Changes in clinical guidelines for the management of patients with arterial hypertension change the paradigm both in terms of attaining target blood pressure (BP) values and in the approach to initiating therapy. The revision of target levels in the European recommendations identified two categories of patients with an optimal target level of SBP of 130-140 mm Hg: patients over 65 years and with chronic kidney disease. The remaining categories of patients should aim for target levels of the SBP of 120-130 mm Hg. The diagnosis was made possible by home measurement of blood pressure, which will help in cases of masked hypertension and hypertension of the white coat. An important aspect in the change of therapy was the adoption of a step-by-step strategy with the predominant use of fixed combinations. All five main classes of drugs can be used to treat hypertension. The use of statins in patients with hypertension is considered rational, starting with a moderate risk. Antiplatelet agents are indicated for secondary prophylaxis only. When choosing specific combinations for the management of patients with hypertension, it is rational to give the most attention to those molecules that have proven to be effective and, consequently, are included in clinical guidelines for treating patients with ischemic heart disease and especially with chronic heart disease (CHF). It is the proven efficacy and safety of the drug (molecule) throughout the entire cardiovascular-renal continuum that allows one to be confident of the correctness of therapy throughout the patient s life, as well as to observe the principle of continuity of therapy during development. As we remember, it was the clinical recommendations on CHF that became the regulator that limits the number of molecules in each class (for example, in the European recommendations: an ACE inhibitor - 5 molecules, sartans - 3 molecules, beta-blockers - 4 molecules). Ramipril is the molecule that follows all the principles of continuity of therapy throughout the patienhs life. This article describes the changes in the recommendations for hypertension and the possibility of using a fixed combination of ramipril and amlodipine in this category of patients.

Purpose. To assess heart rate variability (HRV) before and after stenting of the coronary arteries against the background of acute coronary syndrome (ACS) with and without elevation of the ST segment in patients over 60 years of age. Material and methods. The study included 120 patients with ACS of different age groups who underwent symptom-related coronary artery stenting. After stenting of the coronary arteries, Holter ECG monitoring was performed in all patients and evaluated by HRV. To assess the risk of complications, calculations were carried out on the SYNTAX Score, GRACE and CRUSADE scales. Results. In the group of patients older than 60 years, in the case of ACS, ST segment elevation significantly higher values of HF (42.5 ± 13.2 vs 34.0 ± 15.4 ms²; p = 0.01) and HFnu (0.65 ± 0.15 vs 0.46 ± 0.13 N units; p = 0.0214) in comparison with patients with ACS without ST segment elevation, where LVF prevailed (33.0 ± 16.2 vs 25.1 ± 13.6 ms²; p = 0.0221) and LFnu (0.54 ± 0.13 vs 0.40 ± 0.16 ms²; p = 0.039). Among patients over 60 years old with severe coronary disease, patients with reduced HRV prevailed. In patients with ACS without ST-segment elevation and sharply reduced HRV, an increase in risk was found on the GRACE and CRUSADE scales. Conclusions. Patients older than 60 years with coronary artery stenting for ACS with ST elevation have a parasympathetic regulation of heart rate variability. In patients over 60 years of age with ACS without ST elevation, activation of humoral-metabolic and sympathetic mechanisms of heart rate variability is observed. Low rates of heart rate variability against the background of anterior descending artery lesion in patients over 60 years of age with coronary artery stenting for ACS without ST-segment elevation are associated with a high risk of a complicated hospital period.

Aim. The aim is to analyze the efficacy and safety of the PADN procedure in cardiosurgical patients with mitral valve dysfunction complicated by atrial fibrillation and high pulmonary hypertension, and to assess the effect of pulmonary artery and pulmonary artery ablation on the safety of sinus rhythm in the postoperative period. Material and methods. The results of surgical treatment of 55 patients with mitral valve dysfunction, concomitant atrial fibrillation and high degree of pulmonary hypertension (more than 40 mm Hg) are analyzed. All patients underwent prosthetics of the mitral valve against a destructive lesion of the valvular apparatus, and, due to the presence of atrial fibrillation, a radiofrequency ablation of the atria was carried out according to the Maze IV scheme using the bipolar ablator. The study group comprised 24 patients (20 patients with severe mitral stenosis and 4 with grade 4 mitral valve insufficiency), all of these patients underwent mitral valve prosthesis, Maze IV procedure, and additionally carried out radio-frequency ablation of the trunk and pulmonary arteries (PADN procedure). The control group of patients was 31 patients, also with severe mitral valve dysfunction, atrial fibrillation and pulmonary hypertension more than 40 mm Hg, but unlike the study group, the PADN procedure was not performed. Conclusions. Based on the conducted study, it can be concluded that, the circular procedure PADN, under the control of transmurality, using a bipolar ablator, is a significantly effective and safe method of correcting high secondary pulmonary hypertension, promotes a significant reduction It is necessary to continue further research of the proposed technique involving more patients and an analysis of the long-term results.

