#This guidelines is current as of 01.04.2020. Follow the information updates on the website of the Russian Society of Cardiology www.scardio.ru

Population prevention is the basic component of a public health promotion system. In this area Russia has got extensive experience, which is internationally acknowledged. Ministry of Health of Russia has developed initiatives aimed at reducing availability of the alcohol and tobacco products, creating a safe and smoke-free environment, and establishing a healthy lifestyle. Implementation of measures to strengthen public health requires epidemiological monitoring of the risk factors prevalence and the population commitment to a healthy lifestyle. Individuals leading a healthy lifestyle, compared to those who do not observe it, demonstrated a 39% (p = 0.0003) lower mortality from all causes, 36 % (p = 0.0035) - from cardiovascular diseases, and 19 % (p = 0.0058) of overall cardiovascular events.

In 2019, the group of experts on the treatment of hypertension of the European society of cardiology proposed to abandon the term «hypertensive urgency», retaining the concept of ha only for cases of «hypertensive emergency», in which hospitalization is required and, as a rule, the immediate start of intravenous antihypertensive therapy. Experts of the European society of cardiology, when detecting a high level of blood pressure, but in the absence of damage to target organs, suggest formulating the diagnosis as «inefficiently treated hypertension». It should be taken into account that only captopril is widely available in the Russian Federation for faster blood pressure reduction in patients. You should avoid taking short-acting nifedipine at high blood pressure, especially in the elderly, due to the unpredictability of the response, manifested in an excessive decrease in blood pressure.

The goal of a large, prospective, randomized clinical trial, ISCHEMIA, was to evaluate a routine invasive treatment strategy compared to optimal drug therapy in patients with stable ischemic heart disease (IHD). At first glance, the question of the effect of coronary revascularization on the natural course of stable IHD received a definitive negative answer. However, excessive pessimism regarding coronary revascularization due to the results of the ISCHEMIA study is not justified and when interpreting the results of the project, it is necessary to take into account the criteria for exclusion of patients, conducting revascularization in some patients from the group of drug therapy. Meanwhile, already at present, a significant part of the resources used for widespread revascularization with stable IHD should be directed toward achieving the new goals of lipid-lowering therapy recommended by experts, the use of prognostically effective combined antithrombotic treatment and rational combinations of antianginal drugs.

Early initiation of reperfusion therapy remains to be crucial step of management for ST elevation myocardial infarction (STEMI), as elevation on a 12-lead electrocardiogram (ECG) is considered as a result of coronary occlusion or critical stenosis. At the same time, nearly 10 – 25 % of non-STEMI patients, according to coronary angiography, do have occlusion or critical stenosis of major epicardial vessel. Reperfusion delays in this case lead to worse outcomes. Although criteria for STEMI equivalents briefly mentioned in the current recommendations, data on those specific ECG patterns are lacking. By searching MEDLINE and EMBASE was conducted a structured review of non-STEMI patterns, connected with critical stenosis or occlusion, the sensitivity and specificity data was also provided. It is hard to overestimate the clinical significance of revealing high risk patients in the absence of classical STEMI in the emergency department or the pre-hospital setting.

Aortic stenosis is the most common manifestation of valve heart disease, which requires surgical or endovascular intervention. The prevalence of degenerative aortic stenosis is increasing due to an aging population. The clinical course of aortic stenosis is characterized by a long-existing asymptomatic period. The progressive calcification of the valve cusps leads to the formation of a pressure gradient in the aorta, hemodynamic overload of the left ventricle, the development of myocardial hypertrophy, which contributes to the violation of diastolic function of the left ventricle. After the onset of symptoms of aortic stenosis, the two-year survival in patients who do not undergo surgical correction does not exceed 50 %. The Recommendations of the European Association of Cardiology and the European Association of Cardiothoracic Surgeons for the treatment of patients with valvular heart disease in 2017 discuss aspects of the diagnosis of aortic stenosis and the principles of choosing tactics for managing patients using surgical or catheter treatment methods. Depending on the severity of aortic stenosis, its clinical manifestations, age of patients, and associated pathology, surgical replacement of the aortic valve or its transcatheter implantation may be recommended. The use of drug therapy for aortic stenosis did not show the possibility of improving the prognosis. Drug therapy is used to treat heart failure, hypertension. Important tasks are the control of sinus rhythm and the prevention of thromboembolic complications.

