In older age, patients with atrial fibrillation (AF) have a high risk of stroke, bleeding, and death, but such patients have been underrepresented in randomized clinical trials. A search and analysis of 4 176 literature sources from the MEDLINE/ PubMed  and eLIBRARY  databases  was carried out for the keywords  «atrial fibrillation», «old age», «older», «elderly». The review includes  the most important  studies reflecting  the current understanding of risk factors for development, complications and treatment of AF in old age. The results of therapy to control the ventricular rate, to control sinus rhythm in AF with  drugs  and  catheter  ablation  are discussed. The data of studies  on the prevention of thromboembolic complications in patients with AF by the use of anticoagulants and implantable devices are considered.

The article presents data on heart damage in patients with rheumatoid arthritis (RA), features of the development of ischemic and non-ischemic heart disease with a significant increase in the risk of adverse cardiovascular events. Patients with RA are characterized by an increased risk of developing myocardial infarction, heart failure, rhythm disturbances, sudden cardiac death, and general cardiovascular death. The possibility of a fairly rapid development of myocardial dysfunction in patients with RA from the moment of manifestation of the disease, the development and progression of atherosclerosis of the coronary arteries is emphasized, and with the development of coronary artery disease in RA patients, the worst survival rate after a heart attack was established. The available evidence suggests that rheumatoid arthritis is a disease that makes a significant contribution to cardiovascular morbidity and mortality.

Hepatorenal syndrome, the extreme manifestation of renal impairment in patients with cirrhosis, is characterized by reduction in renal blood flow and glomerular filtration rate. Hepatorenal syndrome is diagnosed when kidney function is reduced but evidence of intrinsic kidney disease is absent. Unlike other causes of kidney injury, hepatorenal syndrome results from functional changes in the renal circulation and is potentially reversible. An analysis of literature reviews, clinical studies, experimental research, clinical recommendations from PubMed / Medline and ELIBRARY databases was carried out for 7 keywords according to the review topic.

Objective: to study the features of the anamnestic background, clinical course, as well as the nature of medical care for elderly patients with acute myocardial infarction (MI) and to assess their impact on the prognosis of the disease. Material and methods: the study included patients 60 years and older who survived acute MI and registered in the «Register of Acute Myocardial Infarction»(Tomsk) (n=410). The study conducted a 5-year prospective follow-up of patients with an assessment of their vital status. The Statistica V10.0 application software package («StatSoft Inc.») was used for statistical processing of the data obtained. Results: the analysis showed that 90% of patients had a history of comorbid pathology. In almost 20% of patients, the onset of the disease was characterized by an atypical clinical picture, which in more than a third of cases was represented by a low-symptomatic form. The presence of atypical MI manifestation lengthened the prehospital stage of medical care due to the late treatment of patients for medical help (120 [49; 311.5] minutes), as well as longer time before the first medical contact (26.5 [20;40] minutes (p=0.005)). A fifth of patients were treated for acute MI in non-core hospitals, where the hospital mortality rate among elderly patients reached 65.7%, which was 3 times higher than the same indicator in specialized cardiology departments (19.7%, p<0.001). Conclusion: the main factors affecting the long-term postinfarction period in elderly patients were: isolated systolic arterial hypertension, diabetes mellitus, impaired renal function, a history of myocardial infarction and acute cerebrovascular accident.

Objective: to study the dynamics of microcirculation indices in patients with arterial hypertension, chronic obstructive pulmonary disease, and in their combination. Material and methods: the study included 226 people, of which 66 people were patients with chronic obstructive pulmonary disease, 54 patients with arterial hypertension, 74 people with a combination of chronic obstructive pulmonary disease and arterial hypertension, 32 relatively healthy volunteers. To assess the circulatory bed, we used a computerized ultrasonic Doppler instrument Minimax-Doppler-K, LLC JV «Minimax». Results: in patients with COPD and AH, microcirculation maladjustment is observed, manifested by a paradoxical reaction to stimuli in the form of an indirect occlusive effect. When studying the correlations between the indicators of the microvasculature and clinical and instrumental data, it was found that there is a relationship between the linear velocities of the microvasculature and the age, the smoking index, systolic blood pressure, pulse blood pressure. A correlation relationship was established between the FEV1 and the maximum linear systolic velocity along the maximum velocity curve in patients with COPD and COPD and AH. Conclusion: COPD and hypertension are comorbid conditions that lead to more pronounced microcirculatory changes, which can have a mutual effect on the course of these diseases.

