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Hypertrophic cardiomyopathy (HCM) is a prevalent genetic heart disease with a worldwide prevalence. Its estimated incidence in young individuals is approximately 1 case per 500 population. HCM in adults can be clinically diagnosed through visualization, either via 2D echocardiography or cardiac magnetic resonance (CMR) imaging, where the maximum thickness of any left ventricular (LV) segment, measured in end-diastolic phase, is 15 mm in the absence of other hypertrophy causes. Aim. To demonstrate the role and diagnostic capabilities of CMR as a powerful diagnostic tool for detecting and evaluating sudden cardiac death (SCD) risk factors in patients with HCM. Materials and methods. From January 2022 to September 2023, 236 CMR examinations were conducted and analyzed at the Diagnostic Radiology Department of Amosov National Institute of Cardiovascular Surgery in patients with suspected HCM. All examinations were performed on a magnetic resonance tomograph “Toshiba Vantage Titan 1.5T” until May 2023, and “Canon Vantage Orian 1.5T” from May to September 2023, with ECG and respiratory synchronization as well as intravenous injection of gadolinium-based contrast agent (Gadovist 1.0) at a dose of 0.1 mL/kg body weight. Statistical and mathematical data processing was performed by using the Statistica 6.0 (StatSoft Inc., USA) application package. Results. The mean age of the examined patients was 41 ± 28 years, there were 142 male (60 %) and 94 (40 %) female patients. Symmetric non-obstructive HCM was identified in 39 patients (16.5 %) and 184 patients (78.0 %) had asymmetric obstructive HCM. Apical HCM was diagnosed in 4 patients (1.5 %), and midventricular HCM – in 9 patients (4.0 %) including one patient with a combination of midventricular and apical forms. Risk factors for SCD were identified in 60 patients (25.4 %) with myocardial thickness exceeding 30 mm, 8 patients (3.3 %) with apical aneurysm, 4 patients (1.6 %) with reduced LV systolic function (LV ejection fraction

Background: Infection with the SARS-CoV-2 virus entails the development of complications which affect the prognosis of the underlying disease. More than 40% of COVID-19 complications represent diseases of the cardiovascular system, most of which are the rhythm and conduction disturbances. In order to avoid these complications, it is necessary to detect cases of infection in a timely manner at the outpatient stage. Clinical case description: A 40-year-old patient came to the clinic with complaints of interruptions in the heart rhythm that appeared after the coronavirus infection. The laboratory examination (CBC) revealed signs of systemic inflammation (leukocytosis 12.6×109 U/l; erythrocyte sedimentation rate 18 mm/h, C-reactive protein 18 mg/l); the instrumental examination of the heart revealed the rhythm disturbances in the form of frequent ventricular ectopic activity and weakness of the SA node. The patient received propafenone (150 mg, 3 times a day) as a therapy with a positive effect. Against the background of improvement in the patient’s condition and despite the history of myocarditis and a positive result of enzyme immunoassay for antibodies to SARS-CoV-2 (IgG, 10 BAU/ml), the patient was prescribed immunization with the CoviVac vaccine. After the immunization, the condition worsening was observed in the form of an increase in the rhythm disturbances, which required an inpatient treatment. A clinical diagnosis of recurrent ventricular arrhythmia — ventricular extrasystole was established, and the therapy was corrected. The outcome was favorable. Conclusion: Myocarditis is one of the most common complications of SARS-CoV-2 and should be kept in mind at all stages of medical care. This clinical case demonstrates the importance of the correct diagnosis and treatment of post-COVID myocarditis, as well as the need to assess contraindications for SARS-CoV-2 vaccination in patients with cardiac complications.

Abstract. Atrial tachyarrhythmias are the most common forms of heart rhythm disorders. According to literature sources, isolated atrial flutter (AFL) is observed in 88 people per 100,000 population. Most quality-of-life assessment methods have been developed and used primarily to assess atrial fibrillation. In this context, the U22 questionnaire becomes a significant protocol aimed at quantifying paroxysmal symptoms associated with tachyarrhythmias. The aim. To evaluate changes in the quality of life in patients with typical AFL after radiofrequency ablation (RFA) and bidirectional conduction block through the cavotricuspid isthmus. Materials and methods. The study is based on the analysis of the results of the treatment of a group of 135 patients at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine in the period from 2014 to 2021. The patients had three follow-up examinations, which were subject to analysis and static processing: before RFA (n=135), after 1 month (n=122) and after 1 year (n=81). All the patients were interviewed concerning their arrhythmia-related symptoms, which were assessed according to the U22 protocol. Results. Before the procedure, the patients noted a low level of well-being (4.3±1.0 points). During the follow-up visit 1 month after RFA, the patients rated their general condition during this period at 8.9±0.7 points. The registered changes were statistically significant compared to the initial state (p

In clinical practice among cardiac patients, symptoms of palpitations diagnosed as premature beats or episodes of atrial fibrillation (AF) are very frequently reported. One of the most common diseases in the field of gastroenterology is gastroesophageal reflux disease (GERD) . However, it may happen that the coincidence of the above-mentioned disease entities may predispose to the development of arrhythmias. In this article we describe the case of a 65-year-old man, without previously diagnosed diseases, in whom a clear association of arrhythmias with gastrointestinal complaints was observed. The presence of a burning sensation in the lower sternal region and typical symptoms resulting from esophagitis aggravated by triggers allows us to suspect esophageal reflux disease. Diagnostic tests performed for concomitant cardiac diseases did not reveal an organic cause of the arrhythmia. The recurrent course of symptoms observed in the present case and the analysis of the cause-effect course made us to diagnose gastrointestinal syndrome, also referred to as Romheld's Syndrome.

Introduction. Atrial fibrillation (AF) is a potentially life-threatening complication of infection. In general, AF has a high prevalence in elderly population with cardiovascular risk factors and comorbidities. Thus, the presence of AF correlates with adverse outcomes in patients with previous coronavirus disease (COVID-19) which deserves increased attention and should be appropriately treated to prevent adverse outcomes. The aim. To analyze the prevalence and clinical course of AF in hospitalized patients after COVID-19 to determine approaches to restoring sinus rhythm. Materials and methods. The study included 179 patients with various types of heart rhythm and conduction disorders who suffered from COVID-19 and were hospitalized to the Department of Clinical Arrhythmology and Electrophysiology of the National Scientific Center “The M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine of the NAMS of Ukraine” from 09/20/2020 to 12/21/2021. 116 patients were hospitalized with AF who suffered from coronavirus infection between 1 and 12 months ago (5.1 ± 0.2 months on average). Other heart rhythm and conduction disorders were the cause of hospitalization for 63 patients (35.2%). The first group was formed by 36 people (31%) in whom AF occurred after coronavirus infection. The second group included 25 patients in whom the form of AF changed, namely: there was a transition from paroxysmal form of AF to persistent AF, or persistent AF to a permanent form of AF. The third group included 55 patients in whom the form of AF did not change. However, in the third group, two subgroups were formed: 3A consisting of 35 patients, in whom, although the form of AF did not change, the frequency or duration of paroxysms increased, and 3B, which included 20 patients without significant changes in the course of AF. As a control group, 49 patients with AF without a history of coronavirus infection were examined. Results. In most patients (65%), the reason for hospitalization was AF. The first recorded paroxysms of this arrhythmia were recorded in 31% of patients 2 months after the coronavirus infection. In this group, more than half of the cases (58.4%) were patients with persistent AF, and 8.3% of those hospitalized failed to restore sinus rhythm. In those who had AF before COVID-19, 75% of its course worsened: the frequency or duration of paroxysms increased. The persistent form of AF was dominant and occurred after a previous infection in 58% of cases. In patients who had AF before COVID-19, its course worsened (in 76% of the examined persons) after the infection. Patients with a history of coronavirus infection had more frequent use of drug therapy, which is probably due to the delayed time of hospitalization to the clinic from the onset of the paroxysm. Conclusion. AF is the most common arrhythmia and has a worse course in hospitalized patients after coronavirus infection.

