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Using a clinical example, the article draws the attention of doctors to the problem of the prolonged QT interval (long QT) and the related problem of fainting (syncope). Syncope is a component of long QT syndrome, and syncope is a precursor of sudden cardiac death. However, syncope in a patient with long QT syndrome may have pathogenesis that is completely unrelated to abnormalities of cardiac ion channels. In other words, such a patient may have a second disease as a syntropy relates to prolonged QT interval, to an extent mimicking long QT syndrome. The presented medical history of a 33-year-old patient S. shows the complexity of differential diagnosis of the causes of syncope. The crucial part in the diagnosis, in addition to the clinical picture, was the so-called tilt test, little-known to general medical practice, as well as the laboriousness of making a final diagnosis of the long QT Syndrome type 2, which required a molecular genetic study whole-exome sequencing. Patient S. had vasovagal syncope that not associated with long QT syndrome, but she has a risk of sudden cardiac death, and the article identifies therapeutic and other measures to reduce this risk.

cardiovascular diseases, sudden cardiac death, risk, treatment, prevention Cardiovascular mortality in Russia is one of the highest in the world reaching 614 deaths per 100,000 annually. The main causes of death from cardiovascular diseases are the progression of congestive heart failure (about half of all cases) and sudden cardiac death (the other half). Thus, we can assume that the incidence of sudden cardiac death in 2016 was no less than 300,000. In the abbreviated version of the National Recommendations in English, the principles of decision-making algorithms in various clinical situations are used.

Aim. To develop a method for determination of the differentiated types of hemodynamics based on the data analysis of integral circulation indicators. Methods. The method for determination of the differentiated hemodynamics types was developed based on the data analysis of integral circulation indicators - cardiac output, heart rate, total peripheral vascular resistance and modulus of volume elasticity. The types of hemodynamics - hyperkinetic, eukinetic, hypokinetic - were determined by cardiac output. Tachy-, normo- and bradisistolic subtypes were determined by the heart rate, subtypes with a predominance of vascular resistance and arterial stiffness were determined by the modulus of volume elasticity and total peripheral vascular resistance ratio. Four groups of patients were examined. The first group included 63 patients with I-III degree of arterial hypertension aged 18 to 77 years, mean age 48.9±12.38 (M±σ). The second group - 82 patients with primary hypothyroidism and I-III degree of arterial hypertension aged of 41 to 75 years, 59.8±7.9 years (M±σ). The third group - 33 patients with rheumatoid arthritis and I-III degree of arterial hypertension aged 17 to 67 years, 47.2±8.12 years (M±σ). The control group included 32 healthy volunteers aged 21 to 37 years, 24.7±5.34 years (M±σ). Results. Eukinetic and hyperkinetic circulation types with predominance of peripheral vascular resistance were mostly identified in healthy volunteers. Eukinetic type of hemodynamic with predominance of peripheral vascular resistance is typical for patients with hypothyroidism and arterial hypertension, and for patients with rheumatoid arthritis and arterial hypertension hyperkinetic and eukinetic types with predominance of the arterial system rigidity are characteristic. Eukinetic and hypokinetic circulation types with predominance of both peripheral resistance and arterial stiffness are mostly present in essential hypertension. Conclusion. Developed method of distinguishing the differentiated types of hemodynamics allows determining the hemodynamic heterogeneity in both healthy people and patients with hypertension.

Aim. To study and comparatively analyze the integral stiffness of arterial system in healthy subjects and in patients with hypertensive heart disease, hypothyroidism associated with arterial hypertension and rheumatoid arthritis associated with arterial hypertension. Methods. The study included 32 healthy volunteers and 178 patients with arterial hypertension, including 63 patients with hypertensive heart disease of 1-3 degree, 82 patients with hypothyroidism associated with arterial hypertension, 33 patients with rheumatoid arthritis associated with arterial hypertension. All patients underwent echocardiography; modulus of volume elasticity (MVE), pulse pressure, mean arterial pressure (MAP), total peripheral vascular resistance (TPVR), and MVE/TPVR ratio were calculated. The stiffness of arterial system was considered the main component if MVE/TPVR ratio exceeded 1; if MVE/TPVR ≤1, TPVR was considered the leading component. Results. Patients with arterial hypertension had higher rates of stiffness of arterial system in comparison with control group by MVE and pulse pressure. In control group, 87.5% persons had prevalence of TPVR, and in 12.5% arterial stiffness prevailed. In 77.8% of patients with hypertensive heart disease prevalence of TPVR was found, and in 22.2% arterial stiffness prevailed. In patients with combination of rheumatoid arthritis and hypertension arterial stiffness prevailed, while patients with combination of hypothyroidism and hypertension had higher TPVR. Conclusion. All patients with combination of rheumatoid arthritis and hypertension had arterial stiffness prevailing over TPVR. In patients with hypothyroidism associated with arterial hypertension TPVR prevailed over arterial stiffness.