The presented review concerns modern approaches to drug therapy for hypertrophic cardiomyopathy. General issues of the treatment are touched upon, including lifestyle modification, maintaining adequate hydration and avoiding situations that increase obstruction. The role of traditionally used b-blockers and non-dihydropyridine calcium channel blockers in the treatment of the disease is described. Data on the use of disopyramide are presented, the treatment of which allows reducing the obstruction gradient, ameliorating clinical manifestations and improving diastolic function. Special attention is paid to a new class of drugs — cardiac myosin inhibitors: mavacamten and aficamten. The results of randomized clinical trials regarding to evaluating the efficacy of these drugs are reported. The review presents a modern view of the place of perhexiline, trimetazidine, ranolazine, eleclazine, angiotensin II receptor blockers, combination of sacubitril and valsartan in the therapy of hypertrophic cardiomyopathy.

Coronary heart disease plays a leading role in global mortality statistics. Despite the obvious progress in the development of new drug regimens, surgical treatment remains an important component. The high prevalence and complexity of treatment of patients with CHD and comorbid pathology, especially diabetes mellitus and chronic kidney disease, make researchers think about proper approaches to therapy of such patients. The decision to perform revascularization is made in consultation with all Heart Team members, taking into account the results of the invasive study, the presence of complaints in the patient and his "response" to drug therapy. Percutaneous coronary interventions (PCI) are still statistically more likely to result in restenosis and repeat revascularizations than open surgery. Hybrid myocardial revascularization is an alternative method combining the advantages of coronary artery bypass and PCI and reducing the risks of both procedures adverse complications. The choice of the optimal strategy of surgical treatment in patients with comorbid pathology requires special attention.

The article presents data on the frequency and features of the development of various cardiac conduction and rhythm disorders in patients with rheumatoid arthritis, the mechanisms of development of these disorders, and discusses the role of inflammation, atrial remodeling, dysfunction of the autonomic nervous system, activation of the renin-angiotensin system, endothelial dysfunction and other factors.

Objective: based on the data of modern domestic and foreign scientific literature, to study the state of the issue of histamine intoxication in scombroid poisoning. Materials and methods: the materials of the works of modern literary sources on this topic are studied. Results: the article presents current information on the development of histamine intoxication in scombroid poisoning. The pathogenetic mechanisms of the disease and its clinical features, possible diagnostic options, principles of therapy are considered. Conclusions: currently, scombroidosis remains an urgent problem, since the absence of specific clinical manifestations and laboratory diagnostics, the similarity of the clinical picture with the symptoms of an IgE allergic reaction to fish are the cause of incorrect diagnosis, underestimation of the clinical symptoms of the disease.

Objective: to evaluate the clinical status of patients with bronchial asthma in the post-Covid period depending on the severity of the acute period of COVID-19. Materials and methods: a case-control study was conducted of patients diagnosed with asthma who had suffered a coronavirus infection, who turned to the Nizhny Novgorod Regional Pulmonology Center for consultation about asthma. The analysis included 56 patients. The survey methods included two stages: retrospective and prospective. The following scales were assessed: the severity of asthma, the level of asthma therapy, asthma control according to the Global Initiative for Asthma (GINA), and the severity of shortness of breath (mMRC test). Results: the analysis revealed statistically significant differences on all scales, regardless of the severity of the acute course of COVID-19, p <0.005. In the process of data analysis, depending on the severity of the acute period of infection, statistically significant differences in the clinical status before and after COVID-19 were found in patients with mild and moderate coronavirus infection. In patients who had mild COVID-19, clinical status indicators worsened on all scales: asthma severity before COVID-19 ─ 2.00 [2.00–2.00], after COVID-19 ─ 2.00 [2.00–3.00], р<0.005; control according to GINA before COVID-19 ─ 2.00 [2.00–2.00] after COVID-19 ─ 3.00 [2.00–3.00]; step therapy before COVID-19 ─ 3.00 [2.25–3.00], after ─ 4.00 [4.00–5.00], р<0.005; severity of shortness of breath before COVID-19 ─ 1.00 [0.25–1.00], after COVID-19 ─ 2.00 [1.00–2.00], р<0.005. Patients who had moderate COVID-19 also worsened all indicators of clinical status on all scales: severity of asthma before COVID-19 ─ 2.00 [2.00–2.00], after COVID-19 ─ 2.00 [2,00–3.00], p<0.005; control according to GINA before COVID-19 ─ 2.00 [2.00–2.00], after COVID-19 ─ 3.00 [2.00–3.00]; level of therapy before COVID-19 ─ 3.00 [3.00–3.00], after COVID-19 ─ 4.00 [4.00–5.00], p<0.005; severity of shortness of breath before COVID-19 ─ 1,00 [1.00–1.00], after COVID-19 ─ 2.00 [1.00–2.00], p<0.005. Conclusion. еhe results of our study demonstrate the negative impact of SARS-CoV-2 on the clinical status of patients with asthma who have suffered a new coronavirus infection.