According to statistics, myocarditis is one of the leading causes of sudden cardiac death (SCD) in children and young adults. The etiology of myocarditis includes infectious and non-infectious, including autoimmune diseases, as well as toxicities and hypersensitivity to various drugs or bites of insects, spiders, snakes, etc. The risk of myocarditis among patients with COVID-19 is 15.7-fold higher than that in the general population. The most common cause of death in myocarditis is heart arrhythmia, such as ventricular tachyarrhythmia, ventricular fibrillation, or severe bradycardia. Genetic predisposition, ion and metabolic disorders, mechanisms of autoimmune response, and direct cardiotoxic action in viral diseases play a role in the pathophysiology of inflammatory myocardial damage. While the majority of patients with myocarditis, who died suddenly, was asymptomatic or had few symptoms, a timely and accurate diagnosis of myocarditis seems to be an important challenge for prevention or minimization of SCD risk. Nonetheless, at present there is no convincing evidence of an association between laboratory and instrumental parameters and the SCD risk in such patients. Endomyocardial biopsy remains the "golden standard" in the diagnosis of myocarditis. Biomarkers (troponins or creatine phosphokinase) are not highly specific. The most common electrocardiographic findings in myocarditis are sinus tachycardia and nonspecific changes in the ST-T segment. The presence of Q wave, bundle branch block, Brugada syndrome, shortened or prolonged QT interval, and early ventricular repolarization are associated with an increased risk of SCD in myocarditis. Given the absence of specific echocardiographic signs of myocarditis, special attention is paid to the assessment of the size of the cardiac chambers, wall thicknesses, global and regional systolic and diastolic function of both the left and right ventricles, visualization of pericardial effusion and intracardiac thrombi. A combined cardiac magnetic resonance imaging using T2-weighted imaging and early and late gadolinium enhancement provides high diagnostic accuracy and seems to be a useful tool in the stratification of patients with suspected acute myocarditis. With the established etiology of myocarditis, specific therapy is necessary to eliminate the pathogen. It is necessary to take into account the likely arrhythmogenic effects of the drugs used in treatment. Non-steroidal anti-inflammatory drugs are generally not indicated in patients with myocarditis because they cause renal impairment and sodium retention, which can exacerbate left ventricular dysfunction and increase the risk of SCD. In the case of severe conduction disturbances and ventricular tachyarrhythmias, implantation of a pacemaker or cardioverter-defibrillator is necessary.

The WolfParkinsonWhite (WPW) syndrome is a condition with early excitation of the heart ventricles due to the conduction of an electrical pulse along the atrioventricular pathway, such as the Kent, James bundle, and Mahaim fibers; the pulse is usually accompanied by supraventricular tachycardia, atrioventricular reciprocal tachycardia in 95% of cases, and fibrillation, atrial flutter, and other supraventricular tachycardia in other cases. WPW syndrome can be observed in patients of any age, approximately 130 per 10,000 people, with male predominance. The disease affects 0.150.25% of the population. Sudden cardiac death occurs in one patient per 1000 annually, and sometimes this is the first "business card" of the disease. This is mainly due to the lightning-fast formation of life-threatening arrhythmias, for example, with the transformation of atrial fibrillation into ventricular fibrillation. The morphological substrate is an additional atrioventricular connection. Currently, transcatheter radiofrequency ablation is the standard of the interventional treatment of WPW syndrome. WPW syndrome has a diverse etiology. Numerous studies reported that genetics play a significant role in the development of WPW syndrome. Several genetic predictors of WPW syndrome are presented in the modern literature, which may be relevant in predicting and diagnosing hidden forms of this syndrome, such as course, development of symptoms and manifestations, and reduction of the risks of sudden cardiac death.

Introduction and purpose: Over the last few years, the number of suicide attempts in Polish women has been steadily increasing. This report presents a case of a 18 years old woman hospitalized in the Toxicology and Cardiology Department due to poisoning with antiarrhythmic drug – Propafenone, taken for suicide purpose. Brief description of the state of knowledge: Propafenone is an antiarrhythmic drug which belongs to class IC according to the Vaughan-Williams classification. The overdose of this drug can cause various symptoms and complications such as cardiac arrhythmias, liver damage, cardiac arrest and even death. This drug has no specific antidote. Conclusions: Propafenone poisoning is a significant clinical challenge and the consequences are often unpredictable and life-threatening. Treatment options such as natrium bicarbonicum, insulin, intravenous lipid emulsion, calcium gluconate seem to be good choices and the effects of treatment with these drugs are promising for the future.

Due to cardiovascular diseases millions of people die around the world. One way to detect abnormality in the heart condition is with the help of electrocardiogram signal (ECG) analysis. This paper's goal is to use machine learning and deep learning methods such as Support Vector Machines (SVM), Random Forests, Light Gradient Boosting Machine (LightGBM), Convolutional Neural Network (CNN), Long Short-Term Memory (LSTM) and Bidirectional Long Short-Term Memory (BLSTM) to classify arrhythmias, where particular interest represent the rare cases of disease. In order to deal with the problem of imbalance in the dataset we used resampling methods such as SMOTE Tomek-Links and SMOTE ENN to improve the representation ration of the minority classes. Although the machine learning models did not improve a lot when trained on the resampled dataset, the deep learning models showed more impressive results. In particular, LSTM model fitted on dataset resampled using SMOTE ENN method provides the most optimal precision-recall trade-off for the minority classes Supraventricular beat and Fusion of ventricular and normal beat, with recall of 83 % and 88 % and precision of 74 % and 66 % for the two classes respectively, whereas the macro-weighted recall is 92 % and precision is 82 % .

