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Myocardial infarction without coronary artery obstruction, according to Russian authors, occurs from 4.1 to 10.3% of cases of all myocardial infarctions. Despite a fairly complete description of the term "acute myocardial infarction", there are often situations when the diagnosis may cause doubts and the cause of the condition cannot be found out. The article demonstrates a clinical case of a 26-year-old young man whose genesis of myocardial infarction after a detailed examination turned out to be unclear.

In patients with initially elevated levels of creatine phosphokinase MB (CPK-MB), its increase after percutaneous coronary intervention (PCI) may be due not only to additional injury, but also to natural release during myocardial infarction. Therefore, CPK-MB should be evaluated relative to the initial values.Aim. To compare the CPK-MB dynamics after myocardial reperfusion relative to baseline values and the upper limit of normal (ULN) for the optimal approach to determining myocardial reperfusion injury in patients with acute coronary syndrome.Material and methods. A single center observational study was conducted with the participation of 90 patients hospitalized with a diagnosis of acute coronary syndrome. Patients underwent a biochemical blood test for CPK-MB twice and its dynamics was determined relative to the initial value and ULN.Results. Between the ischemia time and CPK-MB dynamics relative to the initial values, there is a moderate negative correlation. At the same time, the ratio of CPKMB after surgery to ULN is not associated with ischemia time. Analysis of covariance showed that the CPK-MB dynamics, determined relative to the initial values, is 20% dependent on the ischemia time. Individual features of coronary system anatomy, localization of the infarct-associated artery and the subsequent reperfusion procedure together explain the CPK-MB dynamics after surgery by 27%. When the ratio of CPK-MB to ULN is included in the analysis of covariance, all the above factors lose statistical significance.Conclusion. Thus, for a more accurate assessment of myocardial reperfusion injury after PCI, not the upper limit of normal should be analyzed, but the initial values of CPK-MB. In patients with the left heart dominant, as well as in the infarction localization in the system of right or left anterior descending artery, there is a slight change in the marker. On the contrary, more pronounced dynamics is observed in patients with tortuous coronary arteries and with implantation of 2 or more stents. At the same time, the assessment of CPK-MB in relation to ULN is not associated with the ischemia time and does not depend on the clinical and angiographic characteristics and tactics of the operation.

Aim. To assess structural geometric and functional disorders of the heart in males with coronary heart disease (CHD) comorbid with arterial hypertension (AH) and with visceral abdominal obesity, and to evaluate the grade of association of epicardial fat thickness (EFT) with cardiometabolic risk factors (RF).Material and methods. Totally, 90 in-patients included, males with AH and CHD and with metabolically unhealthy phenotype (MUP) at the age 61,2±1,7 y. o. with normal bodyweight (n=29) — 1 group, overweight (n=21) — 2 group, and obese (n=30) — 3 group, and 30 persons with metabolically healthy phenotype. All patients underwent anthropometric screening, calculation of visceral obesity index (VAI) and insulin resistance (HOMA-IR); lipid profile was assessed, and by the data from echocardiography the myocardial mas index (MMI) was evaluated, and EFT, the characteristics of the left ventricle hypertrophy (LVH) were counted and of diastolic dysfunction (DD).Results. The presence of obesity led to increase of metabolic RF in obese patients. Most informative were indexes as VAI (4,47±0,27; p

Aim. To assess the efficacy of specialized management of pregnant women with cardiovascular diseases (CVD) in the Udmurt Republic (UR) of Russia.Material and methods. In prospective and retrospective study we investigated pregnancy outcomes in all 17948 women in management system created for pregnant patients with CVD in the UR from 2000 to 2007. The system comprises specialized outpatient and inpatient departments and an obstetric hospital within the regional cardiological centre. Pregnant women had different CVD including hypertension, congenital and rheumatic heart disease, cardiac arrhythmias, noncoronary myocardial disease, disorders and autoimmune diseases of connective tissue, etc.Results. Perinatal mortality decreased by 41,1% from 11,2‰ in 2000 to 6,6‰ in 2007. During 8 years, no one woman died.Conclusion. The management system for pregnant women with CVD within the regional cardiological clinic makes it possible to reduce of maternal and perinatal mortality rates significantly.

Aim. To assess the efficacy of specialized management of pregnant women with cardiovascular diseases (CVD) in the Udmurt Republic (UR) of Russia.Material and methods. In prospective and retrospective study we investigated pregnancy outcomes in all 17948 women in management system created for pregnant patients with CVD in the UR from 2000 to 2007. The system comprises specialized outpatient and inpatient departments and an obstetric hospital within the regional cardiological centre. Pregnant women had different CVD including hypertension, congenital and rheumatic heart disease, cardiac arrhythmias, noncoronary myocardial disease, disorders and autoimmune diseases of connective tissue, etc.Results. Perinatal mortality decreased by 41,1% from 11,2‰ in 2000 to 6,6‰ in 2007. During 8 years, no one woman died.Conclusion. The management system for pregnant women with CVD within the regional cardiological clinic makes it possible to reduce of maternal and perinatal mortality rates significantly.

