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Objective. To study the clinical and laboratory features and the early post-infarction period in patients suffering from myocardial infarction with non-obstructive coronary arteries (MINOCA). Materials and methods. A survey of 62 patients hospitalized to the Republican Clinical and Diagnostic Center of the Ministry of Health of the Republic of Udmurtia with a diagnosis of "myocardial infarction" was conducted, 30 of whom had a single-vessel lesion of the coronary bed, 32 myocardial infarction without coronary artery obstruction. Results. Differences in the clinical manifestations of the acute period were noted by the presence of syncope, isolated shortness of breath, and a difficult-to-explain feeling in the chest. The time from the onset of symptoms to hospitalization in the MINOCA group exceeds 1.7 hours. The MINOCA group had a much higher level of markers of myocardial necrosis (troponin I level of 8.9 ng/ml compared to 1.75 ng/ml), despite a significantly lower frequency of detection of hypokinesia zones and the number of affected segments. Conclusions. It is necessary to improve public awareness of the symptoms of acute coronary syndrome, including its atypical manifestations. Routine PCI does not "save" from subsequent angina pectoris if it is present before MI.

Aim. To establish the factors, associated with myocardial damage while performing transcutaneous coronary intervention. Materials and methods. The retrospective analysis included 255 patients, distributed by the dynamics of creatine phosphokinase-MB in the blood after the surgery. Results. Myocardial damage while performing transcutaneous coronary intervention is interconnected with the period from the onset of symptoms to the surgery, initial levels of cardiac-specific markers, localization and degree of manifestation of coronary artery stenoses and endovascular interventions implemented. Conclusions. As a result, the factors associated with myocardial damage while performing transcutaneous coronary intervention were revealed and their concrete boarders were determined.

Aim. To assess the state of electrokinetic properties of red blood cells in different variants of the course of acute coronary syndrome (ACS). Materials and methods. The study deals with the assessment of clinical and laboratory-instrumental data from 201 patients with ACS, the results of electrokinetic parameters of red blood cells, their predictors. Results. According to electrokinetic indices of erythrocytes, no reliable differences between the groups were found out. The mean red blood cell oscillation amplitude (MRBCOA) in group 1 was 1.83 ± 0.05, in group 2 – 1.75 ± 0.06 (t = 0.955, p = 0.341). Stationary red blood cell percentage (SRBCP) in patients with NSTE-ACS was 15.6 ± 1.45, in patients with STE-ACS – 13.54 ± 1.64 (t = 0.957, p = 0.339). The methods of multiple disperse and regressive analysis were used. Predictors of SRBCP indices in NSTE-ACS group appeared to be intima-media complex thickness (IMCT), left ventricle diastolic dysfunction, coronary insufficiency index (CII); in STE-ACS group – IMCT, MRBCOA, troponin I and AST levels. In STE-ACS group, predictors of MRBCOA were SRBCP and troponin I level, in NSTE-ACS – no predictors, influencing MRBCOAwere revealed. Conclusions. In NSTE-ACS group, the following predictors, influencing SRBCP were detected:IMCT, CII, LV diastolic dysfunction. In patients of STE-ACS group, there were found the predictors, influencing electrokinetic properties of red blood cells: IMCT, AST, troponin I. In acute coronary syndrome, changes in electrokinetic parameters of red blood cells are mainly influenced by atherosclerotic process, however, in NSTE-ACS, structural-functional status of myocardium is of primary significance, and in STE-ACS – the degree of manifestation of resorptive-necrotic syndrome.

The problem of physician errors is resolved predominantly from position of empirical data. The related publications are inadequate due to subjectivism at disregarding methodological (formal logical and dialectic) laws of cognition of truth. This situation results in discrepancy and suspense of problem. most of the studies remain within the limits of critical but not positive (constructive) consideration of the problem. On balance authors receive no new knowledge. The article discusses methodological sources of subjective difficulties of implementing the role of physician. The solutions are proposed concerning certain aspects of the mentioned problem.

Aim. To carry out dynamic assessment of the structural and functional indices of cardiovascular system in young men with arterial hypertension (AH) associated with excess body mass (Ebm) against the background of therapy. Materials and methods. Examination of 86 young men aged 18-27 years, including the group of comparison with practically healthy persons ( n = 24) and the group of observation ( n = 62) was performed. The group of observation joined patients with AH without EBM and AH+EBM. The study was conducted initially and 6 months later. Patients with AH+EBM ( n = 25) were divided into 2 subgroups: group 1 (12 persons) without therapy and group 2 (13 persons) against the background of antihypertensive therapy. Results. Six months later, in group 1 there was observed a growth of “office” systolic arterial pressure (SAP) by 3,8 % (145,0 ± 2,88 and 150,54 ± 2,99 Hg mm), p = 0,001, but in the group with antihypertensive therapy, SAP decreased by 12,7 % (145,75 ± 2,80 and 129,33 ± 1,5 Hg mm), p = 0,01 and DAP - by 12,1 % (86,5 ± 1,95 and 77,16 ± 2,41 Hg mm), p = 0,02. Pulse wave propagation velocity (PWPV) along the vessels of muscular and elastic types among patients without therapy was found to grow in dynamics by 12,2 and 16,2 %, respectively. Against the background of therapy, there was a tendency to a reliable reduction in PWPV indices. Conclusions. Antihypertensive therapy in patients with AH+EBM, while decreasing AP, leads to reduction of LVMM, LVMMI, PWPV and IMCV. The early diagnosed lesion of target organs among young men with AH+EBM and timely antihypertensive therapy can improve structural and functional characteristics of cardiovascular complications.

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.

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

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

Effectiveness of laser acupuncture in 152 patients with different stages and forms of bronchial asthma and in 58 patients with chronic obstructive bronchitis in outpatient settings (76 men, 134 women) was studied.

We performed a course of treatment with the helium-neon laser L G-75 in the conditions of a polyclinic for patients with bronchial asthma (170 persons) and chronic obstructive bronchitis (90). Exposure to the laser beam was made taking into account the experience of reflexotherapy. Time of exposure to each biologically active point was 10 s with irradiation power of 25 mW (course - 15-20 procedures).