Objective. To study the possibilities of the «labyrinth» procedure in combination with the left atrium reduction. Materials and methods. Into the investigation 261 patients, suffering isolated failure of a mitral valve Stage IV, operated in the National Institute of Cardio-Vascular Surgery n. a. M. M. Amosov, were included. The left atrium plasty with objective to reduce and prevent the waves spread re-entry was performed in 139 (53.2%) patients. Fragmentation in the left atrium was made in regime of low radiofrequencies (25 - 35 Вт) in accordance to schemes of Maze ІІІ, ІV. Results. In the hospital period 5 patients died (the hospital lethality have constituted 1.9%). While discharge from the hospital the sinus rhythm was noted in majority of the patients after the left atrium plasty, than in the alternative group - in 119 (85.6%) of 139 and in 79 (64.8%) of 122 patients, accordingly. Conclusion. The «labyrinth» procedure in combination with the left atrium plasty owes significant clinical advantages, including restoration and persistence of the sinus rhythm in patients, suffering pathology of a mitral valve.

A new coronavirus infection (COVID-19), which has spread widely in the human population in the past few years, is often complicated by a damage to the cardiovascular system, central nervous system, gastrointestinal tract, and respiratory system organs. The review describes the features of the clinical course and treatment of SARS-CoV-2 infection, which can lead to the development of cardiac complications both in the early and long-term periods. It is assumed that there are three main causes for the development of such complications (the affinity of the virus to endothelial proteins, the damage to blood vessels and the heart as a result of the immune response of the body and the toxic effects of drugs used to treat infection). Among the pathogenic mechanisms of the course of a new coronavirus infection that can lead to the development of cardiovascular complications, the following can be distinguished: manifestations of systemic vasculitis, coagulopathy, thrombosis, the phenomenon of “cytokine storm”, the direct cytotoxic damage to the myocardium, metabolic disorders, imbalance of the ionic composition of the blood, hypoxia and its consequences. The most common complications include myocarditis with arrhythmia (sinus tachycardia, bradycardia, atrial fibrillation and flutter, QTc prolongation, sudden cardiac death), cardiomyopathy (biventricular, isolated dysfunction of the right or left ventricle), cardiogenic shock, coagulopathy, thromboembolism (including strokes), vasculitis. Following recovery from COVID-19, many patients retain (or develop) the symptoms caused by the heart damage: a pain in the region of the heart, palpitations, appearance or aggravation of chronic heart failure, decompensation of hypertension, acute coronary syndrome. The main proposed directions for minimizing the risk of developing cardiac complications in COVID-19 patients include ECG monitoring (assessment of the QT interval, rhythm, conduction and repolarization), echocardiography in patients at risk, 24-hour ECG recording in patients who report palpitations. In addition, it is recommended to adjust the dosages of cardiotoxic drugs and to be cautious when prescribing anticoagulant therapy.

Aim: to determine the features of heart rate variability and electrical changes in the myocardium in women with chronic coronary syndrome, depending on the state of the bone mineral density (BMD). Materials and methods. 121 women with chronic coronary syndrome (CCS): stable exertional angina of II–III functional class (FC) (mean age 68.0 (60.0; 75.0) years) were examined and divided into 3 groups: group 1 − 30 women with ССS and normal BMD; group 2 – 33 women with CCS and osteopenia (OPе); group 3 – 58 women with CCS and osteoporosis (OP). All patients underwent daily ECG monitoring and ultrasound osteodensitometry. Results. In women with CCS and OP, increase in the frequency (by 2.9 times; P < 0.05) and duration (by 2.3 times; P < 0.05) of tachycardia episodes, the frequency of registration of ventricular and supraventricular extrasystole episodes (by 8.1 time and 1.2 times, respectively; P < 0.05) if compared to patients without BMD disorders was found. In women with СCS and OPе there was a tendency to increase in these indicators, which did not reach the level of statistical significance. The presence of BMD disorders in patients with CCS was accompanied with decrease in total HRV activity (RMSSD and HRVT), the development of the predominance of ANS sympathetic domain activity, as evidenced by an increase in LF by 44.3 % at the daytime and 44.0 % at night, decrease in HF 2.3 times during the day and 2.1 times at night in patients with OPe and OP, respectively. According to the correlation analysis data, the presence of correlations between the state of BMD and indicators of electrical and autonomic activity of the myocardium was established. Conclusions. In postmenopausal women with CCS, the severity of autonomic and electrical disorders is associated with the degree of bone disorders and is maximal in osteoporosis.

The aim of the work: to provide medical practitioners with a clinical case of cardiovascular affection with ST-segment elevation in a child as a result of coronavirus disease (COVID-19). Materials and methods. Here is a clinical case of our own observation of the clinical course of post-COVID cardiovascular system involvement with ST-segment elevation in the child who was treated at the City Children’s Hospital No. 5 of Zaporizhzhia City Council. Results. The patient with severe post-COVID cardiovascular implication, COVID in anamnesis confirmed by COVID-19 IgG positivity with negative IgM and PCR test results. The following laboratory findings were also detected when the child was admitted to the hospital: Troponin I was 136 ƞg /ml (referent value – less than 0.32 ƞg/ml), Lactate Dehydrogenase – 4199 U/l (referent value – 110–295), Creatine Phosphokinase-MB – 25.4 U/l (referent value – 0–24), CRP was increased to 6.2 mg/l, D-dimer – to 3221.12 ng/mL (referent value – less than 500 ng/mL). ECG showed QS-waves in leads V3–V6, I, 2.0–2.5 mm ST-segment elevation in leads V4–V6, and Р-mitrale. The clinical course was characterized by cardiogenic shock development. During intensive care, there was moderate positive clinical and laboratory dynamics. Peculiarities of post-COVID myocarditis in children were characterized based on the comparative analysis of this clinical case and results of relevant clinical studies, world recommendations and guidelines. Conclusions. Peculiarity of the case is severe post-COVID syndrome after almost asymptomatic COVID-19. Physicians should be aware after coronavirus disease while providing a close follow-up for six months. Myocardial ischemia is among casuistic post-COVID manifestations in children. The basic treatment is a complex therapy of heart failure, anticoagulant and antiplatelet therapy, as well as corticosteroids administration, which is pathogenetically justified and leads to regression of major clinical and laboratory symptoms.

Background. Study of connection between atrial fibrillation (AF) and reproductive aging has is important for prevention and treatment of arrhythmias. Many researchers consider it appropriate to study this issue for an adequate selection of therapy. The purpose of the research was to study the relationship of paroxysms of atrial fibrillation (AFP) in women with age-related changes in the reproductive system. Material and methods. 157 women with AFP examined and divided into three groups, depending on the stage of reproductive aging. The 1st group includes 48 persons with AFP, occurred in the reproductive period, in the 2nd group there are 57 patients with AFP occurred in the premenopausal period, and in the 3rd group – 52 persons with AFP occurred in menopausal period. Research methods included ECG, Holter’s ECG monitoring, electrophysiological examination of the heart, stress tests, ultrasound of the heart, endocrine criteria for aging of the reproductive system of women. Results. A close (p

The number of patients who underwent total correction of Tetralogy of Fallot (ToF) in early life or infancy is still rising. According to CDC ToF is the most prevalent cyanotic congenital heart disease with incidences of 1 in 2500 births. Rhythm disturbances and haemodynamic disturbances including valves disorders, heart failure, residual defects and more are new challenges for clinicians taking care of adult patients with repaired ToF. Our goal was to describe such a patient and highlight further complications which may be encountered among those patients.

