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Background. Until now, the issue of surgical treatment staging in patients with aortic pathology coexisting with coronary artery disease and atherosclerosis of the peripheral arteries remains controversial because of features of each clinical situation and association with the risk of periprocedural life-threatening complications (ruptured aortic aneurysm, myocardial infarction, stroke).Objective. Present a clinical case of successful treatment of a patient with an abdominal aortic aneurysm, clinically significant lesions of the coronary and carotid arteries.Design and methods. Diagnosis was carried out using computed tomography of the aorta with intravenous contrast. Instrumental examination included electrocardiography, echocardiography (EchoCG), ultrasound dopplerography of the BCA. Coronary angiography with BCA angiography was also performed.Results. Clinical diagnosis is an ischemic heart disease, angina pectoris III FC, chronic heart failure II FC and atherosclerosis of the aorta. Aneurysm of the abdominal aorta (diameter 96 mm), stenosing atherosclerosis of the BCA, PVCA stenosis 80 % and occlusion of the LVCA were observed. Patient had hypertension stage III and risk of CVE 4. Firstly, the patient was underwent stenting of the right internal carotid artery, than coronary artery bypass grafting and on the last stage he was performed — endovascular aotric repair. There were no complications in the perioperative period.Conclusions. Endovascular repair of abdominal aotric aneurysm is an effective method of treating patients with comorbid conditions. However, it is possible the development of fatal cardiovascular complications in patients with combined atherosclerotic lesions of brachiocephalic and coronary arteries that is why they are required a multidisciplinary approach for choosing a safe treatment strategy.

Background. Atherosclerotic disease of the arteries of the lower extremities or peripheral arterial disease (PAD) affects both men and women. PAD can be combined with the damage of other vascular regions, which is defined as multifocal atherosclerosis (MFA) and suggests the most severe course of the disease and an unfavorable prognosis of patients. The high risk of cardiovascular complications determines the importance of active secondary prevention in patients with PAD and MFA. Data on the frequency of MFA, characteristics of risk factors (RF) and their treatment depending on gender are limited in the literature.Objective. To study the prevalence of atherosclerotic lesions, RF for atherosclerosis and their treatment at out-patient stage in men and women with PAD referred for surgical treatment. Design and methods. According to medical records analyzed the results of a survey of 65 men and 26 women consecutively admitted to the department of cardiosurgery of the Almazov National Medical Research Center from January 2018 to January 2019 for surgical treatment. All patients underwent duplex scanning (DS), X-ray or CT-angiography of the arteries of the lower extremities, 49 patients underwent coronary angiography, and 72 patients underwent DS or CT-angiography of the brachiocephalic arteries (BCA).Results. The average age of men and women did not differ significantly. The most common RF were hypertension and current smoking or the PAD. Smoking was observed less frequently in women. Data on lipid profile were available in 62 patients (68 %), the level of low-density lipoproteins (LDL) was determined in 22 subjects (24 %). The incidence of dyslipidemia and diabetes mellitus did not differ significantly in both groups, however, fasting hyperglycemia was found in 9 women without diabetes mellitus (50 %). The target LDL level was achieved only in 3 men. Two or more RF were detected in 87 % of patients; the groups of men and women did not differ in the number of RF. Signs of involvement of one arterial region were found in 18% of patients, two regions — in 48%, three regions — in 28% without differences in men and women (p > 0,05). In combination with PAD, men were more likely to have coronary artery (CA) disease than women (p < 0,05); the incidence of BCA lesions did not differ significantly (p = 0,02). Women less often, although not significant, received statins (69% versus 84%), beta-blockers (46% versus 66%), antiplatelet agents (77 % versus 84,6%).Conclusions. Both men and women hospitalized for surgical treatment of PAD have multiple RF of comparable frequency, with the exception of smoking. Regardless of gender, the majority of patients show signs of MFA with predominant CA disease in men. The absence of significant differences in the number of RF and the frequency of MFA in men and women may be associated with the presence of comparable severe clinical manifestations of PAD, which determine the indications for revascularization of the lower extremities. The evaluation of patients is inadequate: not all patients have controlled cholesterol and LDL levels, tests are not performed in women with fasting hyperglycemia to exclude diabetes mellitus and prediabetes. There is a clear trend towards less active secondary prevention in women.

The incidence of cardiovascular complications in non-cardiac surgery is about 3 %. The review presents the data on the assessment of cardiovascular risk (CVR) in non-cardiac surgery. The algorithm of decisionmaking considers the functional state of the patient and the category of CVR of the upcoming surgery. Functional testing is not indicated for patients with low CVR. Stress tests should be considered in high-risk patients if the test results may change the perioperative drug therapy, the method of anesthesia, or the surgical approach. Routine coronary revascularization does not reduce perioperative risks and is used for special indications. Percutaneous coronary intervention and associated dual antiplatelet therapy may delay the timing of non-cardiac operations. Perioperative drug therapy (beta-blockers, aspirin, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and statins) should be prescribed taking into account the individual risk of the patient.

