Vol 84, No 4 (2012)

Articles
CURRENT APPROACHES TO ASSESSMENT OF LEFT VENTRICULAR HYPERTROPHY ASPECTS OF DIFFERENTIAL DIAGNOSIS
Saidova M.A.
Abstract
Recommendations are proposed how to assess left ventricular hypertrophy (LVH) as well as a complex approach to examination of the heart structure and function in patients with different diseases accompanied with LVH development. LVH differential diagnosis is considered in arterial hypertension (AH), hypertrophic cardiomyopathy (HCMP), accumulation myocardial diseases, non-compact myocardium, valvular and combined cardiac pathology, compensatory LVH in athletes. Novel echocardiological techniques are recommended for use in complicated diagnostic cases. Normal parameters and criteria of LVH severity by thickness of the wall and left ventricular indexed mass according to the latest recommendations of the European and American echocardiology associations are listed.
Terapevticheskii arkhiv. 2012;84(4):5-11
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COMMUNITY-ACQUIRED PNEUMONIA: COMPARISON OF ETIOLOGICAL DIAGNOSTIC METHODS IN CLINICAL PRACTICE
Pustovalov A.A., Rvacheva A.V., Chuchalin A.G., Sokolov E.I., Khaptkhaeva G.E., Tkachev G.A., Zykov K.A.
Abstract
Aim. Comparison of different methods of community-acquired pneumonia (CAP) etiological diagnosis. Material and methods. A total of 20 male and 10 females patients 21 to 75 years of age entered the trial. All of them had CAP running a non-severe course. Microbiological and molecular-genetic methods were used to examine the patients’ sputum, blood serum serological tests were made to measure the level of IgM and IgG antibodies (AB) to Chlamydophila pneumoniae and Mycoplasma pneumoniae. Results. Pathogens were detected in 23(76.7%) patients. Microbiological examination (MBE) detected monobacterial contamination in 19 patients, polymerase chain reaction (pCR) identified monobacterial infection in 10 patients, mixed bacterial infection in 5 and viral-bacterial mixed contamination in 4 patients. MBE provided 19 positive results, PCR 30 ones. Serological examination detected IgM AB to Mycoplasma pneumoniae in 6 patients, sputum investigation with PCR detected the pathogen only in 2 patients. IgM AB to Chlamydophila pneumoniae were detected in 4 patients, PCR failed to detect infection agent. Conclusion. Current etiological diagnosis can be made with the highest efficacy with combination of three methods: microbiological for detection of bacterial pathogens (except atypical agents), molecular-genetic for identification of both bacterial and viral pathogens and serological for diagnosis of atypical pathogens.
Terapevticheskii arkhiv. 2012;84(4):11-16
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PULMONARY ARTERY THROMBOEMBOLISM: FACTORS OF PREHOSPITAL OVERDIAGNOSIS
Ermolaev A.A., Plavunov N.F., Spiridonova E.A., Baratashvili V.L., Stazhadze L.L.
Abstract
Aim. Detection and analysis of factors of pulmonary artery thromboembolism (PATE) overdiagnosis in a prehospital setting. Material and methods. A total of 102 patients with prehospital diagnosis of PATE entered the study. Prehospital clinical and ECG picture was compared in groups of verified PATE (n=61) and rejected PATE (n=41). Clinical probability of PATE was assessed retrospectively according to Revised Geneva Score (RGS) scale. In 47 cases the analysis was made in dynamics (in 92±42.1 min, on the average). Results. In the group of patients with false-positive PATE diagnosis we significantly more frequently observed angina-like chest pain and satisfactory condition at examination, ECG evidence for right heart overloading (the most significant marker S I—Q III; p=0.009) occurred less often, mean heart rate was significantly lower than in patients with verified PATE (85 ± 23,8 and 100±23,0 b/min, respectively; р = 0,007). Low probability of PATE by the RGS scale was stated in 37% patients from the group with false-positive diagnosis and only in 8% patients with a verified diagnosis of PATE (р = 0.0005). Conclusion. Prehospital PATE overdiagnosis can be explained by non-specificity of clinical and ECG picture of the disease in acute period. Application of the RGS scale is effective for objective assessment of the condition and accurate diagnosis.
Terapevticheskii arkhiv. 2012;84(4):17-22
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LEFT ATRIAL DEFORMATION IN HYPERTENSIVE PATIENTS WITH AORTIC STENOSIS AND LEFT VENTRICULAR HYPERTROPHY OF DIFFERENT SEVERITY
Kalinin A., Alekhin M.N., Bachs G., Leinieks A., Kalninsh S., Schipachov P.