Infiltrative cardiomyopathies are a group of diseases characterized by the deposition of abnormal substances in heart tissues, which leads to thickening of the walls or dilation of chambers with a secondary decrease in wall thickness and the development of diastolic, less often systolic, ventricular dysfunction. Most often, these are progressive diseases that, in the absence of adequate therapy, have an unfavorable prognosis. Clinical manifestations of infiltrative cardiac diseases are variable, which often leads to diagnostic difficulties and errors. In most cases, specific laboratory and morphological tests are required to confirm or clarify the diagnosis. Early diagnosis is critical to initiating therapy and improving patient prognosis. This article provides characteristic signs and symptoms, the so-called "red flags", making it possible to suspect infiltrative cardiomyopathies, diagnose them at an early stage and start life-saving therapy.

Introduction. Hernia of the esophageal opening of the diaphragm in 90% of cases is the main cause of the development of reflux esophagitis. The doctrine highlighted a large group of extraesophageal manifestations of reflux esophagitis, including gastrocardiac syndrome.Аim. The purpose of this publication is to evaluate the effectiveness of antireflux surgery in patients with hiatal hernia through the prism of its effectiveness in the dynamics of gastrocardial syndrome regression.Material and мethods. The paper presents the results of diagnostics and surgical treatment of 101 patients with hiatal hernia.Results. According to the data of instrumental research methods, cardiac hernias of the esophageal opening of the diaphragm were detected in 45 (44.5%) patients, cardiofundal in 40 (39.6%), subtotal in 15 (14.8%), total in 1 (0.9%). The main place in the clinical picture of gastrocardial syndrome was occupied by the pain syndrome behind the breastbone (83.1%). Thus, arrhythmias were found in 16 (40.0%) patients with cardiofundal, in 10 (66.6%) subtotal and in 1 (100.0%) total hiatal hernia, and angina pectoris is characteristic of cardiac hernias and was observed in 20 (44.4%) patients. The clinical manifestation of reflex angina pectoris and arrhythmias depended on the degree of shortening of the esophagus. Thus, arrhythmias were more common in patients with cardiofundal (50.0%), subtotal (71.4%), total (100.0%) hiatal hernia with II degree of shortening of the esophagus, and angina pectoris characteristic of cardiac (75.0%) hiatal hernia. with II degree of shortening of the esophagus. Reflex angina is typical for patients of the older age group, and manifestations of arrhythmia are recorded at a younger age. Heart rate variability was considered, according to electrocardiogram and Holter ECG monitoring before and after surgical treatment, where the parameters significantly (p> 0.05) decreased.Conclusions. The phenomena of gastrocardial syndrome regressed after antireflux surgery in 44 (43.5%) patients. Surgical treatment from the endovideosurgical approach did not worsen the results of surgical treatment.

The work is dedicated to the issue of atrial cardiomyopathies (ACs). They have a significant effect on the heart function, provoke rhythm disturbances and increase the risk of thromboembolic complications. The aim. To analyze the latest publications on the topic. The material for the analysis were the papers published by the leading arrhythmological clinics. Discussion. This paper describes the origin of the term “atrial cardiomyopathy”, highlights the conditional classification of changes in the atrial myocardium according to the EHRAS classification. The causes of this nosological form may be some types of gene mutations, as well as hypertension, congestive circulatory failure, diabetes mellitus, myocarditis, etc. ACs play an important role in the occurrence of atrial fibrillation (AF) and also affect its natural course and treatment outcomes. Electroanatomical mapping and magnetic resonance data show significant fibrotic changes in the atria in individuals with this form of arrhythmia. The DECAAF study (Delayed enhancement MRI and atrial fibrillation catheter ablation) showed that fibrotic changes in the atrial myocardium are directly related to the frequency of recurrent arrhythmias after catheter ablation. The DECAAFII study confirmed the effectiveness of the influence on the fibrous substrate in the catheter treatment of AF at stages 1 and 2 of fibrosis. The results of catheter treatment depend on the severity of fibrosis, which shows the importance of taking this factor into account when determining the indications for ablation. Conclusions. Thus, AC is an important component of the pathogenesis of AF. Improvement of techniques for influencing the fibrous substrate will improve the results of catheter treatment of AF.

Pneumonia presents a considerable challenge in patients with cardiovascular disease due to an increase in the incidence, difficulties of diagnosis and treatment, high mortality. Aim: to study the characteristics of cardiac arrhythmias and heart rhythm autonomic regulation in patients with chronic coronary syndrome (CCS) and community-acquired pneumonia (CAP), and to define their relationship with the clinical features of the disease. Materials and methods. A monocenter cross-sectional study analyzed 90 patients with CCS in parallel groups. The main group included 60 CCS patients with CAP; the control group consisted of 30 patients without concomitant CAP. A complex clinical examination of patients was performed on 1–3 days of hospital stay in accordance with the National Recommendations. Holter ECG monitoring was performed using a CARDIOSENS K device (XAI-MEDICA, Ukraine). Results. Based on the results of 24-hour ECG monitoring, heart rhythm disorders, increased duration of myocardial ischemia and ST-segment depression depth with an increase in the total duration of tachycardia episodes within 24 hours were more common in the main group patients. The severity of CAP on the PSI/PORT scale was correlated with the 24-hour mean heart rate (r = +0.31, P < 0.05), the number of ventricular extrasystoles – with respiratory rate (r = +0.29, P < 0.05), supraventricular extrasystoles – with the duration of ST-segment depression (r = +0.57, P < 0.05). In patients with CCS and CAP, there was a decrease in the total heart rate variability (HRV), mainly in the passive period, combined with an increase in the LF/HF ratio and stress index (SI), which was directly correlated with the severity of CAP and intoxication syndrome. Conclusions. Patients with CCS and CAP are characterized by the increased 24-hour heart rate, duration of ST-segment depression, frequency of supraventricular and ventricular arrhythmias on 24-hour Holter monitoring, paroxysms of atrial fibrillation with the decreased total HRV combined with significantly increased activity of the sympathetic autonomic nervous system.

