Тематичний Архів | Category Archives: Practice observations

O.I. Mitchenko, A.V. Rudenko, V.U. Romanov, M.V. Gvozdyk, M.M. Gelmedova, V.V. Gutovsky.Coronary atherosclerosis in patients with diabetes mellitus and hypothyroidism.

The current rata regarding impact of the thyroid gland dysfunction (hypothyroidism) and type 2 diabetes mellitus on progression of coronary atherosclerosis and coronary artery disease course after coronary artery bypass grafting are reviewed. The literature data are illustrated by four clinical cases that included the dynamic monitoring of patients with hypothyroidism, type 2 diabetes mellitus and their combination in the perioperative period and during long term observation.

Full article

Yu.V. Zinchenko, A.V. Doronin, O.Yu. Marchenko.Clinical case of successful treatment of atypical atrial flutter in the elderly.

The case of successful catheter treatment of atrial flutter in the patient of 86 is presented. At electrophysiological examination focal left atrial tachycardia with concomitant left atrial flutter was found, which is extremely rare. The described case shows that patient’s age should not become a restriction for catheter destruction procedure, which is an effective means of tachyarrhythmia treatment.

Full article

M.I. Lutai, I.P. Golikova, A.V. Tsyzh, V.V. Bugayenko.Cardiac amyloidosis: definition, diagnosis, treatment. Case report.

In this article recent data on cardiac amyloidosis diagnosis, assessment of the severity and prognosis, as well as contemporary treatment methods are reviewed. A clinical case of primary cardiac amyloidosis (AL) which appeared in middle-aged woman with rapidly progressing clinical symptoms of heart failure and syncope, is presented. Suspicion of cardiac amyloidosis should arise in case of restrictive cardiomyopathy along with significant thickening of heart walls and other organs damage. Significant thickening of the left ventricle is not associated with ECG signs of myocardial hypertrophy, pseudo-infarction pattern may be found in the precordial leads (V1–V3) without previous myocardial infarction. For patients with amyloid deposition confirmed with non-cardiac biopsy, involvement of heart can be confirmed by positive heart biopsy and/or left ventricular wall thickening (interventricular septum > 12 mm) in the absence of hypertension or other potential causes of left ventricular hypertrophy. Contemporary methods of amyloid visualization, biochemical markers and quantitative methods for detection of amyloid proteins allow earlier and more accurate diagnosis of the disease.

Full article

Yu.V. Zinchenko, S.V. Lizogub, M.R. Ikorkin Efficacy of sinus rhythm restoration and preservation in patients with three-years long atrial flutter episodes.

We performed electrical cardiac stimulation to achieve cardioversion without background antiarrhythmic therapy in three patients with 3-years long typical non-valvular type I atrial flutter (AF) with successful sinus
rhythm restoration in all cases. Presented clinical cases clearly demonstrate, that treatment of type I AF differs from management of patients with atrial fibrillation in many directions, including restoration and preservation of sinus rhythm, as well as anticoagulation therapy terms. Therefore, in order to establish further optimal treatment, cardioversion is necessary, regardless of arrhythmia duration.

Full article

I.Ye. Belaya Informative value of vectorcardiography for thrombolytic therapy for patients with acute myocardial infarction

Thrombolytic therapy (ТТ) is preferable when timely and optimal percutaneous coronary intervention is not performed. ECG is a method of instrumental control of the effectiveness of thrombolytic therapy. However, in the case of iatrogenic complications before the completion of the drug infusion assessment of the impact of the thrombolytic infusion is not carried out. Therefore the use of vectorcardiography (VCG) in addition to ECG makes it possible to objectify the results of ТТ. The paper includes clinical case of the patient with damage of the posterior­inferior wall of left ventricle confirmed by ECG. During the VCG­study signs of abnormalities of coronary blood circulation at anterior wall and basal regions of ventricles as well as at the area of apex were detected. Furthermore, the overload of ventricles due to intact area of the myocardium and hemodynamic overload of atriums with disorder of the processes of repolarization at posterior­lateral region of left atrium and posterior wall of right atrium were recorded. On the 8th day of the disease high symmetrical T waves were recorded; VCG­data showed disorders of repolarization at the posterior­inferior wall. In general, the use of the VCG makes possible a detailed analysis of electromotive forces of heart in patients with acute coronary pathology even after unfinished TT when ECG is not informative.