The treatment of patients with pulmonary thromboembolism was analyzed. The patients were divided into 2 groups depending on the chosen treatment tactics: the 1st group included 32 patients who underwent balloon angioplasty of the pulmonary artery in combination with thrombolysis (main group), the 2nd group included 37 patients who underwent conservative treatment with thrombolysis followed by anticoagulant therapy (the control group). Despite the small sample and short observation period, we can talk about obtaining significantly better results in the main group of the study. The positive dynamics of echocardiography indicators, and in particular pulmonary hypertension, CID of the pancreas, functional class of heart failure according to the NYHA, as well as reduction of overload of the right heart according to the ECG, indicates that the method of surgical treatment of pulmonary embolism - balloon angioplasty of the pulmonaiy arteiy in combination with thrombolytic therapy - is effective and safe. Findings. 1. Balloon angioplasty of the pulmonary artery in combination with thrombolytic therapy reduces the pressure in the pulmonary artery by 32 %, helps eliminate signs of overload of the right heart on the ECG, while normalizing the size of the right ventricle in 64 % of patients with pulmonary embolism. 2. Balloon angioplasty of the pulmonary artery significantly contributes to the improvement of the functional class of heart failure in the NYHA compared with the group of patients with isolated thrombolytic therapy.

The article substantiates the necessity of active involvement of a medical psychologist in comprehensive work with inpatients and outpatients of the center of neurology with rehabilitation treatment. The most frequent symptoms are highlighted, which are, in fact, the reason for applying to the department for diagnosis and distant care in the form of psychological correction of the emotional and personal sphere. The most widely used methods for the mental status evaluation of the patients are considered.

A comparative analysis of EchoCG parameters between women aged 18-25 years with idiopathic arterial hypotension - 120 women (SBP 61-98 mm Hg, DBP 59 mm Hg and below) and normal arterial pressure - 96 women (SBP 120-129 mm Hg, DBP 80-84 mm Hg). The results showed that hypotension reduced the sizes, volumes and indices of the left atrium and left ventricle. In women with hypotension, the final diastolic size of the right ventricle is reduced, the aortic valve opening is smaller and the aortic root index is larger. For hypotension is characterized by a decrease in the thickness of the wall of the right and left ventricles in systole and diastole. Left ventricular myocardial mass and left ventricular myocardial index are lower with hypotension than with normal arterial pressure. With hypotension, the fractions of the shortening of the subendocardial and middle layers of the myocardium, the rate of circulatory shortening of the left ventricular myocardial fibers, are increased. The maximum blood flow velocities and blood pressure gradients at the level of the aortic and pulmonary valves, the values of the stroke volume, the minute volume of blood and the cardiac index in the test group are less than the normal parameters of the echocardiography, and the time of expulsion of blood from the left ventricle is greater than at normal arterial pressure. The revealed echocardiographic changes in hypotension confirm cardiac hypotrophy and reduction of cardiac hemodynamics. Conclusions. For idiopathic arterial hypotension, young women are characterized by cardiac remodeling according to the type of hypotrophy (decrease in the mass of the left ventricle myocardium, left ventricular myocardial mass index, reduction in the size of the heart chambers and thickness of the muscular walls), reduction of the pumping function of the heart and speed parameters of intracardiac hemodynamics.