The article describes a rare clinical case of hyperkalemia backgrounded by type 1 diabetes mellitus with signs of acute cardiovascular insufficiency, arrhythmia and QRST disturbances which was primarily diagnosed as acute coronary syndrome with ST elevation. Coronary angiography excluded pathology of the coronary arteries. Hyperkalemia, as the cause of ECG changes, was suspected in the hospital treatment. Stabilization of the patient’s condition, renewal of heart rhythm and conduction was obtained against the background of infusion support and insulin therapy. The pathogenesis of arrhythmia and QRST complex had a secondary genesis in relation to fluid and electrolyte metabolism disorders, so the restoration of sinus rhythm occurred without usage of antiarrhythmics. The usage of antiarrhythmic drugs according to the guideline of management of patients with ACS can deepen electrolyte shifts and lead to fatal arrhythmias in conditions of insulin deficiency and hyperkalemia. This example illustrates the urgent need to diagnose life-threatening electrolyte changes, namely hyperkalemia, under the guise of acute coronary syndrome, as well as signs of ACS, along with ECG, to pay special attention to the assessment of medical history and clinical data for the correct choice of emergency care and further treatment tactics.

Introduction and purpose: Acromegaly is a rare disease which occurs with the frequency of 0.2-1.1 cases per 100 000 patients per year. The main cause is the excess level of growth hormone (GH) which stimulates the liver to the insulin-like growth factor type 1 (IGF-1) secretion. IGF-1 leads to the tissues overgrowth. In addition, acromegalic patients suffer from many comorbidities, such as: cardiovascular, endocrinological, neoplastic and musculoskeletal complications. The main aim of this review is the update of the latest information concerning cardiovascular comorbidities in patients with acromegaly.State of knowledge: Studies revealed that 80% of acromegalic patients will develop cardiovascular comorbidities. Complications such as: hypertension, cardiomyopathy, arrhythmia, heart valve disease, atherosclerosis and coronary heart disease as well as myocardial infarction were the most widely described. They are responsible for 44% of deaths in the first decade of the acromegaly and 23% in the second one.Conclusions: Because of the delayed diagnosis of acromegaly in most patients, most comorbidities are discovered in advanced stages leading to the decrease in patients’ life span. Adequate knowledge about potential complications is necessary to increase patients’ quality of lives.

INTRODUCTION Acute dizziness (AD) can be a manifestation of a large number of diseases, including both benign pathology and life-threatening conditions, particularly stroke. In his diagnostic search, the doctor can adhere to two tactics: the exclusion of peripheral vestibulopathies (the most common cause of AD), and the identification of symptoms of damage to the central nervous system.AIM OF STUDY Comparison of instrumental research methods data with the clinical picture in patients with AD.MATERIAl AND METHODS We examined 160 patients admitted to N.V. Sklifosovsky with the only or leading complaint of dizziness. In all patients neurological status was assessed, Dix–Hallpike (DH) and Pagnini–McClure (PMC) positional maneuvers, Halmagyi–Curthoys (HC) test, duplex scan of brachiocephalic arteries, transthoracic echocardiography, computed tomography, and magnetic resonance imaging were performed. brain. In patients with suspected cardiogenic cause of dizziness, the diagnostic search included 24-hour Holter ECG monitoring.RESUlTS The frequency of some symptoms differed in patients with acute cerebrovascular accidents (ACVA) and other diseases. In patients with stroke such symptom, as postural instability was statistically more frequently detected than in patients with other causes of dizziness (44% vs. 6%, p

Introduction. Atrial fibrillation is the most common supraventricular arrhythmia which is also a frequent cause of calls by Emergency Medical Services Teams.The purpose of the work was presentation of the conduct of the Medical Rescue Teams in about patients with atrial fibrillation. Research methodology. The study included an 86-year-old woman who was called by the Medical Rescue Team due to increasing weakness accompanied by chest pain and dyspnoea. At the patient after a thorough medical history and physical examination, the first episode of atrial fibrillation was found. An individual case study method was used. The study was conducted on the basis of a medical rescue cardthose. Conclusions.There is no one size fits all regimen for the management of patients with atrial fibrillation. There are algorithms that facilitate the implementation of appropriate treatment. The rescue operation must always be tailored to the individualthe patient's health status and modified as necessary. Thanks to this procedure, paramedics minimize the chances of making a mistake and improve the patient's health.

Introduction. Cardiovascular disease occupies an important place throughout the world, which necessitates the development of more effective modern means of diagnosis and treatment. The primary diagnosis of heart disease is based on analysis and processing of an electrocardiogram (ECG). Despite the fact that there are many methods and algorithms for ECG analysis and processing, one of the urgent problems of cardiology remains to obtain the most complete information about heart electric potential, respectively, the behavior of the waves P, Q, R, S and T.Aim. Development of algorithms and software for processing and analysis of electrocardiograms (ECGs), as well as calculation of heart rate and detection of arrhythmias based on Labview.Materials and methods. The methods for removing noise using the wavelet transform method to eliminate baseline deviation ,to extract ECG signs ,to calculate heart rate and to detect arrhythmias based on Labview have been adopted as a mathematical apparatus for processing and analyzing ECGs.Results. Organizing of the ECG database, developing algorithms for converting the ECG file of the database into a useful format for Labview, processing of the ECG signal with removing noise from the original ECG signal, extracting signs for obtaining ECG diagnostic indicators, calculating heart rate and detecting arrhythmias.Conclusion. An analysis of the results demonstrates that systematic approaches to evaluating ECG signals allow to avoid one-way decisions and to integrate different methods into an integrated system of ideas of the state. The implementation of the proposed algorithms using Labview programming system ensures the removal of noise and artifacts, the extraction of the necessary ECG signs, the calculation of heart contractions and the detection of arrhythmias.

Aim of investigation is to research properties of patients at remote period after mitral valve replacement (MVR). At ana-lyzed group are included 634 patients with mitral valve diseases, which were treated by MVR in National Amosov Institute of cardiovascular diseases from 1st January 2005 to 1st January 2007. Average being of research was 7.3 ± 0.9 years. Following values of research at 10-year step: survival 69.4%, stability of good results – 57.3%, freedom from thromboembolic events – 79.7%, freedom from reoperations – 95.4%. Plasty of LA was performed in 57 (10.1%) patients. Maze procedure was oc-cured in 39 (6.9%) patients. Concomitant tricuspid malformation (TV annuloplasty) was observed in 135 (23.7%) patients. Concomitant CABG was observed in 93 (5.0%) patients. Previous heart surgery (mainly closed mitral commissurotomy) had 129 (21.4%) patients. Reoperations were occured: thromboses (panus, paraprost. fistula) of mitral prostheses (n = 5), endocarditis (n = 3). AV blockade (pacemaker) was occured in 9 (1.6%) patients. Best results of mitral valve replacement were observed in remote period in patients at II–III NYHA class with presence of sinus rhythm. Patients must be followed-up with tightly observation especially risk group–IV functional class, atrial fibrillation, concomitant tricuspid valve diseases, left atriomegaly (diameter of 6.0 cm or more), ejection fraction less than 0.45, high pulmonary hypertension (PASP > 70 mmHg), CABG + progressive ischemic heart disease, left ventriculomegaly (ESVI > 95 ml/mq), female, age more than 60 years. Mitral valve replacement with operation Maze allows successfully renew sinus rhythm on a hospital stage, and stabilize it well during half-year after operation.