Objective: the purpose of this study was to identify possible factors for the occurrence of atrial fibrillation (AF) in patients with obstructive sleep apnea syndrome (OSA). Materials and methods: the retrospective study included 50 patients (38 men and 12 women, average age 53 (13) years) admitted to Sleep Medicine Center of University clinic of  Lomonosov State University with complaints of snoring and stop of breathig during sleep and who underwent a polysomnographic study. The study included only patients with moderate and severe OSA. For all patients included in the study, the presence of comorbidities was assessed: arterial hypertension (HTN), type 2 diabetes mellitus (DM), coronary heart disease (CHD) and restless legs syndrome (RLS). Results: 11 patients had a history of atrial fibrillation and/or during polysomnography. When assessing heart rhythm during a polysomnographic study, 5 patients (10%) had AF, of which 1 patient had not previously reported the presence of arrhythmia. A predictive model was developed to estimate the probability of AF (atrium fibrillation) conditioning on age, average desaturation, % using binary logistic regression. The resulting regression model is statistically significant (p < 0.001). Based on the value of Nagelkerke R², the model explains 50.6% of the observed AF variance. 1 increase of age is associated with 1.211 times increase in AF odds. 1 increase of average desaturation, % is associated with 1.448 times increase in AF odds. Conclusions: it was shown for the first time that, along with such a well-known risk factor for AF as age, parameters of respiratory disorders during sleep, namely, average desaturation, can play a role in the development of AF through the mechanisms of myocardial ischemia-reperfusion. Average desaturation, reflecting the degree of ischemia-reperfusion, may become a risk factor for the development of AF.

Objective: to dynamically study the clinical characteristics, the level of growth differentiation factor 15 (GDF-15) during hospital treatment in patients with acute ST-segment elevation myocardial infarction (STEMI). Materials and methods: an analysis of clinical and laboratory data of STEMI patients during hospital treatment and echocardiography parameters was carried out. Scores were calculated on the GRACE scale to assess the prognosis of in-hospital mortality of patients. The characteristics of patients with STEMI were identified taking into account GDF-15 values. Statistical processing using the statistical software package "Statistica 10.0 for Windows". Results: clinical and laboratory characteristics of STEMI patients on the first day of the disease determined the prognosis. GDF-15 values increased on the first day of STEMI development and depended on the risk of in-hospital mortality on the GRACE scale. GDF-15 values tended to decrease during the inpatient phase of treatment. Patients with STEMI with a GDF-15 concentration equal to or more than 1200 ng/ml did not reach reference values in the dynamics of hospital treatment and had higher values of markers of myocardial necrosis, reflecting the impact on the prognosis. Conclusion: the GDF-15 indicator can be used as a marker for the prognosis of STEMI in combination with the GRACE scale assessment. High GDF-15 values during the hospital phase of patient treatment reflect the prognosis of STEMI patients.

Objective: study of the features of changes in the heart, blood vessels and internal organs (liver and kidneys) in men with hypertension, depending on the BMI value. Materials and methods: 194 men aged 25 to 63 with hypertension were examined. All the examined patients were divided into 3 groups depending on the BMI value. All patients included in the study were determined by serum creatinine (calculated by GFR), glucose, aspartate aminotransferase, alanine aminotransferase, lipid spectrum, uric acid. In addition, echocardiography, ultrasound of the kidneys with measurement of arterial and venous blood flow through the main vessels of the kidneys, ultrasound of the liver were performed. In the future, the groups were compared with each other according to the studied laboratory and instrumental data. Results: as the BMI values increased, the indicators of alanylaminotransferase, IFDS, RWT LV, MMLV, IMLV, the size of the right lobe of the liver, the incidence of hepatosteatosis significantly increased. Adherence to antihypertensive therapy in the selected groups ranged from 18,9 to 20,5%. Bilateral disorders of outflow through the renal veins were 1,8 times more common among people with normal BMI compared with obesity (p<0.05). Conclusion: among the examined young men with hypertension, there are features of an unfavorable "cardiological" profile and low adherence to antihypertensive therapy, which, as the age and length of the disease increases, is associated with a high risk of developing associated clinical conditions in the future. In male patients with hypertension and obesity, the incidence of hepatosteatosis is 100%, having an additional adverse effect on cardiovascular risk. The revealed features of renal venous blood flow among patients with hypertension deserve further investigation.

