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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 Brugada syndrome (BS) belongs to the group of hereditary channelopathies associated with elevated risk of sudden death (SD) in the absence of structural heart diseases. The disorder phenotypically manifests by specific electrocardiographic pattern, associated with ventricular tachycardia (VT). VT can be accompanied by loss of conscience, and after transformation to ventricular fibrillation result in SD. BS is extremely rare among children and adolescents. We present here a clinical case of teenager (age 17 years) with BS manifested by syncopal state at the background of fever.

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.

Literature data and results of our own register have indicate that hypertension is one of the most common risk factor in patients with ischemic heart disease (IHD) who have undergone coronary artery bypass grafting (CABG). But despite proven benefits of control of hypertension after CABG adherence of patients to corresponding recommendations remains low. Fixed combinations of antihypertensive drugs are associated with better compliance. In 30 IHD patients after CABG we studied effects of fixed lisinoprillamlodipine combination. This combination was safe and had high antihypertensive activity. Practically all patients responded to therapy and achieved target level of arterial pressure.

The problem of optimal control of a one-sector economy on a finite time interval in the presence of tax deductions is studied on the class of linear homogeneous production functions using the criterion of maximization of consumption of employers in the case of exponential growth of labor resources. The solution is obtained in the form of the “Turnpike Theorem”. The “Golden Rule of Saving” is studied. The results are specified for the case of the Cobb-Douglas production function.

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.

Fifty patients with stable angina who had undergone elective coronary angioplasty with stenting were examined. Myocardial microlesions diagnosed from the elevated levels of troponin (Tn) I and creatine phosphate kinase MB (CPK-MB) were detected in 48-54% of the patients; however, the content of Tn I exceeded the high reference level only in 18%. Tn I is a more specific method than CPK-MB in detecting myocardial microlesions during intracoronary intervention. The signs of myocardial microlesions were most commonly detected during intervention into the arteries with types B and C stenoses in case of complicated or technically difficult stent implantation.

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.

A single administration of nitroglycerin, corinfar, anapriline was studied for effects on exercise tolerance in 33 patients with exercise-induced angina with varying adrenergic vasoconstriction during exercise estimated by responses to pratsiol. The effect was found to be related to the degree of functional vasoconstriction. It is concluded that there is a pathogenetic heterogeneity of angina on effort in which in 57% of patients having high coronary reserve, adrenergic vasoconstriction along with organic changes in of great value in the genesis of myocardial ischemia during exercise. In 33% patients with low coronary reserve, the major role is played by organic changes in the coronary bed and vasoconstrictive responses are unassociated with adrenergic exposure. Only in 12% of patients the functional component of coronary vasoconstriction is lacking.

The aim of the present investigation was to evaluate sympathetic vasoconstrictor influence and to define its role in the formation of coronary occlusion in patients with effort angina. The investigation covered 22 patients with Functional Class II-III stable effort angina. To detect vasoconstrictor responses on exercise and to identify their adrenergic component, pair bicycle tests were performed before and after administration of nitroglycerin and pratsiol. Repeated bicycle tests were conducted twice a day: at 10-11 a.m. and at 3-4 p.m. to study spontaneous exercise tolerance variations confirming the presence of dynamic coronary occlusion. The examinations indicated that in 18 patients the exercise resulted in functional major artery narrowing, aggravating the organic stenosis. Activation of smooth muscle alpha-adrenoreceptors is of a definite significance in the genesis of dynamic coronary occlusion in 50% of all the examinees.

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.

Using the results of a prospective follow-up of 106 patients with angina, the authors examined the factors influencing the prognosis of coronary heart disease, including the prognostic value of dynamic coronary occlusion detected during an intravenous ergometrine test. The indicators that are most typical of patients groups with varying outcomes were identified by using the discriminant analysis. The highest value is shown by the factors associated with the extent of coronary occlusion in the prediction of a fatal outcome. A tendency to vasoconstrictive reactions shown as a high sensitivity to ergometrine is a risk factor of myocardial infarction and acute heart failure in individuals highly tolerant to exercise.