Objective: to study the comparative efficacy and safety of the use of perindopril/amlodipine and valsartan/amlodipine combinations in patients with a combination of arterial hypertension and chronic obstructive pulmonary disease. Materials and methods: 85 patients with a verified diagnosis of arterial hypertension and chronic obstructive pulmonary disease were examined, the average age of patients was 60.9±1.1 years; 54% of men and 46% of women who were prescribed two variants of combination therapy (group A amlodipine/perindopril, group B amlodipine/valsartan). At the first visit and 6 weeks after the start of therapy, all patients underwent clinical, laboratory and instrumental examinations in accordance with the current protocols for the treatment of hypertension and chronic obstructive pulmonary disease, a daily blood pressure study, the frequency of depressive disorders was assessed on the Beck scale and the quality of life according to the SF-36 questionnaire. Results: the use of both antihypertensive regimens in comorbid patients was accompanied by comparable antihypertensive efficacy of therapy, contributed to the same statistically significant decrease in daily, day and night blood pressure indicators. The analysis of the indicators of the function of external respiration revealed the absence of negative dynamics of spirographic indicators in both groups. The use of both combinations of antihypertensive drugs contributed to the statistically identical recovery of both physical and mental components of the patient's quality of life. The improvement in the quality of life of comorbid patients was accompanied by a decrease in the manifestations of depressive disorders in the studied patients according to the Beck scale. The average score of the Beck scale in patients of group A before treatment was 11.6±0.97, against the background of therapy — 9.1±0.77, p <0.001. In patients of group B, it decreased from 13.0±1.06 to 9.3±0.78, p <0.001. Conclusion: the use of antihypertensive combined strategies amlodipine / perindopril and amlodipine / valsartan for the treatment of hypertension in patients with chronic obstructive pulmonary disease is characterized by comparable effectiveness of blood pressure control, which is confirmed by the data of daily monitoring of blood pressure. Effective control of blood pressure was accompanied by statistically significant (p<0.001) positive dynamics of most indicators of the quality of life of patients in both study groups and the severity of manifestations of depression. Any of the studied combinations, which demonstrated comparable efficacy and tolerability in the study, can be recommended as the first step of antihypertensive therapy in patients with arterial hypertension in combination with chronic obstructive pulmonary disease.

Objective: assess influence of five-component antihypertensive therapy on the main indicators of the daily monitoring of arterial pressure (DMAP), a structurally functional state and diastolic function of a myocardium at patients with the refractory arterial hypertension (RAH) depending on «saltsensitivity» phenomenon. Material and methods: 88 patients with RAH (54 «salt-sensitive» patients, 34 -«salt-resistant»), receiving as antihypertensive therapy ACE inhibitor, a blocker of slow calcic channels (the digidropiridiny), thiazide diuretics, beta-blocker and direct inhibitor of a renin in full doses are surveyed. To all patients DMAP and an echocardiography till 48 weeks of treatment were carried out. Results: 68,5% of «salt-sensitive» and 79,4% — «salt-resistant» of patients on five-component therapy have reached the target level (TL) the AP. Irrespective of a «saltsensivity» the combination of 5 preparations provided reliable positive changes of all indicators of DMAP and Echo, but thus at «salt-resistant» of patients more expressed positive dynamics of indicators of DMAP, the AP daily profile and a myocardium hypertrophy in comparison with «salt-sensitive» patients is noted. Conclusion: five-component therapy provided more significant antihypertensive and antiremodeling effects at «salt-resistant» of patients with RAH, in comparison with «salt-sensitive».

Objective: to study the clinical features, dynamics of the NTproBNP level in patients with STEMI, taking into account the risk of hospital mortality scales. Materials and methods: the study included 150 patients with STEMI. All patients were divided into subgroups: according to the GRACE scale (low, medium and high risk) and the degree of acute heart failure (AHF) classification T.Killip II and III-IV. The clinical and laboratory characteristics of patients, including the level of NTproBNP, were studied. Results: the average age of STEMI patients was 61.7±2.96 years. Dyslipidemia, increased level of markers of myocardial necrosis, high concentration of NTproBNP without tendencies to changes in the dynamics of hospital treatment were detected on the first day of STEMI. Patients with STEMI of Killip III-IV had a statistically significant NTproBNP level 2.0 times higher (p<0.05), and at discharge 2.1 times (p<0.05) compared with the group of patients with Killip II. It should be noted that during hospital treatment, the values of NTproBNP did not change statistically significantly regardless of the degree of T.Killip AHF (p>0.05). A high level of NTproBNP was obtained on the first day of the STEMI in all risk groups of hospital mortality on the GRACE scale. A tendency to increase the values of NTproBNP (p<0.05) with an increase in the risk of hospital mortality was revealed. Conclusion: patients with STEMI AHF Killip III-IV have a greater volume of myocardial damage and the level of NTproBNP, determining a high risk of heart failure. NTproBNP values progressively increase with increasing GRACE scale risk and will not change during inpatient treatment.