Objective: to evaluate the features of development and course of arterial hypertension (AH) and changes in vascular stiffness in patients with ankylosing spondylitis (AS) who underwent COVID-19. Materials and methods: 60 patients with a reliable diagnosis of AS were included in the study. Patients were divided into 2 groups depending on the presence of COVID - 19 in anamnesis. The main group consisted of 30 patients with AS who had suffered COVID-19 of varying severity during the previous 12 months. The comparison group consisted of 30 patients with AS who had no laboratory and clinically confirmed COVID-19 infection within the last year. Patients were interviewed regarding the severity of their previous coronavirus infection and persisting symptoms in the post-COVID-19 period. AS activity was evaluated by ASDAS (CRB, BASDAI-index). BP measurement and study of arterial stiffness parameters by oscillographic method, evaluation of the results of ambulatory BP measurement were performed. Results: 6 (20%) patients had BP destabilization at the outpatient stage during home BP measurement early after COVID-19. After 12 months, BP elevation persisted in only 2 (7%) patients, the rest had BP stabilization with withdrawal of antihypertensive drugs. No correlation between BP level, arterial stiffness and AS activity was found. There was a weak inverse correlation between the severity of coronavirus infection and the level of systolic blood pressure, between age and pulse wave velocity. No significant differences in systolic, diastolic blood pressure, pulse wave velocity, aortic augmentation index were found in patients with AS with and without coronavirus infection. In the main group, 1 fatal outcome due to the development of acute ST-elevation myocardial infarction 6 months after COVID-19 was recorded, and no adverse cardiovascular events were registered among patients in the comparison group. Conclusion: it was hypothesized that patients with AS who underwent COVID-19 would be more likely to show BP elevation than those who did not undergo COVID-19. It was found that early after COVID-19 (first three months) a reversible increase in BP without significant changes in arterial stiffness is possible. However, no significant differences in the frequency of BP elevation, BP level, and arterial stiffness were found in patients with AS and COVID-19 or without COVID-19 in anamnesis.

Purpose: To evaluate data on the dynamics of lipid metabolism in patients with arterial hypertension stage II who have had COVID-19, when the L-arginine complex + dihydroquercetin. Materials and methods: The article provides data on the dynamics of lipid metabolism in patients with arterial hypertension stage II who have had COVID-19, when the L-arginine complex (500 mg tablets 1 time per day) + dihydroquercetin (25 mg tablets 2 times) is included in combination antihypertensive therapy per day. Results: In patients who received combination antihypertensive therapy, which included statins (group 1), the target triglyceride value (<1.7 mmol/l) was not achieved. The target value for calculated low-density lipoprotein cholesterol (<3.7 mmol/L) was also not achieved. More significant changes in lipid metabolism were detected in patients (group 2) who took the L-arginine + dihydroquercetin complex as part of combined antihypertensive therapy, which included statins. Thus, in patients of group 2, total cholesterol and triglycerides decreased significantly (by 20-30%). There was also a significant decrease in this group of patients (by 30%) in the calculated indicator of low-density lipoprotein cholesterol and its target value was achieved (<3.7 mmol/l), namely 3.13±0.19 mmol/l. Summary: the inclusion of the L-arginine complex (tablets 500 mg 1 time per day) + dihydroquercetin (tablets 25 mg 2 times per day) in the combined AHT + statins in patients with stage II hypertension who have had COVID-19 is more effective than the combination AHT + statins affect OB, which is manifested by an improvement in its key indicators (TC, TG, LDL-C and HDL-C), as well as the calculated indicator of non-HDL-C.