Mutations in the LMNA gene cause developing of several phenotypes, both with isolated involvement of cardiac, muscle, adipose and bone tissues, and with their combination. The dominance of cardiovascular signs in the clinical performance and false clarity in nosology definition can cause underestimation of subclinical markers of other systems partaking. It leads to an incorrect interpretation of the true disease etiology, failure in genetic diagnostics, and untimely determination of the correct management and prognosis. The article presents clinical cases that demonstrate both the most typical manifestations of laminopathy and rare combinations of symptoms, which represent a certain diagnostic difficulty.

Aim. To study the myocardial morpho-functional abnormalities, the incidence and nature of cardiac arrhythmias in patients 3 months after the coronavirus disease 2019 (COVID-19).Material and methods. The study included 77 patients (mean age, 35,9 years) treated for coronavirus infection, which underwent echocardiography and 24-hour Holter monitoring 3 months after COVID-19. The patients were divided into 3 groups: group 1 — 31 patients with upper respiratory tract involvement; group 2 — 27 patients with bilateral pneumonia (CT grade 1, 2), 3 — 19 patients with severe pneumonia (CT grade 3, 4). Statistical processing was carried out using Statistica 10.0.Results. According to echocardiography, the peak tricuspid late diastolic velocity and isovolumetric contraction time in all groups increased (P

Aim. To optimize treatment tactics in children with arrhythmias based on the evaluation and prediction of the therapy efficacy.Material and methods. Prospective cohort study was performed from 2007 to 2017 A total of 100 patients aged 0 to 7 years with different types of significant arrhythmias received prophylactic antiarrhythmic therapy. Data of medical history, 12-lead electrocardiography (ECG), Holter ECG monitoring, and echocardiography were studied. To verify electrophysiological variant of tachycardia, some patients underwent transesophageal electrophysiologic study.Results. The study showed that antiarrhythmic drug therapy was most efficacious in patients till one year old without signs of arrhythmogenic cardiomyopathy (ACM). Older age of children, the presence of pronounced ACM manifestations are factors that increase the risk of ineffective AAT. Based on the data obtained, a multifactor model was developed to predict the effectiveness of prolonged antiarrhythmic therapy.Conclusion. The study showed that age and intracardiac hemodynamic status affected the efficacy of antiarrhythmic therapy. Proposed model allowed to avoid unnecessary prolonged pharmacological load and to timely administer other methods of treatment in case when ineffective result of the antiarrhythmic therapy was predicted.

This paper presents a study of heart rate variability indicators based on a phase-frequency analysis of an electrocardiogram. As part of the task of diagnosing the state of drowsiness and stress of vehicle drivers, a method for determining the level of wakefulness is described. We studied electrocardiograms with deviations of the heart rate from the normal signals. Examples of the analyzed signals, their parameters, as well as analysis results are given. Based on the obtained data, it is planned to build a multi-threshold analysis system.

The article presents a method of phase-frequency spectral analysis of an electrocardiogram signal for use in portable arrhythmia detectors. The selection of spectrum values for differentiating between normal and abnormal QRS complexes of the electrocardiogram signal is describe. Sample spectra for various QRS complexes of real life signals are given. We developed an algorithm for detecting arrhythmias and further distinguishing them. The results that was obtained by spectral analysis should be used to prevent the development dangerous type of arrhythmias and their timely exposure detection.

Aim. To study the structural and functional cardiac changes and arrhythmias in patients with type 1 diabetes (T1D) complicated with ketoacidosis.Material and methods. We analyzed 24-hour Holter monitoring data in 112 patients with T1D complicated with diabetic ketoacidosis (DKA). To assess the left ventricular (LV) diastolic function, all patients underwent echocardiography.Results. In patients with T1D complicated with DKA, the following cardiac arrhythmias were recorded: supraventricular arrhythmias — 60,7%, premature ventricular contractions — 26,2%, premature ventricular and supraventricular contractions — 13,1%. In 30% of patients with T1D complicated with DKA, premature ventricular contractions were classified as class 4A, in 10% — class 4B. With severe DKA, 5% of patients had short runs of unstable ventricular tachycardia. As the severity of ketosis increases, myocardial remodeling and LV diastolic dysfunction are recorded, as well as the spectral and temporal parameters of heart rate variability decrease.Conclusion. In patients with T1D complicated with DKA, structural and functional LV abnormalities, the development of LV diastolic dysfunction and cardiac arrhythmias are more often recorded. The most pronounced changes were found in the group of patients with T1D with moderate and severe DKA.

The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC)Developed in collaboration with the Association for European Paediatric and Congenital Cardiology (AEPC)

Background. The study of ECG measurements is closely related to ventricular ectopy and the analysis of their relationship to autonomic regulation provides the basis for new ways of diagnosis and treatment of risk-stratified markers of sudden cardiac death. The aim of the study was to develop new approaches to prediction and prevention of life-threatening arrhythmias in patients with myocardial infarction and people with high and very high cardiovascular risk by the SCORE scale. Material and methods. We have analyzed the protocols of Holter monitoring of heart rate of patients with coronary heart disease and those with cardiovascular disease risk factors by the SCORE scale. Results and conclusions. We have established, that people with high cardiovascular risk by the SCORE scale have high stress level, and those with very high cardiovascular risk have the same indicators of heart rate variability, as in people with cardiovascular disease.

An analysis of 293 victims with cardiac and pericardium injuries was made. Cardiac complications could appear suddenly and be registered on any stage of treatment process. They differentiated by character and duration of wound process. Pericarditis took place in 288 patients. The syndrome of system inflammation reaction was noted in 47,9% of patients, a sepsis (sometimes severe sepsis) was in 14,3%. Complications in postoperative period were determined by posthypoxic and hemic hypoxia, coagulopathy. They were manifested by myocardial ischemia and thromboembolic complications. An acute myocardial infarction took place in 29 (9,8%) cases and rhythm and conductivity abnormalities were in 23 (7,8%) patients. The circulatory failure with clinical picture of pulmonary edema was developed in 12 (4,1%) cases. The lethality consisted of 44 (15%) patients.