Objective: to evaluate the effect of thyrostatics on clinical symptoms, the frequency of cardiac arrhythmias and morpho-functional parameters of the left heart in patients with a combination of thyrotoxicosis and ischemic heart failure. Materials and methods: 85 patients participated in the study. Group 1st — patients with CHF of functional class II-III (FC) on the background of coronary heart disease and concomitant thyrotoxicosis (n=40), average age 58.6±4.6 years; group 2nd — patients with manifest thyrotoxicosis without cardiovascular pathology (n=45), average age 46.7± 4.1 years. When included in the study and after 6 months of therapy with the addition of thyrostatics, the clinical condition of patients and physical activity were evaluated, daily monitoring of an electrocardiogram and an echocardiographic study (EchoCG) were performed. Results: after 6 months of combined therapy with the inclusion of thyrostatics against the background of persistent drug-induced euthyroidism, exercise tolerance increased in comorbid patients (group 1) (p<0.001), the severity of clinical symptoms of CHF decreased, and the frequency of cardiac arrhythmias significantly decreased (p<0.05). The analysis of the dynamics of EchoCG results in group 1 patients revealed a significant increase in the index of shock ejection (p=0.04), left ventricular ejection fraction (p=0.01), shock volume (p=0.03), a decrease in the value of myocardial stress (p=0.02) and parameters characterizing the transmittal flow (E/A, p<0.05), which allowed us to judge the improvement of systolic and diastolic function of the left ventricle (LV) under conditions of drug compensation thyrotoxicosis. Conclusion: the inclusion of thyrostatics in combination therapy and normalization of thyroid function contributed to the reduction of clinical symptoms of heart failure, the frequency of cardiac arrhythmias, improvement of systolic and diastolic LV function in comorbid patients with ischemic CHF and concomitant thyrotoxicosis.

Objective: to analyze the prevalence of asymptomatic hyperuricemia (HU), as well as to assess its relationship with metabolic disorders, pathological conditions and complications in chronic kidney disease (CKD), we conducted a retrospective cohort study in the form of a total cross-section of patients hospitalized in a round-the-clock bed of the nephrology department. Material and methods: 261 patients were included in the study, the average age was 50.9±17.2 (M±SD), there were 261 males and 99 females. The structure of CKD in hospitalized patients was as follows: CKD C1 — 53 patients, C2 — 70 patients, C3A — 46, C3B — 46, C4 — 36, C5 — 7 patients. The study did not include patients diagnosed with gout. Results: the uric acid level in the examined cohort was 369.8±109.7 mmol/L, ranging from 157 to 768 mmol/l. As the glomerular filtration rate (GFR) decreased, the probability of HU increased. With the development and progression of dyslipidemia, there was an increase in the probability of detecting HU. In patients with CKD, an increase in the level of daily proteinuria was also accompanied by an increase in the probability of detecting HU. The risk of progression of CKD to the terminal stages, as well as LVH, arrhythmias, hypertension is associated with high values of uric acid in the blood. Conclusions: the high prevalence of HU in patients with CKD, along with data on its negative impact on the course of CKD, is an important argument in favor of its detection and control. The association of HU with metabolic disorders against the background of high proteinuria explains one of the mechanisms of its detrimental effect on the course of CKD. The influence of HU on the probability of detection of hypertension, LVH, arrhythmias and terminal stages of CKD is shown, which determines the importance of the modifiability of this risk factor in the prognosis of the course of CKD

Objective: to estimate the prevalence of sarcopenia and evaluate the contribution of myostatin and mTOR to the development of muscle mass loss and strength in patients with end-stage renal disease treated with program hemodialysis. Materials and methods: the study included 80 patients with CKD5D, the average age of study participants was 51.7±11.6 years. In all patients, anamnestic data were analyzed, the results of laboratory and instrumental examination were evaluated, the levels of myostatin and mTOR in the blood serum were determined, hand dynamometry, bioimpedancemetry, and a leg raising test were performed. Results: the average volume of muscle mass in the subgroup with sarcopenia was 20.5±0.7 kg and significantly differed from that in the subgroup without sarcopenia 25.23±0.8 kg (p <0.05). The prevalence of sarcopenia in the general group was 38.75%. In men, decreased muscle mass was statistically significantly more common than among women (p <0.05). The level of mTOR in the blood serum of patients with sarcopenia was significantly lower than that in the subgroup without sarcopenia (6.61±0.4 ng/ml and 9.4±0.3 ng/ml, respectively (p <0.001)). The level of myostatin was significantly higher in the subgroup of patients with sarcopenia than without it (12.2±0.6 ng/ml vs. 8.1±0.3 ng/ml, respectively (p <0.001)). The increase in myostatin was accompanied by a decrease in mTOR both in the general group (r=-0.57) and in the subgroup of patients with sarcopenia (r=-0.55). Conclusion: A high prevalence of sarcopenia was found in patients with CKD receiving renal replacement therapy. Myostatin and mTOR have demonstrated their diagnostic potential and can be used as promising markers for the verification of sarcopenia.