Objective: to evaluate the effectiveness of the use of iron carboxymaltosate in late pregnancy and in the postpartum period. Materials and methods: dynamic observation of the effectiveness of iron carboxymaltosate in 46 pregnant women diagnosed with anemia, latent iron deficiency due to the lack of positive dynamics against the background of taking oral forms of iron preparations, complaining of palpitations, shortness of breath with minimal physical exertion, weakness. The assessment was carried out by the level of hemoglobin (Hb), ferritin a month after the treatment with a high-dose iron preparation intravenously drip. The follow–up period is the third trimester of pregnancy, 2 days after delivery, a month after delivery. Results: the treatment with iron of carboxymaltosate led to an increase in the Hb level of 18±3 g/l, the ferritin level of 70±35 mcg/l a month after the infusion, and an improvement in the clinical condition. Conclusion: the use of iron carboxymaltose in the late stages of pregnancy allows to quickly normalize and maintain target values of hemoglobin and ferritin levels for a long time, already during the postpartum period, as well as improve the quality of life of women.

Objective: to evaluate changes in markers of apoptotic processes and lipid peroxidation (POL) by accumulation of malondialdehyde (MDA) in the mitochondrial fraction of the liver of animals carrying Lewis epidermoid carcinoma at different stages of the tumor process with the introduction of bis-(3,5-di-tert-butyl-4-hydroxyphenyl)dimethylolol thiolate (Me-3) and (3,5-di-tert-butyl-4-hydroxyphenyl)triphenylololate (Me-5). Materials and methods: the work was performed using laboratory animals - female mice of the C57Bl line/6. 48 hours after the Lewis epidermoid carcinoma strain was transplanted, substances Me-3 and Me-5 were administered once a day for 5 days intraperitoneally at the maximum effective dose of 375 mg/kg and 250 mg/kg, respectively. Animals of the control group were injected with a carrier in similar modes and volumes. Results: when Me-3 was administered at the maximum effective dose on days 7 and 21, a decrease in the level of all the studied indicators was noted, which indicates a high actioxidant activity of a hybrid organotin compound containing one tin-containing [-Sn(CH₃)₂] and two protective antioxidant fragments (3,5-di-tert-butyl-4-hydroxyphenyl). The compound Me-5 has a more pronounced prooxidant potential, as evidenced by high levels of damage to mitochondrial DNA (8–hydroxy–2'–deoxyguanosine) and malonic dialdehyde. Conclusion: the introduction of bis-(3,5-di-tert-butyl-4-hydroxyphenyl)dimethylolol (Me-3) and (3,5-di-tert-butyl-4-hydroxyphenyl)triphenylolol (Me-5) compounds revealed a change in the pro/antioxidant state and the launch of apoptotic processes in liver cells.

Granulomatosis with polyangiitis (Wegener's granulomatosis, GPA) is a rare disease of unknown etiology with multiple organ lesions, characterized by the development of necrotizing granulomatous inflammation and signs of autoimmune vasculitis, predominantly affecting small and medium-sized vessels. In the above clinical case, the patient has a classic triad of symptoms (damage to the upper respiratory tract, lungs, kidneys), the diagnosis was confirmed morphologically. The peculiarity of the described clinical case is its rare prevalence, the difficulty in making a diagnosis due to the multiorganism of the lesion, the absence of specific signs at the onset of the disease, which required a differential diagnosis. Early detection of antineutrophil cytoplasmic antibodies (ANCA) in the blood increases the frequency of GPA diagnosis, and timely diagnosis allows prescribing therapy as soon as possible and avoiding disability in patients.

The article considers a clinical case of atypical hemolytic-uremic syndrome, which was the starting mechanism for the development of membranous nephropathy. Patient X. 23 years after acute respiratory viral infection, signs of nephrotic syndrome, arterial hypertension, and impaired kidney function appeared. Puncture nephrobiopsy was performed and the morphological picture corresponds to immunocomplex glomerulonephritis, most likely membranous nephropathy with the presence of segmental glomerulosclerosis, cellular half-moons. In parallel, the patient had verified signs of thrombotic microangiopathy in the form of microangiopathic anemia, thrombocytopenia, increased lactate dehydrogenase levels as a sign of cytolysis (primarily intravascular hemolysis). During the differential diagnosis, we stopped at the diagnosis of atypical hemolytic-uremic syndrome. The uniqueness of the described clinical case is that cases of glomerulonephritis against the background of atypical hemolytic-uremic syndrome are extremely rare, and membranous nephropathy is described for the first time.