Full article

M.I. Lutai, I.P. GolikovaDoes stenting influence tone of coronary arteries?

Ischemia is almost always associated with coronary atherosclerosis in patients with chronic coronary artery disease. In addition to morphological factors, the functional factors provide significant effects upon coronary circulation (coronary arteries tone). The degree of narrowing of the coronary arteries may vary depending on smooth muscles tone change in the segment adjacent to atherosclerotic plaque. After stent implantation in coronary artery, diameter of the vessel in prosthetic area remains unchanged, but in artery sites free of stents there remains an adequate tone response to various physiological situations. This heterogeneity of the vascular wall response may affect uniformity of blood flow in a vessel. The coronary circulation may also change under influence of the vessel reactivity due to coated stents implantation, releasing biologically active substances, the diffusion of which in arteries regions adjacent to the stent affects these segments endothelium. The article presents three clinical observations of patients with coronary artery disease after stent implantation, including covered ones.

Full article

B.M. Тоdurov, О.J. Zharinov, О.А. Yepanchintseva, О.P. Nadorak, О.M. Grytsay, V.Yu. Kundin, S.І. Mashkovska, N.V. Ponych Clinical course and treatment of cardiac arrhythmias after coronary artery bypass grafting with aneurysmectomy.

The publication discusses clinical course and treatment of cardiac arrhythmias after coronary artery bypass grafting with aneurysmectomy. The clinical case is presented in which ventricular arrhythmias evident before
revascularization and aneurysmectomy were not registered anymore after operation. At the same time, paroxysms of atrial fibrillation and flutter appeared in early postoperation period. Radiofrequency catheter
ablation of cavotricuspidal isthmus interrupted atrial flutter. This was associated with favourable course of atrial fibrillation at long-term observation.

Full article

B.M. Todurov, G.I. Kovtun, A.O. Shmidt, V.O. Shevchenko, M.V. Honcharenko, S.I. Mashkovska, I.M. Kuzmich, O.I. Mararenko, S.O. Sheludko, T.V. Kropyvko, O.V. Shnyrkova Heart transplantation as method of treatment of endstage heart failure.

End-stage heart failure is a leading cause of death in developed countries. Cardiac transplantation is the most effective treatment for heart failure refractory to medical or surgical therapy. This article analyses the first clinical experience in orthotopic heart transplantation in Ukraine during period 2001–2009. Four orthotopic heart transplantations were performed. The idiopathic dilated cardiomyopathy was the case of end-stage heart failure in three patients and the ischemic cardiomyopathy was the case in one patient. Follow-up period ranged from 6 months up to 33 months. All patients were males, the mean age was 32.7 yrs. All four patients were in III class of NYHA. Three-component therapy (cyclosporine A, methylprednisolone, azathioprine) was applied for immunosuppression. The most common complications in the postoperative period were: fungal infection,
ejection, steroid diabetes, duodenal bleeding and arterial hypertension. Two patients died. The first one died in the intensive care unit after 11 days due to severe infection. The second one died after 9 months due to severe bacterial endocarditis. Two patients survived. Cardiac index, ejection fraction and NYHA class dramatically improved after transplantation. Heart transplantation is a definitive therapy for end-stage heart failure. Infection and rejection reduce the percentage of early and late survival. That’s why it is very important to balance between immunosuppressive and antibacterial therapy. It is of great importance in the early postoperative period to monitor the patients daily clinically and laboratory. In this period we have the highest risk of infection due to the high dosage of immunosuppressant medication.

Full article