Abstract
Aim. To study left atrial (LA) deformation in patients with arterial hypertension, aortic stenosis (AS) and left ventricular hypertrophy (LVH) of different severity. Material and methods. LA deformation was studied in 20 healthy subjects and 68 patients. Of them 30 patients had AH and mild LVH, 22-AH and manifest LVH, 16patients had AS. Standard echocardiography (EchoCG) was made and then analysed with the method of two-dimentional seroscale deformation (TDSD). Segmentory maximal deformation was estimated in 5 middle segments of left atrial walls, middle maximal deformation was determined in 4and 2-chamber positions, global maximal deformation were evaluated in left atrial contraction and accumulation phases. Results. Due to pressure-induced overloading, LVH was accompanied with abnormal left atrial deformation, AH patients demonstrated decreased deformation even in mild LVH. AS was associated with most pronounced changes of left atrial deformation. Abnormal left atrial deformation in AH and AS was more significant in accumulation phase. In contraction phase, left atrial deformation deterioration occurred only in AS. Conclusion. Conduction of TDSD enables analysis of atrial deformation and opens wide perspectives for further investigations aimed at better understanding of changes in the atria.
Terapevticheskii arkhiv. 2012;84(4):23-29
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CHARACTERISTICS OF DIAGNOSTIC APPROACH TO ERYTHROCYTOSIS OF DIFFERENT GENESIS
Sokolova M.A., Khoroshko N.D., Dmitrieva M.G., Zhuravlev V.S., Sagdieva N.S., Egorova M.O., Moiseeva N.S., Nareyko M.V., Gemdjan A.G., Sahibov I.D.
Abstract
Aim. To show distribution of the investigated patients into diagnostic groups, find out the diagnostic value of the levels of hemoglobin and packed cell volume as possible markers of absolute erythrocytosis in the group of patients with polycythaemia. Material and methods. We evaluated 61 patients, mean age was 46 years (18-82), 9 females and 52 males before treatment. Mean levels of hemoglobin in females — 171g\l (143-190), packed cell volume 52% (49-61). Mean levels of hemoglobin and packed cell volume for males were 187 g/l(168-196) and 57,8% (49-65), respectively. All blood samples were taken in the morning. Full blood picture of venous blood was determined by Coulter principle on Gen S ("Beckman-Coulter", USA) blood analyzer with preserving agent (ethylene diamine tetraacetate, EDTA). Red cell mass and plasma volume were measured by the radionuclide method (Cr-51). Results were performed with an allowance for patient’s surface area and were interpreted according to International Council for Standardization in Haematology guidelines (ICSH) (Pearson et al. 1995). Results. Polycythaemia vera was detected only in 19(31%) among 61 patients, 15 patients refused from further investigation. Among others 46 patients 14 subjects had secondary erythrocytosis, among them 9 were diagnosed with absolute erythrocytosis (hypoxic) and 5 with idiopathic erythrocytosis. Relative ("apparent") erythrocytosis was detected in 13 cases. Measurement of red cell mass allowed us to divide patients into groups with absolute and relative erythrocytosis. Such laboratory parameters as hemoglobin, number of red blood cells and packed cell volume do not always completely show the level of red cell mass due to possible variations of the plasma volume and can not be the reason for diagnosis of haematological disorder. It is shown that hemoglobin level over 185 g/l confirms the presence of absolute erythrocytosis only in 50% of males with polycythaemia, 15% of males with secondary erythrocytosis might have incorrect diagnosis as though increased red cell mass. Statistically defined highly significant (p=0,001) difference of the level of red cell mass in males with polycythaemia and patients with "apparent" polycythaemia turned out to 166% and 111%, respectively. The levels of red cell mass in patients with polycythaemia confirm absolute erythrocytosis over superior normal limit (more then 25%) in comparison with secondary erythrocytosis where red cell mass rate remained normal. Average plasma volume measurements in the same groups of patients were at normal range — 95% и 81%, respectively. Difference between these mean values was authentically significant. Conclusion. Red cell mass and plasma volume measurement is easy and necessary procedure for estimation absolute and "apparent" polycythaemia. Rather common occurrence of different forms of erythrocytosis and in particular "apparent" erythrocytosis must determine certain diagnostic approach according to specific clinical case.
