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Aim. To assess the effectiveness and safety of refralon based cardioversion on the experience of the cardiology department of Orenburg Regional Clinical Hospital.Methods. The archival medical histories of 14 patients with persistent atrial fibrillation (AF) and 2 patients with persistent atrial flutter (AFL) (overall 16 patients), who underwent an attempt to restore sinus rhythm with refralon, were analyzed. The mean age of the patients was 51.7±10.4 years. The mean duration of AF/AFL since its last detection was 8.0±6.5 weeks (from 8 days to 8 months). Fifteen patients had hypertension, 3 of them had coronary artery disease (CAD), and 1 patient had CAD with type 2 diabetes mellitus. One of the patients had lone AF. Before cardioversion, all patients underwent the following examination: clinical and biochemical blood tests, clinical urine tests, electrocardiography (ECG), echocardiography (Echo), transesophageal Echo, Holter ECG, the determination of the level of thyroid-stimulating hormone, thyroxine, electrolytes, including potassium and magnesium.Results. According to Echo, initially, the transverse size of the left atrium in patients was 4.3±0.3 cm. Its increase was noted in 68.7% of patients (from 4.3 to 5.0 cm). Restoration of sinus rhythm after the first step of refralon administration at a dose of 10 μg/kg was achieved in 8 patients, after the second step of administration (total dose 20 μg/kg) - in 5 patients and after the third step (total dose 30 μg/kg) - in 2 patients. In 1 patient, restoration of sinus rhythm was not achieved after the administration of the third bolus. Out of 15 patients with restored sinus rhythm, AF recurrence occurred in three. In one of the patients with successful cardioversion, the sinus rhythm was restored the next day. The duration of the last episode of AF and the size of the left atrium did not significantly affect the effectiveness of cardioversion and amounted to 62±54 days and 4.3±0.35 cm, respectively, in patients with successful cardioversion, and with a recurrence of AF - 34.3±28 days and 4.2±0.35 cm (p=0.2; р=0.6). The efficacy of cardioversion with refralon was 71.4% in patients with AF, and 100% in patients with AFL. No adverse events of refralon were found in patients.Conclusion. At the time of discharge, sinus rhythm was recorded in 12 out of 16 patients (75%). The ineffectiveness of cardioversion with refralon was noted only in patients with AF; in all patients with AFL the sinus rhythm was restored.

The article describes a clinical case of the occurrence of complex disorders of the heart rhythm and conductivity in a patient of 45 years with decompensated hypothyroidism. The literature data on specific cardiomyopathy appearing in patients with hypothyroidism (“hypothyroid heart”), metabolic, hemodynamic changes against the background of hypothyroidism and possible violations of heart rhythm and conductivity are given. In the described clinical case the patient’s medical history is given, who has been observed in an endocrinologist for hypothyroidism for the last 3 years. 6 months before this hospitalization patient stopped taking levothyroxine on her own initiative. She noticed deterioration in the last 3 months: the clinic of hypothyroidism appeared and began to grow, a frequent extrasystole appeared. At an objective survey — a symptomatology of the expressed hypothyroidism. A comprehensive examination of the patient was performed, which revealed atrioventricular blockade of the 1st degree, frequent ventricular extrasystole, prolongation of the QT interval on the ECG, late ventricular potentials against the background of low concentrations of sodium and potassium in the blood. During the first 24 hours of hospitalization, there was a clinical death. A clear positive dynamics was traced against the background of therapy aimed at the correction of electrolyte disorders, as well as hormone replacement therapy with levothyroxine.

The purpose of our study was to investigate the main parameters of thyroid status in patients with rheumatoid arthritis (RA), as well as particularities of course of this disease depending on of thyroid gland function disorder. Materials and methods. 52 women with RA were examined. The first group consisted of 11 women with subclinical and manifestive hypothyroidism the second one 41 women without thyroid gland function disorder. The group comparison was conducted on main indexes of thyroid gland condition the hormon level, AT-TPO, ultrasonic data, as well as clinical and laboratory RA data. Results. In women with hypothyroidism the systemic manifestations of RA were more often truely diagnosed; DAS28 indexes, ESR, the number ot swollen joints were higher. The high level ot AT-TPO was diagnosed in 54,55% – I group and in 31,7% – II group TTG level was really less in patients receiving synthetic glycocorticoids. Small thyroid gland volume was diagnosed in 23,07% of examined patients. The thyroid gland status indexes in them did not differ from patients with normal thyroid gland volume. Reliable increasing of the peripheral resistance index was revealed in lower thyroid artery according to the ultrasonic study data under the reduced thyroid gland size. Conclusions. High incidence of hypothyroidism and AT-TPO carriage in RA was revealed. Hypothyroidism development is accompanied by high clinic-laboratory RA activity. The reduction of the thyroid gland volumes in RA is possibly stipulated not only by autoimmunal pathology, but also chronic ischemia of the organ in the conditions of immune-complex vasculitis and early atherosclerosis. The TTG level in patients with RA is defined not only by pathology of the thyroid gland, but glycocorticoid therapy as well.

Lupus erythematosus (SLE) and systemic sclerosis (SS). Methods. 45 SLE and 44 SS pts were included. Some of them received antirheumatic drugs in combination with enalapril other were treated with antirheumatic drugs only. The pts were examined before and 6-12 months after the beginning of the treatment. Echocardioscopy and biomicroscopy of bulbar conjunctiva vessels were performed in all cases. Results. Treatment with enalapril improved state of all SLE and SS pts. The drug was well tolerated and provided decrease of dyspnoea and edema as well as blood pressure normalization. Most prominent improvement was evident 12 months after the beginning of enalapril treatment. Reduction of left ventricle myocardium hypertrophy, improvement of its diastolic function and reduction of structural changes of bulbar conjunctiva microcirculation were achieved at that time. Conclusion. Enalapril administration in combination with antirheumatic drugs improves state of SLE and SS pts as well as echocardiography and bulbar conjunctiva vessels biomicroscopy results. It can be recommended for treatment of these diseases.