The function of platelets and erythrocytes and content of Willebrand's factor in the plasma from 45 patients with exercise-induced or spontaneous angina pectoris were examined before and after ergometrine, 0.1 mg. The patients with a negative ergometrine response showed a lower platelet sensitivity to all the aggregation inductors used in vitro, spontaneous platelet aggregation being absent. The function of erythrocytes and plasma levels of Willebrand's factor remained unchanged. The patients with a significant ischemic response to ergometrine exhibited platelet activation attended by the release of granule contents and formation of blood circulating platelet microaggregates. Concurrently, there was a decrease in erythrocyte deformability, as well as spontaneous blood red cell aggregation, the plasma levels of Willebrand's factor were increased 1.5-2-fold.

Ninety-five coronary patients were studied, including 44 patients with stable angina and 51 with unstable angina. All patients underwent bicycle ergometry and the intravenous ergometrin test. An anginal attack developed in response to bicycle ergometry in 63.5% of patients with stable angina and in 74.4% of patients with progressive coronary insufficiency. The threshold capacity achieved was directly related to the functional class of stable angina, and dependent on the clinical variety of unstable angina. The ergometrin test was positive in 70.4% of patients with stable angina and 82.4% of patients with unstable angina. An ergometrin-induced anginal attack developed where the double product was significantly smaller than that of threshold stress. The differences were the highest in patients with progressive angina and attacks of acute coronary insufficiency.

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.

The results of coronarography of 145 patients with unstable angina and 102 patients with a stable course of the disease are presented. The findings obtained were analyzed with regard to the clinical variant of progressive coronary insufficiency. It was found that both in patients with progressive angina and in those suffering from attacks of acute coronary insufficiency following the preceding angina, the degree of obstructive damage was virtually the same as in stable angina. At the same time almost half the patients suffering from attacks of acute coronary insufficiency with no history of previous angina showed normal or only slightly altered coronary arteries. The mentioned specific features of the morphological changes seen in a group of patients with acute coronary failure suggest that spasm of the coronary arteries may underlie the pathogenesis of its attacks in patients without a previous history of angina.

A study of 157 patients with verified or suspected coronary disease, subjected to the intravenous ergometrin test, is reported. A clear-cut correlation is demonstrated between the rate of clinically and electrocardiographically positive tests, the pattern of the pain syndrome and the clinical course of the disease. Vasospastic response was particularly common in patients with unstable angina. Of those, patients prone to attacks of acute coronary insufficiency in the presence of progressive angina with recent clinical coronary manifestations were particularly sensitive to ergometrin. Among patients with stable angina, angina of the higher functional classes was associated with a considerable rate of positive ergometrin tests. Vasoconstrictive response was rather uncommon in individuals with intact stress tolerance and spontaneous chest pains, suggestive of spontaneous angina. There were no vasospastic reactions in patients with the atypical pain syndrome.

An attempt has been made to elucidate causes of heart rate change during exercise in anginal patients, using multifactorial mathematical analysis. Seventy-one patients underwent bicycle ergometry and the intravenous ergometrin test. Heart rate variation was found to be unrelated to the type of stress (bicycle ergometry or Master's test), or the presence or absence of ischemic ECG changes during an attack of pain. During exercise, heart rate shifts preceding an anginal attack are similar to those in patients with painless response to stress. At the onset of pain, an abrupt rise in heart rate is seen, its magnitude being particularly great in postmyocardial infarction patients with low physical stress tolerance and high sensitivity to ergometrin. Myocardial insufficiency may be the cause of excessive tachycardia in this category of patients. In patients with high stress tolerance in the absence of ergometrin sensitivity, increased sensitivity to endogenic catecholamines may be a cause of tachycardia during an anginal attack.