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The study objective to estimate the clinical manifestations of infectious myocarditis in men compared to women in real clinical practice.Materials and methods. A retrospective analysis of medical records from 2011 to 2015 of patients with infectious myocarditis that were hospitalized in the cardiology department No. 1 “Regional Clinical Hospital”. We compared the clinical manifestations of myocarditis in men and women. Statistical data processing was carried out with StatPlus 2009 Professional package.Results. In group of men with moderate myocarditis heart disruptions was a dominated complaint (75 %) in group of women with a similar degree of severity of the disease this complaint was also a major (71 %). However women were significantly more marked hyperthermia in this subgroup compared with men (57 % in females and 25 % males (p < 0.05)). In the subgroup with severe myocarditis in both sexes equally the most common complaint was disruptions in heart; the dyspnea was significantly more often and harder identified among men compared with women (92 % vs 72 % (p < 0.05)). In the structure of cardiac arrhythmias and heart blocks different variants of extrasystoles were significantly more often in women (64 % vs 39 % (p < 0.05)), the atrial fibrillation was more typical for men (36 % vs 28 % (p > 0.05)). The conduction abnormalities were registered in group of women.Conclusions. The clinical manifestations of infectious myocarditis in men and women revealed some interesting features. Dyspnea with severe myocarditis in men is registered more often than in women, probably due to the higher rate of smoking among men, as well as the presence of chronic obstructive pulmonary disease patients in our study. At moderate myocarditis in women hyperthermia dominated compared with men. Cardiac arrhythmias in myocarditis occur with equal frequency in both men and women, the most common extrasystoles recorded in group of women, atrial fibrillation in our study was prevalent in men. Conduction abnormalities were harder and more common in women.

Aim - to highlight current aspects of the concept, etiology, pathogenesis and prevention of sudden cardiac death. Discussion. Sudden cardiac death in a wide sense is known as non-violent death due to cardiac pathology, with the rapid development of circulatory arrest, which is preceded by loss of consciousness. Sudden cardiac death is often the first and only manifestation of coronary heart disease, and it occupies a vast niche in mortality from cardiovascular pathology. Despite the high prevalence, there are many controversial and unresolved issues regarding the pathogenesis of the sudden cardiac death. There are some difficulties with the precise definition of this diagnosis. Conclusion. The review considers the concept of sudden cardiac death, presents several theories of pathogenesis, risk factors, which are thoroughly analyzed and synthesized. Methods of primary and secondary prophylaxis are analyzed, and comparative characteristics of medicinal substances used for prevention of sudden cardiac death are given.

Objective – to study features of cardiac rhythm disorders and conduction disturbances in patients with arterial hypertension. Methods of the study. Under our observation there were 110 patients with first-third degree hypertension stage II, aged 38 to 72 years (mean age – 50.63 ± 1.34 years). The gender distribution of patients was as follows: 61 female (55 %) and 49 male patients (45 %). The control group comprised 30 healthy individuals, of whom 13 were male and 17 female (43 % and 57 % respectively) and whose mean age was 49.75 ± 1.83 years. Cardiac arrhythmias and conduction disorders were detected by means of Holter ECG. Statistical analysis was carried out on a personal computer, using such programs as Excel-7.0 (Microsoft Corp., USA) and «Statistica® for Windows 6.0» (StatSoft Inc., License number AXXR712D833214FAN5) through parametric and nonparametric methods. Results. Cardiac arrhythmias were found in 71 (65 %) patients with arterial hypertension and were characterized by the presence of supraventricular extrasystole in 43 (39 %) patients and paroxysmal atrial fibrillation in 10 (9 %) patients. Ventricular extrasystole and episodes of unstable ventricular tachycardia were diagnosed in 13 (12 %) and 5 (5 %) patients, respectively. In hypertensive patients supraventricular arrhythmias were detected in 2.8 times more likely (p < 0.01), and single ventricular premature beats – 6.2 times more likely (p

Aim. To study changes in course of arrhythmias, depending on the efficacy of coronary blood flow restoration due to pharmacoinvasive revascularization in patients with ST segment elevation myocardial infarction (STEMI).Material and methods. STEMI-patients (n=117) with an effective (according to ECG criteria) thrombolytic therapy (TLT) and the subsequent (after 3-24 hours) percutaneous coronary intervention (PCI), were included into the study. Telemetry ECG was performed before and after PCI with analysis of the arrhythmias and cardiac conduction disorders.Results. Patients (n=84; 71.8%) with an effective TLT, confirmed by the coronary angiography (CAG), and with subsequent effective PCI were included into the group "without rethrombosis" (RT(–)). Patients (n=33; 28.2%) with CAG proven rethrombosis of the infarct-related coronary artery and subsequent effective PCI were included into the group "with rethrombosis" (RT(+)). Regardless of the stability of coronary blood flow restoration after the TLT, PCI was associated with an increased incidence of ventricular tachycardia (VT) (p

Analysis of the data of progesterone effect on cardiovascular system, bone and muscle function, and nervous system were presented in the paper. Possible effects of progesterone activity inhibition are discussed. Physiological progesterone concentration characterized by its protective effect on cardiovascular system. It was demonstrated in the literature that progesterone significantly influence repolarization process in cardiomyocytes and shorten QT interval. At the same time QT-interval prolongation is a strong marker of the risk of arrhythmia. Also, the hormone decreases apoptosis of cardiomyocytes and increase NO production. Different effects of progesterone on lipid metabolism are described in the paper. Data concerning progesterone influence on central nervous system and its ability to regulate human behavior and influence on the risk of depression and cognitive disorders are given in this review. Progesterone protection effects in patient survived stork are known now. Anabolic effect of the hormone and its ability to increase muscle mass are highly important to maintain women health. Analysis of the data of both branch and clinical studies suggests that the drug interacts with the progesterone receptor and glucocorticoid and less with the androgen receptors (to testosterone). The data showed lack evidence of safety profile for long-term use of mifepristone, the duration of most clinical trials do not exceed 6 months, and more often presented in a dose of 5–10 mg per day. Also, two clinical cases of arrhythmia onset during long-term therapy with mifepristone due to leiomyoma are given to illustrate possible side effects. Without a doubt, scientific data about the safety of long-term use of mifepristone demonstrate the necessity of randomized clinical trials to study possible side effects of the drug on cardiovascular system, bone, muscles and nerves system as well as its metabolic effects.