Terapevticheskii arkhiv. 2012;84(4):29-35
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THE ROLE OF DUPLEX SCANNING OF THE CAROTID ARTERIES IN DETECTION OF CORRELATIONS BETWEEN CAROTID AND CORONARY ATHEROSCLEROSIS BY THE RESULTS OF CORONAROANGIOGRAPHY IN PATIENTS WITH STABLE ANGINA
Gaisenok O.V., Martsevich S.Y., Kalashnikov S.V., Boshkov V.B., Shatalova I.V.
Abstract
Aim. To determine probability of detection of coronary artery atherosclerotic lesion in coronaroangiography (CAG) depending on the presence or absence of carotid artery (CA) atherosclerosis according to findings of duplex scanning (DS). Material and methods. Of 851 patients admitted to hospital for coronary heart disease (CHD), 67 entered the trial. The patients were examined with DS of CA, exercise test, CAG. Analysis was made of correlations between detection of atherosclerosis in DS of CA and coronary atherosclerosis in CAG. Odds ratio and their confidential intervals were estimated. Results. Probability of coronary atherosclerosis detection in patients with CA atherosclerosis was much higher than in the absence of CA atherosclerosis by DS findings. Conclusion. It is recommended to use CA DS data in selection of anginal patients for CAG especially in cases when exercise test cannot be conducted or is not informative.
Terapevticheskii arkhiv. 2012;84(4):35-38
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TRIMETAZIDINE ADDITION TO ANTIANGINAL THERAPY: EFFECTS ON EFFICACY AND QUALITY OF LIFE IN PATIENTS WITH STABLE ANGINA TREATED OUTPATIENTLY
Shalenkova M.A.
Abstract
Aim. To compare effects of original trimetazidine versus its generics addition to antianginal treatment efficacy and quality of life in patients with stable angina (SA). Material and methods. Twenty patients aged 37-74 years with SA of functional class (FC) II-III received standard SA treatment with addition of trimetazidine generics which were later changed for original trimetazidine. Original trimetazidine effects were examined by frequency of anginal attacks and use of short-acting nitrates, changes in anginal FC and chronic cardiac failure, in quality of the patients’ life. Results. SA treatment with hemodynamic drugs in combination with trimetazidine generics was insufficiently effective. Change of the generics for an original drug (preductal MB) raised antianginal treatment efficacy as shown by less frequent anginal attacks (reduction from 9.0±6.9 to 0.3±0.6 per a week) and by reduced need in short-acting nitrates (from 9.1±6.9 to 0.4±0.6 per week) and significant improvement of the patients’ quality of life. Conclusion. In combined treatment of SA patients it is more effective to use preductal MB which is an original trimetazidine drug than trimetazidine generics.
Terapevticheskii arkhiv. 2012;84(4):38-41
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CHOICE OF TREATMENT OF PATIENTS WITH ARTERIAL HYPERTENSION: SYMPTOMATIC AND BASIC, STANDARD AND SITUATIONAL
Gogin E.E.
Abstract
The article analyses cardiovascular morbidity and mortality with consideration of arterial hypertension (AH) involvement in terms of pathogenesis, chronicity of AH and its complications, causes of target organs affection. Such methods of treatment as symptomatic, basic, standard and situational are reviewed.
Terapevticheskii arkhiv. 2012;84(4):41-46
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VARIANTS OF ORTHOSTATIC HYPOTENSION. NEW CLASSIFICATION AND DIAGNOSTIC METHODS
Rogoza A.N., Oschepkova E.V., Pevzner A.V., Kuzmina Y.V.
Abstract
The article presents a new classification of postural hypotension (pH) and PH detailed characteristics by parameters of arterial pressure, central and peripheral hemodynamics including cerebral circulation; describes methods of detection of different PH variants; gives original data on modified diagnostic criteria and diagnosis of one of the least studied variants of PH initial PH.
Terapevticheskii arkhiv. 2012;84(4):46-51
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WIRELESS ECG TRANSFER AND CENTRALIZED SYSTEM OF ECG ANALYSIS AND STORAGE. EXPERIENCE WITH EASY ECG USAGE IN THE RUSSIAN CARDIOLOGICAL RESEARCH CENTER
Ryabykina G.V., Sobolev A.V., Sakhnova T.A., Blinova E.V., Smirnova Y.S., Schedrina E.V., Kozhemyakina E.S.
