were analyzed, predictors of unfavorable outcomes in the early hospital period were assessed. The discussion presents the modern criteria of cardiogenic shock in patients with myocardial infarction, prognostic scales, emphasis is placed on the controversial and poorly studied provisions of the recommendations and issues requiring further study.

Purpose of the study. Extract original operational data containing information on the effect of non-steroidal anti-inflammatory drugs (NSAIDs) and the inclusion in the outcomes of the new coronavirus infection SARS-CoV‑19, descriptive analyzes and meta-analyzes, as in emergency and planned in gynecology, NSAIDs are used for the purpose of pain relief.

Materials and methods. A systematic literature search was carried out to identify suitable studies in the electronic databases MEDLLINE, the Cochrane Central Register of Controlled Trials, the Chinese Biomedical Literature Database (CBM), domestic publications of the Russian information and analytical portal eLibrary.ru. The time horizon of publications on the problems of pain relief in women during endovideoscopic operations was 20 years. The search for publications in all languages on the use of NSAIDs in the conditions of SARS-CoV‑19 in all patient populations, regardless of gender, age, severity of the condition, was carried out for 2019–2021. The last search query is of 12/20/2021.

Results and conclusions. The solution to a number of problems of anesthesia can be the refusal to use narcotic analgesics for endovideoscopic operations for female infertility. There is no clear clinical indication of the effect of NSAIDs on the risk of infection or an increase in the severity of SARS-CoV‑19 disease.