We have collected, processed and analyzed the results of treatment of 329 patients with gastrointestinal bleedings in which the course of the underlying disease is aggravated by the pathology of the cardiovascular system, in Communal institution "Dnipro Clinical Emergency Care Association" of Dnipro City Council» in the period for 2017. First, the frequency of background diseases was determined, chronic pathology being 93.4%. Ischemic heart disease (IHD): cardiosclerosis of various origins (post-infarction, diffuse, atherosclerotic), hypertonic disease (HD) - HD-I, HD-II, HD-III are the most common, while acute disorders of cerebral circulation, the state after coronary artery bypass surgery, renal artery bypass, arrhythmias, acute myocardial infarction made up 16 (5%), 1 (0.3%), 3 (1%), 1 (0.3%), respectively. Secondly, the quality of endoscopic hemostasis in case of ulcerative bleeding from the stomach, duodenum, gastroenteroanastomosis, was assessed by Forrest classification, connecting the results with the accompanying pathology of the cardiovascular system. We found that active bleeding F I was determined in 24 people (7.3%), of which F Ia - in 14 (4.3%), F Ib - in 10 (3%). Unstable hemostasis with a high risk of recurrent F II bleeding, was observed in 251 patients, which makes up 76.2%, and F III - in 54 (16.5%). The degree of blood loss was directly influenced by drug - anticoagulants, antiplatelet agents, hypotensive drugs, as well as their combinations, aimed at correcting the rheological properties of blood. Depending on the degree of blood loss, the quality of hemostasis, the general condition of the patient, the treatment tactics for this cohort of patients was determined. 313 patients received conservative treatment, which made up 95.1%. 16 patients were operated. Postoperative mortality is 12,5%. The overall mortality of the above cohort is 10%. [ABSTRACT FROM AUTHOR]

Aim: To assess prevalence of certain cardiac arrhythmias and conduction disturbances in the Russian population of systemic sclerosis patients using standard 12-lead and 24-hour electrocardiography (ECG); to estimate correlation between cardiac arrhythmia and clinical features of systemic sclerosis. Materials and methods: 80 systemic sclerosis patients and 60 sex- and age-matched controls were included. All patients underwent standard 12-lead and 24-hour ECG. Results: Arrhythmias on standard 12-lead ECG were demonstrated in 14 patients (17.5%) including sinus arrhythmia in 2 cases and premature beats in 13 cases (16%). Supraventricular (SV) and ventricular (V) ectopic beats were recorded in 5 (6%) and 7 (9%) patients, respectively; in one patient both SV and V ectopic beats were found. ECG signs of focal fibrosis were demonstrated in 9 patients (11%). In 24-hour ECG, frequencies of SV and V ectopic beats were 40 and 65%, respectively. Compared to the controls, systemic sclerosis patients had significantly higher prevalence and severity of cardiac arrhythmia. 36% of patients had high grade ventricular premature beats, associated with potential risk of life-threatening arrhythmia and sudden cardiac death. Conclusion: Cardiac arrhythmias and conduction disturbances are found in the majority of patients with systemic sclerosis. Standard ECG does not reflect true prevalence of cardiac arrhythmia in systemic sclerosis. In systemic sclerosis patients, 24-hour ECG is recommended as obligate method for initial examination and treatment efficacy control.

The article discusses the development and implementation of a portable analyzer arrhythmias, electrocardiographic signal analysis technique for the presence of arrhythmias. The block diagram of the algorithm realizing the technique of the analysis arrhythmias is developed and presented. Filters for decrease of a noise level in a signal are offered. For these filters are chosen and resulted theirs types and characteristics.

Purpose: to study the changes in psychological status, autonomic nervous system, as well as their relationship to the level of biogenic amines blood arrhythmias of various types and origins on the background of a combined treatment of anti-arrhythmic and psychotropic drugs.Materials and methods: surveyed, 95 patients (mean age of 45,2 +1,24 years), 42 men and 53 women with ekstrasystolichniy fibrillation, paroxysmal supraventricular tachycardia, atrial fibrillation on the background of coronary artery disease and vegetative dysfunction. Psychological testing conducted scales anxiety of Spilberger, depression Tsung, Hamilton, test RESINS, the content of biogenic amines in the serum were determined using a sensitive method in the sample.Results: the revealed disorders of autonomic balance, increased levels of anxiety, depression, poorer quality of life, reducing the protective functions of the CRL of the body.Summary: combined therapy, including activators SLS had a more pronounced antiarrhythmic effect, contributed to the stabilization of the ANS, and resolved the levels of biogenic amines is more effective than on the background of basic therapy.

This review covers various aspects of etiology, pathogenesis and modern methods of prevention and treatment of postoperative arrhythmias after heart transplantation.

For today there are convincing evidences of beneficial effect of ω-3 polyunsaturated fatty acids (PUFA) - eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids – in a number of cardiovascular diseases. Efficacy of ω-3 PUFA was confirmed by results of the large-scale clinical trials. Data on ω-3 PUFA efficacy in heart failure and cardiac arrhythmia were received, besides their well-known hypolipidemic effect. Low level of ω-3 PUFA biomarker , ω-3 index (content of EPA and DHA in erythrocytes), is considered as a risk factor of coronary heart disease as well as a risk factor of fatal arrhythmias. Use of standardized medicinal product with high content of EPA and DHA leads to the positive therapeutic effect in patients with different cardiovascular diseases.

Aim. To study effect of long-acting theophylline (Theotard, KRKA) and combination of salmeterol and fluticasone (Seretide, GlaxoSmithKline) on heart rhythm variability (HRV) and number of arrhythmic episodes in patients with chronic obstructive pulmonary disease (COPD).Material and methods. 144 patients with COPD and 35 patients of control group were examined. The analysis of HRV and Holter monitoring were made f on 2th and 14th days.Results. Treatment with both drugs led to increase in power of low- and high frequencies and their ratio (LF/HF), decrease in rate of supraventricular and ventricular arrhythmias. Theophylline therapy raised in a number of single and pair supraventricular extrasystoles. Treatment with combination of salmeterol and fluticasone did not change a number of extrasystoles.Conclusion. Combination of salmeterol and fluticasone is more preferable as a broncholytic therapy for patients with COPD and heart rhythm disorders.

Highly selective β-adrenoblockers (β-AB) are used in pregnant women with cardiovascular diseases (arterial hypertension, arrhythmia, Marfan syndrome, hypertrophic cardiomyopathy). β-AB fall into the category C according to safety classification of Food and Drug Administration (US FDA). Their prescription in different clinical situations meets the principle of "risk–benefit". Fetus and newborn status should be monitored because β-AB can cause bradycardia, hypoglycemia, apnea and metabolic disorders. The risk of these side effects is extremely low, while β-AB clinical efficacy is high.

Aim. To reveal the factors determining prognosis in patients with morphologically documented myocarditis presented with rhythm disorders.Material and methods. Totally, 75 patients studied with lymphocyte infiltration myocarditis, 22 patients with dilated cardiomyopathy (DCMP). All patients underwent standard echocardiographic investigation, enhanced magnetic-resonance tomography, endomyocardial biopsy, viral genome molecular test, standard laboratory panel and autoantibodies profile in blood serum. Control group included 30 almost healthy individuals.Results. There were no established differences between the groups with or without rhythm disorders by the activity of inflammatory process and prevalence of viral genome finding in myocarditis patients. The similarity was found for autoantibodies profile in DCMP and myocarditis with rhythm disorders that probably related to fibrous changes in myocardium.Conclusion. The course of arrhythmia development in inflammatory myocardium diseases has complicated multifactorial nature related to a direct harm by infection, to development of autoimmune reactions and structural remodeling of myocardium. Not the arrhythmias influence prognosis, but structural changes in myocardium associated with the decrease of its global contractility.