Abstract
Methods of wire and wireless ECG remote registration and a centralized system of ECG reception, analysis and storage are outlined in the context of setting up computer case history. Qualitative assessment of an algorithm of computer syndromal diagnosis used in the Easy ECG system is presented. The system comprises an ECG recorder, digital amplifier and software. The system is easy to use and is recommended for introduction into wide medical practice.
Terapevticheskii arkhiv. 2012;84(4):52-57
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CURRENT RECOMMENDATIONS ON DIAGNOSIS AND TREATMENT OF PULMONARY ARTERIAL HYPERTENSION
Avdeev S.N.
Abstract
Pulmonary hypertension is a rather frequent pathophysiological and hemodynamic condition detectable in many clinical situations including pulmonary and cardiac diseases. Pulmonary arterial hypertension (pAH) is a specific clinical group of severe and rare diseases with similar morphological, hemodynamic and therapeutic characteristics. PAH diagnosis is confirmed by catheterization of the right heart. Special pharmacotherapy has been developed of late for PAH-oriented treatment. PAH is a progressive disease and therefore demands continuous monitoring and escalation of pharmacotherapy if therapeutic targets fail to be achieved with monotherapy. Combined treatment of PAH seems to be optimal now.
Terapevticheskii arkhiv. 2012;84(4):57-63
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EXERCISE TESTS IN UNSTABLE ANGINA SUSPECTS
Alekhin M.N., Eremina N.V., Radova N.F.
Abstract
The review is devoted to exercise tests (ET) potential in patients with different forms of coronary heart disease (CHD) exacerbation and suspected unstable angina. It is well known that unstable angina untreated pharmacologically is a contraindication for ET. Of interest in clinical practice is diagnosis, risk assessment and treatment policy in patients with chest pain. The main focus is on ET conduction in unstable angina suspects with low and intermediate risk, on safety and validity of ET conduction in these patients.
Terapevticheskii arkhiv. 2012;84(4):63-68
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PHARMACOLOGICAL CORRECTION OF HEART RATE IN MYOCARDIAL ISCHEMIA
Astashkin E.I., Glezer M.G.
Abstract
Cardiovascular diseases is one of the key causes of lethality in developed countries. Coronary heart disease and arterial hypertension make significant contribution to this lethality. The above two diseases are often accompanied with compensatory acceleration of the heart rate (HR). At the same time long-term tachycardia is an independent risk factor of complications resultant from high consumption of oxygen, disturbed energy metabolism in cardiomyocytes, regress of heart contractility, development of cardiac failure. Heart contraction rhythm depends on electric activity of the sinus node cells which spontaneously generate action potentials (AP) present in all heart compartments and triggering contractile activity of cardiomyocytes. The study of the pacemaker cells (pC) discovered not only mechanisms responsible for AP rise and HR physiological regulation but revealed new ionic channels —f-channels involved in acceleration and lowering of the heart rate. Reduction of current along the f-channels (If-current) lowers AP generation in PC and, therefore, HR. Three groups of medicines are now used for HR lowering : beta-adrenoblockers, non-dihydropyridine calcium antagonists and recently introduced into clinical practice innovative drug ivabradin (coraxan) selectively suppressing activity of f-channels of sinus node cells and thus lowering HR. The review analyses differences in mechanisms of a negative chronotropic effect of these drugs.
Terapevticheskii arkhiv. 2012;84(4):68-73
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ROLE OF AUTOIMMUNE REACTIONS IN DEVELOPMENT OF CARDIAC ARRHYTHMIA AND CONDUCTION DISTURBANCES
Rodionova E.S., Mironova N.A., Aparina O.P., Rogova M.M., Zykov K.A., Golytsyn S.P.
Abstract
Cardiac arrhythmias and conduction disturbances are an important cause of morbidity and mortality in many countries all over the world. Etiology of these disorders remains unclear in many patients. Experimental and clinical studies show that autoimmune reactions may be involved in development of arrhythmias and cardiac blocks. Precise identification of an autoantibody-mediated mechanism opens new perspectives in the treatment and prevention of cardiac arrhythmias including use of immunosuppressive agents or removal of autoantibodies by absorption technique. The review focuses on cardiac autoantigens, autoantibodies and their interactions that may be involved in development of cardiac arrhythmias.
Terapevticheskii arkhiv. 2012;84(4):74-78
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KALENDAR' YuBILEYNYKh DAT ISTORII TERAPII 2012 GOD
- -.
Abstract
Terapevticheskii arkhiv. 2012;84(4):79-80
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