Aim. To prove the advantage of the long-term controlled antihypertensive therapy compared with the real usual standard therapy in patients with mild to moderate arterial hypertension.Material and methods. It was multicenter, randomized, prospective parallel-group study in patients with mild to moderate hypertension. One part of patients (treatment group) received the strongly regulated stepped antihypertensive therapy based on ACE-inhibitor spirapril, the second one (control group) continued their usual standard therapy prescribed by doctors of polyclinics or other patient care institutions. The study lasted one year.Results. 1742 patients were enrolled in the study, 854 patients were included in the treatment group and 888 – in the control group. 220 patients dropped out of the study by different reasons, and 1552 patients finished the study. There were 651 (37,6%) men and 1081 (62,4%) women. It was substantial decrease in blood pressure in both group, but distinctions between systolic and diastolic blood pressure in the treatment and control group during the study were significant.The target levels of blood pressure (systolic < 140 mm Hg and diastolic < 90 mm Hg) were registered substantially more frequent in the patients of treatment group than in control group (69,4% и 39,3% after three months and 83,6% и 66,9% after 12 months of the treatment correspondingly).Conclusion. Controlled stepped antihypertensive therapy resulted into more significant decrease in systolic and diastolic blood pressure and more frequent achievement of target levels of blood pressure in comparison with control group. It supposes better prognosis of patients.

Aim. To prove the advantage of the long-term controlled antihypertensive therapy compared with the real usual standard therapy in patients with mild to moderate arterial hypertension.Material and methods. It was multicenter, randomized, prospective parallel-group study in patients with mild to moderate hypertension. One part of patients (treatment group) received the strongly regulated stepped antihypertensive therapy based on ACE-inhibitor spirapril, the second one (control group) continued their usual standard therapy prescribed by doctors of polyclinics or other patient care institutions. The study lasted one year.Results. 1742 patients were enrolled in the study, 854 patients were included in the treatment group and 888 – in the control group. 220 patients dropped out of the study by different reasons, and 1552 patients finished the study. There were 651 (37,6%) men and 1081 (62,4%) women. It was substantial decrease in blood pressure in both group, but distinctions between systolic and diastolic blood pressure in the treatment and control group during the study were significant.The target levels of blood pressure (systolic < 140 mm Hg and diastolic < 90 mm Hg) were registered substantially more frequent in the patients of treatment group than in control group (69,4% и 39,3% after three months and 83,6% и 66,9% after 12 months of the treatment correspondingly).Conclusion. Controlled stepped antihypertensive therapy resulted into more significant decrease in systolic and diastolic blood pressure and more frequent achievement of target levels of blood pressure in comparison with control group. It supposes better prognosis of patients.

The use of pharmacotherapy in prevention is aimed at the correction of already existing consequences (pathology), rather than the prevention of causes. The number of multiple known risk factors (RFs) is steadily increasing, which limits their effective control in the real-world practice. On the other hand, focusing only on a limited number of RFs (7–9) leaves plenty of room for error. Causality is a unity of multiple RFs, unique in each individual case. Determining causality with the use of mathematical modelling can facilitate a more reliable prognostic assessment in cardiovascular disease.

The review of the existing evidence on the problem of excessive mortality in Russia has demonstrated that the country is at the initial stage of the irreversible depopulation process. The current healthcare situation, in regard to cardiovascular disease (CVD), does not provide much hope for the effectiveness of existing measures for fatal CVD prevention. It is clear that a large-scale focussed analysis of the clinical and organisational limitations of the existing prevention systems is urgently needed. This discussion should be started in the nearest future.

The medical community has to address global problems of Russian population health. There is a discrepancy between the magnitude of claimed and practically assessed population health problems, which has been demonstrated in this review of medical and philosophical literature.

Background. Hypertensive disorders in pregnancy have been recognized as an important risk factor for atherosclerotic CVD in women. Therefore, lifestyle modifications, regular blood pressure control, and control of metabolic factors are recommended after delivery, to avoid complications in subsequent pregnancies and to reduce maternal cardiovascular risk in the future. There are no uniform recommendations for the treatment of post partial hypertension (HT) yet.Methods. In a case-control, open-label 1-year study, 54 post-partum hypertensive women (aged 22-38 years; body mass index 26.7±3.8 kg/m2; 18 with previous pre-eclampsia, 18 pre-existing HT, 18 pre-existing HT plus superimposed pre-eclampsia) were studied. Nursing mothers (n=27) received adjusted-dose methyldopa (Egis) 500-2000 mg daily, 27 non-feeding women received indapamide SR (Servier) 1.5 mg daily. No significant differences observed between two groups at baseline.Results. After comprehensive follow-up, clinical blood pressure was not found to differ substantially between indapamide and methyldopa groups (124.8±3.2/83.2±2.1 mmHg vs 125.3±3.8/81.5±2.9 mmHg respectively; p =NS), but indapamide significantly better improved diurnal BP patterns. No maternal adverse effects were registered in both groups, except for sleepiness and bad mood in 18.5% of methyldopa patients. There was a significant difference in weight reduction, in favour of indapamide (-11.3 kg vs -2.7 kg; p =0.032), as well as in decrease of microalbuminuria (-189.2 mg/24 h vs -51.4 mg/24 h; p