Object: identification of electrophysiological features in patients with dyscirculatory encephalopathy at the stage of moderate cognitive disorders according to the developed scenario of registration of EEG with cognitive load. Materials and methods: the study was conducted in the conditions of MBUZ GB No. 1 «Polyclinic for adults», Department of Medical and Biological Physics of the Rostov State Medical University during 2016-2019. A total of 80 patients with dyscirculatory encephalopathy and vascular risk factors were examined, who made up 3 observation groups: «A», «B» and «C». Group «A» is represented by patients with grade I and II DEP and concomitant moderate cognitive disorders, group «B» — patients diagnosed with grade I DEP, cognitively healthy according to the results of neuropsychoological testing (40 and 25 people, respectively), control group «C» —15 people, without manifestations of DEP and cognitive disorders. All patients underwent electroencephalogram registration using the Encephalan-131-03 device. Results: the detected neuropsychiatric disorders in patients with DEP are a reflection of violations of the bioelectric activity of the brain. A tendency to shift bioelectric activity towards slow waves has been revealed according to statistical analysis. The aggravation of the degree of cognitive disorders correlates with a decrease in the activity of the a-rhythm by 12% and an increase in the activity of the δ-rhythm by 16%. According to the spectral analysis, the reflection of cognitive impairments on the parameters of the α- and δ-rhythm was also revealed. As the power of the α-rhythm decreases and above the δ-rhythm, the pathological processes associated with cognitive impairment in the brain in patients with DEP are aggravated. Also among the pathognomonic changes detected by spectral analysis is a significant asymmetry in all leads, and it was especially pronounced in the frontal (Fp1, Fp2) and temporal (T3, T4, T5, T6) areas of the brain. Conclusions: Thus, a new method for studying the EEG in patients with DEP makes it possible to detect characteristic differences, the most significant changes were found in the α- and δ-bands. Changes in cognitive activity reflected in the EEG can serve as additional diagnostic criteria, provided that the experiment is extended.

Nowadays spontaneous coronary artery dissection is an increasingly recognized cause of an acute coronary syndrome. This article presents data on the epidemiology, predisposing factors, risk groups, factors contributing to the development of this disease. In this article we report the case of a 53-year-old woman with an acute ST-elevation myocardial infarction secondary to a spontaneous dissection of the right coronary artery.

Hodgkin's lymphoma (LH) is a B-cell malignant lymphoproliferative disease. There are no specific symptoms characteristic only for this disease. Here may be an asymptomatic increase in peripheral lymph nodes; symptoms of intoxication (B-symptoms — fever above 38 ° C for at least three consecutive days without signs of inflammation; night profuse sweats; weight loss by 10% of body weight over the past 6 months); intermittent fever; itching; in patients with massive mediastinal lesion — chest pain, cough, shortness of breath, symptoms of compression of the superior vena cava, with localization closer to the sternum, discomfort behind the sternum is possible. The presence of the formation of mediastenia and purulent process (abscess, phlegmons, osteomyelitis), resistant to surgery (autopsy, drainage, resection) and antibacterial therapy requires the exclusion of the neoplastic process. It is necessary to carefully observe the technique of performing biopsy and transporting material in a neutral formalin solution at an early date to the pathological - anatomical laboratory, in case of non-standard manifestations of the disease, revision of the biopsy material with mandatory immunohistochemical examination. It is important to bear in mind that the presence of comorbidity (obesity, hypertension, diabetes mellitus) creates additional objective difficulties in the diagnosis and treatment, and requires a collegial decision by a consultation of specialists in patient management tactics.

Authors consider topical aspects of keeping secret information of limited access, to which medical secrecy refers, as well as risks associated with their illegal communication to third parties. Particular attention in the article is paid to the issues of determining the limits of the lawfulness of disclosing medical secrecy, as well as the registration of the written consent of a citizen for such actions of medical personnel.

The article discusses the features of teaching clinical discipline (hospital therapy) in the special conditions of a pandemic, the possibility of combining full-time and distance learning, presents the experience of using distance technologies as an addition to traditional forms of teaching clinical discipline.