Citrulline is an amino acid that is a common molecule in intermediary metabolism. The small intestine releases large amount of citrulline that is an end product of the intestinal glutamine metabolism. Moreover, citrulline can also be synthesized from arginine. NOSs are an important sources of citrulline. The activity of the intestinal enzymes that catabolize citrulline is very low. Therefore, citrulline can not be used in situ, and it is released into circulation. Citrulline is mainly taken up and metabolized by the kidneys. The plasma concentration of citrulline reflects difference between intestinal production and its metabolism by the kidney. Citrulline is a good marker of the functional state of intestine and kidneys. Citrulline level could be used to estimate the degree of renal damage, to detect acute and chronic renal failure. Citrulline concentration is increased in mild renal failure without any changes in uremia and creatininemia. Citrulline level is a surrogate marker for the NO synthesis. It may be also used as a marker of metabolic disorders and for estimation of the severity of heart failure.
The article is devoted to the ECG diagnosis of myocardial infarction combined with disorders of intraventricular conduction. Myocardial infarction may occur against the background of existing intraventricular conduction disturbances, or be complicated by the emergence of acute intraventricular blockades. The article discusses ECG changes depending on the location of the disturbances in the system of Gis – Purkinje and focal myocardial lesions. We provide some ECG criteria of acute coronary syndrome combined with left bundle branch blockade, as one of the most difficult electrocardiographic syndromes.
The article presents data on clinical manifestations and course of the coronary heart disease (CHD) in women. The the data regarding incidence of false-positive stress tests and features of the coronary artery lesions are provided. The detailed analysis of gender differences in pharmacokinetics and pharmacodynamics of acetylsalicylic acid, beta-blockers, calcium channel blockers, statins and angiotensin-converting enzyme inhibitors is included. The results of the primary and secondary prevention of CHD, as well as long-term follow-up show gender features of CHD.
Cardiac rehabilitation is a sum of multidisciplinary activities aiming at restoration of the patient’s physical activity, reducing disability and return to work. The widespread use of effective medicines along with primary percutaneous interventions have created illusion and, perhaps, a hope for the solution of many problems in the treatment of this category of patients and diminished the role cardiac rehabilitation. Despite complexity of cardiac rehabilitation activities, including matters of secondary prevention, physical rehabilitation remains one of its most important components. Data on cardiac rehabilitation in patients with myocardial infarction in different countries are presented. The highest coverage of patients with cardiac rehabilitation activities is achieved at the 1st stage. At the same time in different countries there are differences related to the duration of the program stages, the number of patients involved, indications, contraindications and nosologies. Different types of physical rehabilitation and physical training programmes are described. Well-designed and well-executed cardiac rehabilitation programs contribute to significant reduction in overall mortality, cardiovascular mortality, recurrent coronary events, readmissions, improve quality of life of patients and accelerate their return to work.
Principles of the electrocardiographic diagnosis of ventricular preexcitation syndromes are discussed in the lecture. Contemporary classification of accessory pathways and associated preexcitation syndromes is provided. ECG signs of Wolff – Parkinson – White syndrome and criteria of its differential diagnosis with other diseases are presented. Based on clinical examples, possibilities and limitations of the existing algorithms to establish accessory pathways localization are analyzed. Most prevalent paroxysmal tachycardias appearing in preexcitation syndromes are shown. Special attention is driven to the decreased role of drug treatment and priority of catheter interventions.
The lecture provides analysis of literature data and original results of renin-angiotensin-aldosterone system status in patients with essential hypertension and different plasma renin activity: normal, high and low renin activity hypertension, primary and idiopathic hyperaldosteronism, hromaffin tissue tumor and cortisol-producing suprarenal tumor complicated with secondary hypertension.
Clinically relevant issues of classification of intraventricular conduction disorders (IVCD), such as stability, localization and stage, are discussed in the lecture. IVCD is considered to be an important diagnostic criterion, but may limit ECG diagnosis of ventricular hypertrophy and myocardial infarction. Influence of IVCD upon clinical course and prognosis of cardiac diseases is closely related to structural and functional changes of myocardium. In many clinical situations two- and three-bundle blockades, as well as IVCD combined with syncopal episodes may predict further appearance of complete atrioventricular blockade and are considered as indications for pacing. Morphology and duration of QRS complex are key criteria for resynchronization therapy in patients with heart failure.
This review presents contemporary data on the relationship of cardiovascular disease with functional state of kidneys. The concept of cardiorenal and renocardiac syndrome is considered. The data on the impact of
cardiorenal syndrome on the clinical course of the disease are presented. The drugs potentially able to improve prognosis in these patients are discussed.
The lecture summarizes approaches to evaluation, risk stratification and treatment choice in patients with ventricular tachycardias (VT). The classification of VT according to duration, morphology and electrophysiological mechanisms is provided. Electrocardiography criteria of differential diagnosis of VT and supraventricular tachycardias with wide QRS complexes, principles of substrate evaluation and of monomorphic VT source localization are characterized in detail. Principles of VT management depending on background heart disease, electrophysiological mechanisms and VT morphology, indications for antiarrhythmic therapy, catheter treatment, implantation of automatic internal cardioverter-defibrillator and revascularization procedures are summarized.
Myocardial scyntigraphy (MSG) makes possible to reveal disturbancies of myocardial perfusion at early stage of the disease, to evaluate severity of the pathological process in patients with ischemic heart disease and to establish treatment tactics. Sensitivity and specificity of MSG in the evaluation of myocardial ischemia is 80–90 %, postinfarction changes – 100 %. Contrary to the coronary angiography providing information about
prevalence and severity of the coronary stenoses, MSG reflects myocardial dysfunction at the stenosis location. Therefore, MSG should be used at the early stages of the myocardial perfusion evaluation, together with
traditional methods of functional diagnostics and Doppler echocardiography.