Anemic syndrome is one of the most common in the practice of doctors of all specialties. The ability to interpret peripheral blood counts, knowledge of the main diagnostic criteria for anemia of different genesis allows the doctor to conduct the necessary examination, clarify the pathogenetic variant of anemia, its cause, prescribe adequate therapy in a timely manner, which depends on the effective restoration of blood counts, the speed of normalization of the patient’s condition, the restoration of its performance, as well as success in treating the underlying disease.

Purpose: to study the frequency of lesions of the gastrointestinal tract in NSAIDs users with rheumatoid diseases, as well as to increase the effectiveness of therapeutic and preventivestrategies.

Matherials and methods: 112 patients (50 men, 62 women) with various rheumatic diseases and long-term NSAIDs were examined. All patients underwent upper and lower endoscopy, in some patients video capsule endoscopy of the small intestine was also performed.

Results: аccording to the data obtained, the most common NSAID-induced gastrointestinal damage was NSAID-gastropathy, observed in 43 % of all NSAID users. 68.6 % of patients with NSAID gastropathy during video capsule endoscopy were additionally diagnosed with NSAID enteropathy, and 9 % of patients with NSAID gastropathy were also diagnosed with NSAID colopathy, which were significantly more common in patients receiving non-selective NSAIDs. Combined lesions of all sections of the gastrointestinal tract, the gastroduodenal zone, small and large intestine, were observed in a significant number of patients — in 27 % of cases, most often in patients with rheumatic diseases who took non-selective NSAIDs. A generalization of the existing experience in the treatment of patients with NSAID-induced gastrointestinal lesions showed that in the case of a combination of NSAID-gastropathy and NSAID-enteropathy, the preferred preventive strategies should be H. pylori eradication, the use of rebamipide and the use of selective COX-2 inhibitors. With the combination of NSAIDs with concomitant excess bacterial growth syndrome and NSAIDs-colopathy, rifaximin, rebamipid and sulfalazine are effective.

Conclusions: the data obtained confirm the high prevalence of combined lesions of the proximal and distal gastrointestinal tract in rheumatological patients, which may indicate a universal damaging effect of NSAIDs on the entire gastrointestinal tract.

Objective: to develop reliable criteria for the diagnosis of neurovascular conflict - the pathogenetic basis of classical trigeminal neuralgia (TN).

Materials and methods: 25 patients with classical TN were examined. Multispiral x-ray computed angiography in 3D mode provides identification of two types of neurovascular conflict (NVC). Electroencephalography was performed before and after the removal of NVC.

Results: the first type of NVC was detected only in patients with TN. The second type was found with the same frequency in both TN patients and healthy individuals. The dynamics of the bioelectric activity of the brain before and after the elimination of NVC allowed us to establish reliable signs of changes characteristic of NVC.

Conclusion: detection of the first or second type of conflict in the patient and changes in the bioelectric activity of the brain typical for classical TN (formation of an epileptiform focus, foci of irrigation in the medulla oblongata, excess of electric activity power) allows distinguishing neurovascular contact from NVC.

Objective: to study the clinical and functional manifestations of various forms of gastroesophageal reflux disease (GERD) with comorbid peptic ulcer of the duodenum (PUD) and gastric ulcer (GU) to clarify the diagnosis and identify targets for pathogenetic therapy at the stage of primary health care.

Materials and methods: 287 patients with GERD, comorbid with uncomplicated ulcer, were examined. Questioning of patients was carried out, An in-depth endoscopic examination (EGDS) was performed in combination with an acid perfusion test (APT) to detect non-erosive reflux disease (NERD) and gastric endoscopic chromoscopy to determine the acid production of the stomach.

Results: in patients with GERD with comorbid PUD, heartburn and acid regurgitation were more often detected in comparison with NERD. According to the results of chromoscopy, hyperand normochlorhydria were characteristic for patients with PUD, hypochlorhydria - for patients with GU. An acute GERD stage and the frequency of positive CBT are associated with an exacerbation of the PUD. There was a direct correlation between the age of patients and the stage of GERD. Moreover, the age and stage of GERD revealed a direct correlation with a positive APT, which reflects a violation of the permeability of mucosae of the esophagus.