The work was carried out on experimental material. Thyroidectomy was performed on 73 white male rats sexually mature, weighing 250-300 grams. Operation thyroidectomy was performed under general anesthesia. The duration of the experiment is 60 days. The rats were removed from the experiment on the 7th, 14th, 21st, 28th, 35th and 60th days. As a control, 23 rats were used, which did not undergo thyroidectomy. For histological examination, pieces of the myocardium of the left and right ventricles of the heart were taken. The pieces were fixed in 10 % buffered formalin, then conducted through an alcohol battery, poured into paraffin, and 5 microns thick sections were prepared. Sections were stained with hematoxylin and eosin, picrofuxin according to Van Gison, toluidine blue. The immunohistochemical study was performed by peraksidase- antiperoxidase method using standard diagnostic protocols of the manufacturer. Biomarkersdesmine and muscular-specific actin (SA) were used. In histological study of myocardium in rats, vascular disorders and interstitial edema were revealed. Hydrophobic dystrophy is observed in the cytoplasm of cardiomyocytes, erosion of the pattern, uneven staining is noted. In the stroma of the myocardium, multiple focal lymphocytic infiltrates were found. At the end of the experiment, severe dystrophic and destructive changes develop in the myocardium, multiple foci of plasmolysis, fragmentation of fibers, thinning and atrophy of them, the formation of cavities filled with edematous fluid. In immunohistochemical studies, desminus expression is positive cytoplasmic. By the end of the experiment, desmine expression becomes uneven. Cardiomyocytes react differently. Expression is weakly positive. Expression of SA at the beginning of the experiment is positive uniform. There is a bright diffuse staining. At the end of the experiment, there is a weakly positive expression.

The Purpose. Improving the efficiency of treatment of patients with recurrent MI, including without ST-segment elevation with a low left ventricular ejection fraction (LVF), by expanding indications for the use of primary PCI, regardless of the timing of admission. The study included 743 patients with recurrent MI with a left ventricular ejection fraction (LV EF) < 45 % aged 31 to 95 years treated at the institute from 2008 to 2017 year. Primary PCI in up to 72 hours was performed in 373 patients. The comparison group consisted of 370 patients on drug therapy. Surgical myocardial revascularization was performed in 90 patients 1-6 months after repeated MI. Hospital and late cardiovascular mortality fin/e years after PCI was 8 and 6 %, in the comparison group - 16 and 61 %, in patients with surgical myocardial revascularization - 2.2 and 3.0 %, respectively. From the data obtained it follows that conservative treatment of recurrent myocardial infarction is unpromising. The severity of coronary disease and severe LV dysfunction increase the risk of reperfusion strategies. However, the use of primary PCI, including urgently delayed late admission, prevents the progression of LV dysfunction, the development of complications and deaths. Upon completion of the evolution of recurrent MI, the main method is surgical treatment. Complete myocardial revascularization increases the contractile function of the LV, prevents coronary events. The futility of drug therapy justifies the increased risk of reperfusion treatment strategies.

Introduction. Thyroid dysfunction often develops in cardiac patients received amiodarone (up to 20 % of cases) and is an important clinical problem. Amiodarone-induced thyrotoxicosis type 1 develops in conditions of thyroid diseases (Graves' disease, nodular goiter). Amiodarone-induced thyrotoxicosis type 2 develops without any thyroid disease. Differential diagnosis and treatment of thyrotoxic syndrome in such patients is a complex clinical task. Patient T., 56 years old, entered the clinic of the Research Institute of Cardiovascular Diseases with complaints of frequent paroxysms of atrial fibrillation, periodic increases in blood pressure, increased fatigue in normal physical activity, trembling in the hands. It is known that the patient has a multinodular goiter in her anamnesis. Paroxysms of atrial fibrillation were stopped by intravenous administration of amiodarone in a hospital. At the time of admission to the cardiology department, the level of thyroid-stimulating hormone is reduced to 0.011 mlU/l, the detection of antibodies to the thyroid-stimulating hormone receptor (30.4 IU/L), the increase in free triiodothyronine and thyroxine levels. Objectively, the patient showed an increase in the thyroid gland (volume by the results of ultrasound of 29 cm³) and manifestations of Graves’ ophthalmopathy (bilateral periorbital edema). Thus, the manifestation of Graves’ disease due to the amiodarone administration is not in doubt. The sinus rhythm was restored on therapy with thyreostatics and beta-blockers. Conclusion. Thyrotoxic syndrome is a frequent cause of atrial fibrillation, therefore before the appointment of antiarrhythmic therapy, it is recommended to determine the level of TSH and the volume of the thyroid gland.

This article deals with issues related to different approaches in the diagnosis of mitral valve insufficiency of various etiologies.A modern approach to the diagnosis of mitral valve insufficiency is based on the use of all modes of transthoracic echocardiography, and, if necessary, on the use of three-dimensional echocardiography. The article reflects the capabilities of magnetic resonance imaging in assessing the severity of mitral regurgitation. Thus, the diagnosis of mitral valve insufficiency with the use of an integrated approach allows to improve predicting and optimizing tactics for subsequent correction of pathology.