Relevance. Rational provision of medical specialists is an urgent problem for maintaining the health of the population. The purpose of the study was Analysis of the availability of outpatient departments of medical organizations by physicians of functional diagnostics. Material and methods. Data of the forms of federal statistical observation No. 30 (Information on the medical organization» for the period from 2012 to 2016. Analyzed using descriptive and analytical methods of statistics. Results of the study. In general, the Russian Federation and its okrugs have a favorable situation with the provision of functional diagnostics by physicians providing medical services in outpatient settings. An analysis of the staffing of the functional diagnostics of medical organizations providing services in outpatient settings, based on the number of individuals in their positions, showed a low staffing level, although there was a positive trend in the dynamics. Conclusions. Over the past five years, doctors’ availability of functional diagnostics in the country as a whole has grown by 11.2, the number of individuals in the occupied positions - by 8.5 %.

Atrial fibrillation (AF) is the most common arrhythmia causing thromboembolic complications. The prevalence of AF is growing with age and approximates 2 % in general population. Systematic ECG-monitoring reveals AF in one of twelve patients with stroke. The purpose of current research was to identify the prevalence of AF and risk factors for brain complications in rural population by means of ECG-12-telemetry (T-ECG) at prophylactic medical examination. For stroke risk assessment CHA2DS2-VASc scale was used. With implication of T-ECG AF was diagnosed in 1.7 % of the examined population, in 5 % of these primarily. Risk factor analysis CHA2DS2-VASc displayed high risk of stroke in 38 patients (79.1 %), which was indication for anticoagulation therapy. 15 % of the patients met the criteria of intermediate risk. Medication treatment analysis showed deviation from treatment standards. New oral anticoagulants were not prescribed. Timely T-ECG-based diagnostic of heart rate disturabances improves AF and thromboembolic risk factors detection.

Electrocardiography (ECG) is the most commonly used method of instrumental screening, which can detect phenomena in athletes that are not typical of individuals in the general population. Such electrophysiological phenomena as sinus bradycardia, sinus arrhythmia, functional atrioventricular (AV) block, etc., can lead to errors in the diagnosis and tactics in the athlete. The most well-known algorithm for the interpretation of Domenico Corrado and Antonio Pelliccia (2010) is now extended and supplemented by the criteria of Shrarma S. and Drezner J. A., (2017). Along with the changes previously adopted, arising under the influence of increased vagal and morphological remodeling, paid attention to racial and age influences.

Objective. To identify optimal protocol of exercise treadmill testing for exercise capacity assessment in patients aged 70 years and older. Materials and methods. The study comprised 40 patients of both genders, aged 70 years and older, who did not have a baseline history of established CAD or heart failure. All patients underwent treadmill stress testing on 2 consecutive days. Stress testing was carried out using a modified Bruce protocol and individualized ramp protocols. The Borg 10-point category ratio scale was used to assess perceived exertion. Results. Significant differences between the protocols were the longer exercise duration (10,4±1,5 vs. 2,4±1,4 min in men, P<0,001; and 10±1,9 vs. 2,2±1,7 min in women, P<0,001) and the greater achieved workload (6,2±2,3 vs. 3,7±1,5 MET in men, P<0,001; and 5,8±1,1 vs. 3,3±1,2 MET in women, P<0,001) resulting from the individualized ramp protocols. The mean maximum heart rates, systolic blood pressures and diastolic blood pressures did not differ significantly. The rating of perceived exertion from the revised Borg scale (0 to 10) in men and women was 5±2 for the ramp protocol and 8±1 for the modified Bruce protocol (P <0.01), indicating that the subjects found the ramp protocol easier. Conclusion. In patients aged 70 years and older individualized ramp treadmill protocol more often allows to achieve of optimal test duration with higher degrees of workload and greater patient comfort during the test than the modified Bruce protocol.

Anatomy of the mitral valve in HCM has specific features such are systolic anterior motion(SAM)of anterior mitral valve leaflet, leading to LVOT obstruction and the MV insufficiency of varying severity. The article presents brief characteristics of 2D Echocardiography of MV, which is currently not fully satisfy the diagnostic need of cardiac surgery. Using three-dimensional reconstruction of MV helps to examine thoroughly all of its structural and anatomical characteristics, whereby it is established that three-dimensional anatomy of the leaflets of MV differs from the traditional views obtained by two-dimensional echocardiography. A new interpretation of the anatomy of the leaflets, fibrous ring, and the mechanism of SAM of anterior mitral valve leaflet opens up new opportunities for revision of the traditional concept of surgery for HCM with the aim of developing new, original corrective techniques.

Current review contains data concerning the role of exercise or dobutamine stress echocardiography (stress-echo) in mitral valve diseases. Challenges of clinical impairment and necessity of surgical treatment in mitral stenosis are discussed. The clinical indications for stress testing are proposed. Clinical and hemodynamic parameters for stress-echo assessment are presented. The principles of test result interpretation, risk stratification and selection of patients for surgical treatment, based on stress-echo data, are summarized.

Sarcoidosis is a systemic disorder of unknown etiology almost universally affecting pulmonary tissue and intrathoracic lymph nodes. A. A. Wiesel (2009) and M. E. Thomeer (2005) mentioned significant differences of worldwide incidence of sarcoidosis (0.125-24.0 new cases per 100000 people per year), so annual prevalence of the disease varies from 1 to 64 cases per 100000 people per year. Such as modern diagnostic technologies became available, there are no difficulties in diagnosis of sarcoidosis of lungs and intrathoracic lymph nodes. Nevertheless cardiac involvement may be primary (due to myocardium and other heart structures infiltration by sarcoid granulomas), and secondary (due to pulmonary artery compression by intrathoracic lymph nodes and pulmonary vascular fibrosis). Most studies of heart in patients with pulmonary sarcoidosis used only rest echocardiography (Echo). Today, the in-depth cardiac examination both at rest and during exercise became available, especially to detect subclinical changes at early stages to prevent complications of the baseline disease and for prognostic objectives. Our purpose was right and left chamber quantification and pulmonary artery pressure assessment in patients with pulmonary sarcoidosis using Echo and stress-Echo. Special attention is paid to changes in global longitudinal strain and pulmonary artery systolic pressure in patients with pulmonary sarcoidosis at rest and at the peak of exercise test.

The methodological foundations of long-term monitoring electroencephalographic studies are considered in the lecture. The recommendations on organization of work and equipping of the monitoring study room are given. Shown, that introduction video-EEG-monitoring to the standards of epilepsy diagnosis significantly enhanced the possibility of a detailed analysis of bioelectric activity and clinical picture of an attack based on video recording, increased the accuracy of the epileptic seizure initiation zone localization.