Conclusion: in patients with GERD with comorbid PU, patient-oriented diagnosis may consist of endoscopic chromoscopic determination of stomach acid production and endoscopic APT to confirm NERD and identify GERD phenotypes comorbid with acid-dependent diseases in order to determine treatment tactics.

Objective: to study molecular effects of thiotriasoline of the patients with coronary heart disease (CHD).

Materials and methods: 60 patients with stable angina of I – III functional classes were compared regarding the effects of thiotriasoline via standard therapy regime (STR), taking into account the activity of basic products level free radical oxidation (FRO) and antioxidant systems (AOS), proteomic protein profile.

Results: in 24 weeks on the background of STR and thiotriasoline there is a revealed statistically reliable growth of glutathione reductase content, reduction of malonic dialdehyde, increase of endothelial lipase detection rate, phosphomevalonatekinase, γ-butyrobetaine hydroxylase, linoleil CoA-desaturase, reduction of delta-5 desaturase.

Conclusion: thiotriasoline possesses cardioprotective activity with antioxidant and cytoprotective effects, reducing free radical products content and raising the activity of antioxidant systems ferments with regard to patients with CHD.

Objective: to study the features of cardiovascular lesions in patients with rheumatoid arthritis (RA), depending on the age of diseaseʼs onset.

Materials and methods. The study included 140 patients with RA. The average age is 53,8 ± 11,2 years, women 82.1 %, men 17.8 %. Depending on the age of the RA debut, patients are divided into 2 groups: I — patients with a debut of the disease up to 45 years (n = 59) and II — with a debut after 45 years (n = 81). A comparison group consisted of sex and age-comparable patients with essential hypertension without RA.

Results: hypertension in the group with RA debut after 45 years was more common than in I group (57.4 % and 46.6 % respectively). In I group, only 6.6 % of patients had hypertension at the time of debut of RA, in the second group — 28.5 %. In the second group the frequency of such traditional risk factors as overweigth and obesity, metabolic syndrome was higher. Atherosclerotic plaques in the carotid arteries in II group were more common (78.5 %) than in I (53.3 %). In the 1st group men and women plaques were found with the same frequency, in the second — among men more often than often women (100 % and 71.4 % respectively).

Conclusion: the debut of RA after 45 years is more often associated with hypertension at the onset of the disease, they are more likely to have traditional risk factors, which accompanied by more pronounced structural changes in the carotid arteries when compared with RA debut up to 45 years.

The article presents as an introduction a mini-review devoted to the problem of cutaneous leukocytoclastic vasculitis. Despite the wide prevalence of this local vasculitis, cases of its combination with systemic lesions are rare. Isolated cases of combination of leukocytoclastic vasculitis with kidney damage are described. We present a clinical case of patient N. with leukocytoclastic vasculitis in combination with chronic glomerulonephritis. Both lesions were confirmed morphologically. We assume that vasculitis is systemic and kidney damage is caused by it. The stages of management of the patient, the response of the disease to the therapy are presented.

В работе изложены основные принципы диагностики рака поджелудочной железы. Приведены собственные клинические наблюдения: случай этого заболевания, иллюстрированный лабораторно-инструментальными методами диагностики и верифицированный по результатам аутопсии.

The article presents a historical review of therapeutic schools in the Don region from the time of their origin up to the present day. The history of therapeutic schools is closely connected with the history of therapeutic communities, their foundation being laid by the outstanding scientists and clinicians, who marked the bright period in the development of the Don medicine. Their disciples put a lot of effort into further improvement of internal medicine in the region, maintaining the best professional traditions. Today new personalities are taking the leading positions and head up a celebrated regional school of therapeutics.

The modern needs of society for an effective system of health management, accessibility and quality of medical care have led to a significant update of the legislation. Certainly positive trends include modernization of the conceptual apparatus, ensuring the quality of medical care through the development of not only medical care procedures, medical care standards, but also clinical recommendations; ensuring availability of palliative care and pain relief, possibility of visiting patients in the intensive care department; optimization of compulsory health insurance; legal guarantees of drug security. Federal laws have a fundamental role to play in the legal regulation of health care. By-laws adopted by the Government of the Russian Federation and the Ministry of Health of the Russian Federation are also important.