The paper reviews the role of registries in clinical practice and their difference from randomized clinical trials. The article focuses on the use of registries and databases in the management of patients undergoing revascularization surgery, and on the particular need for the registry of patients who underwent planned bypass surgery.

The problem of optimal control of a single-sector economics over a finite time interval was studied for the class of the linear uniform production functions in terms of the criterion for maximum employer consumption under exponential growth of the manpower resources. Solution was obtained in the form of the "turnpike theorem." Its properties were considered. The results obtained were specified for the case of the Cobb-Douglas production function.

Norepinephrine, blockers of beta-adrenoreceptors, angiotensin-converting enzyme inhibitors and angiotensin I receptor blocker were investigated in organotypic tissue culture of cardiomyocytes of 10-12-day-old chicken embryos and newborn rat heart in a wide range of concentrations. The data obtained show that low concentration of norepinephrine led to the cardiomyocyte growth control. The application of beta-adrenoblockers metoprolol and atenolol prevented stimulating effect of norepinephrine. Zofenopril inhibited the growth of cardiomyocytes but enalapril had no effect on this process. The effect of angiotensin I receptor blocker depended on concentration - low concentrations resulted in activation of cardiomyocyte growth; and high concentrations led to the decrease of their growth.

The review addresses modern concept of calcium antagonist pharmacological properties which allow to use them in patients with hypertension and concomitant coronary artery disease. The antihypertensive, antiischemic and antiatherosclerotic effects of calcium channel blockers are discussed as well as influence on arterial elasticity and safety reasons.

Whether 24-h ECG monitoring (ECGM) may be used in detection of multiple arterial obstructions in anginal patients and to compare diagnostic efficacy of ECGM and bicycle exercise (BE) in prediction of 2 or 3 lesions was investigated in 137 patients subjected to ECGM and selective coronarography. 117 of them did bicycle exercise. The number of episodes of painful and painless myocardial ischemia in ECGM was related with the extension and depth of the coronary flow obstruction. The overall index of myocardial ischemia has been estimated warranting higher probability of detection of subjects with obstruction in 1 or more coronary arteries. Sensitivity and prediction value of ECGM was similar to those of BE, but the latter was more specific.

In twenty-eight men (the mean age 49.3 +/- 3.2 years) with different clinical varieties of angina pectoris, analysis was made of the heart rate and the grade of ischemic depression of the ST segment, associated with anginous attacks seen during bicycle ergometry and other physical exercises in the course of daily cardiomonitoring. The data obtained indicate that in the same patient, the same grade of ischemic depression of ST was recorded despite varying heart rate. On the contrary, in spite of the same heart rate the grade of ischemic depression of the segment could vary. Dynamic coronary obstruction determined by the mechanisms of adrenergic vasoconstriction is the most probable cause of changeability of the threshold of angina pectoris in patients belonging to functional classes III-IV. The probability of fluctuations in the threshold of angina pectoris should be taken into consideration in deciding expert problems and in the assessment of the efficacy of antianginal therapy.

To study the role of the vasospastic factor in the etiology of CHD pain forms a total of 326 patients were examined using coronary angiography, of them a test with i. v. administration of ergometrine was made to 117. An analysis of the peculiarities in the CHD course showed that angina destabilization usually associated with the addition of a dynamic component, could occur in a different duration of disease. The first clinical signs of CHD in more than half of the cases in a stable and unstable course of angina developed in the marked obstructive involvement of the coronary bed. Obvious vasospastic reactions in the ergometrine test were more frequently noted with recently developed unstable angina however they could occur in a different period of disease. The data obtained indicated that in most cases two mechanisms were involved in the development of angina: fixed coronary obstruction as a morphological basis of coronary insufficiency and spasm of the coronary arteries which could be a leading factor in a number of patients or determine angina instability.

Study of changes in the electrocardiogram during spontaneous attacks of angina pectoris has shown that out of 80 patients examined, 78 (98.6%) patients with angina pectoris at rest manifested ischemic-type changes in the end part of the ventricular complex of the ECG, whereas in 81% of the patients, rhythm and conduction abnormalities were recorded in addition. It has been established that during a spontaneous angina pectoris attack, the degree of an increase in the double product was lower while the degree of the ischemic depression of the ST segment was greater than during threshold load. Apparently, the reduction of the coronary blood flow rather than a dramatic increase in myocardial oxygen requirement plays the leading part in the pathogenesis of spontaneous attacks of angina pectoris.