Short- and long-term prognosis in patients with unstable angina and anemia

Aim. To investigate correlation between anemia and long- and short-term prognosis in patients with unstable angina. Material and methods. The study included 96 patients (34 females), aged 63.3±10.3 years, with unstable angina. All patients received conservative treatment. Individuals with severe associated pathology and hemorrhages in anamnesis were excluded from the study. Anemia was diagnosed according to WHO criteria; unstable angina class was registered. Short-term, in-hospital prognosis assessment included registering severe, recurrent angina, myocardial infarction (MI), number of ischemic episodes during 24-hour ECG monitoring before discharge. Long-term prognosis was assessed during 6 post-discharge months: death, MI, and combined endpoint (cardiac death, MI, recurrent angina) were registered. Results. Anemia was diagnosed in 38 patients (39.58 %). Angina at rest was associated with lower mean hemoglobin (Hb) level and greater anemia prevalence (46%), comparing to the group of progressing effort angina (25%). Participants with prolonged angina episodes had significantly lower Hb level (122.23±13.3 g/l) than the others (130.9±13.56 g/l). Among patients with ischemic episodes at 24-hour ECG monitoring, anemia was registered in 50%, among individuals without such episodes – in 30.4%. Recurrent unstable angina during 6 post-discharge months was associated with higher anemia prevalence: 57.6% vs 21.05% in participants with better outcome. Logistic regression analysis demonstrated negative independent influence of anemia on combined endpoint. Conclusion. Patients with anemic syndrome were characterized by severe in-hospital course of unstable angina. Anemia was associated with increased risk of MI and recurrent unstable angina in the first 6 months after discharge

ARTERIAL HYPERTENSION AT SPORT ACTIVITIES IN MIDDLE AGE AND ELDERLY SPORTSMEN

Aim. To analyze the changes of systemic arterial pressure (BP) before and after sport load, incl. the diagnosis of arterial hypertension (AH) and antihypertensive treatment, in veteran sportsmen.Material and methods. Questionnaires were applied for the main cardiovascular risk factors assessment, and BP measurement upright resting (before warming up exercises) and just after the load in 108 competitive sportsmen 40-72 y.o. In the study, the previously set diagnosis of systemic hypertension was taken in consideration and its treatment type.Results. Among all participants, 41% had increased systolic BP (SBP) and 29,6% — diastolic (DBP) at baseline. After exercises, increase of SBP was found in 41% and DBP — in 50,9%. During competition, baseline increase of SBP had 61,8% of all participants, increased DBP — 35,3%. After competition, increase of SBP was found in 67,6% sportsmen, of DBP — 41,2%. Among those with no AH diagnosis, 30,6% had SBP >139 mmHg at baseline, and 42% — after warming up. In sportsmen with already diagnosed AH, raised SBP before warming up was found in 56%, after — 60%. The tendency was even more prominent during competitions. In AH sportsmen, the characteristics of BP change at sport loads did not differ significantly by the type and regularity of antihypertension drugs intake.Conclusion. Almost a half of adult and elderly sportsmen have AH diagnosis, and of those less than a half do take regular antihypertensive therapy. Most of veteran sportsmen experience raised BP before and after sport load, including those taking regular therapy and a third of those not diagnosed with AH

Carvedilol therapy effects on structural and electric remodeling in chronic heart failure

Aim. To assess the effects of combination therapy with ACE inhibitors and carvedilol on cardiac remodeling, cardiac arrhythmias, and quality of life (QoL) in patients with mild to moderate chronic heart failure (CHF).Material and methods. The study included 109 patients with mild to moderate CHF, developed in arterial hypertension, coronary heart disease, or their combination with diabetes mellitus and obesity. Initial carvedilol dose was 6,25-25 mg/d. At baseline, 3, 6, and 9 months later, physical examination, biochemical assay,  lectrocardiography,QoL and clinical outcome assessment were performed. Doppler echocardiography and 24-hour electrocardiogram (ECG) monitoring were performed at baseline and 6 months later.Results. CHF therapy, including the combination of ACE inhibitor and carvedilol, was associated with reduction in structural left ventricular (LV) remodeling, as well as with systolic and diastolic LV function normalization. According to 24-hour ECG monitoring data, the total number of supraventricular (including paired and grouped) and ventricular (including paired ectopic complexes) extrasystoles significantly decreased. Combination, carvedilol-including CHF therapy resulted in significant QoL and clinical prognosis improvement.Conclusion. In patients with mild to moderate CHF, carvedilol demonstrated its clinical effectiveness, including reduced structural and electric remodeling progression

Corrected orthogonal vectorcardiography in pulmonary hypertension diagnostics

Aim. To assess potential of corrected orthogonal vectorcardiography (VCG) in diagnostics of right heart dilatation in various pulmonary hypertension (PH) forms. Material and methods. VCG examination was performed with corrected orthogonal lead system by MacFeeParungao, in 77 patients aged 14-77 years: 35 individuals with primary PH (PPH), 42 participants with secondary PH (CPH) due to congenital and acquired valve disease (CVD, AVD), or chronic obstructive pulmonary disease (COPD). Results. According to VCG results, right atrium dilatation was observed in 80.5% of PH patients, right ventriculum dilatation – in 90.9%. Prevalence of right heart dilatation was maximal in PPH – 94.3%, being lower in COPD (80%), CVD, and AVD (59.1%). VCG predictors of right heart dilatation in PH were: P loop spatial area, P loop diameter in optimal approach plane, and total R wave amplitude regarding z and S in lead x. Conclusion. According to the results obtained, VCG method could be recommended for right heart size assessment in patients with various PH forms

POLYCYTHEMIA VERA IDENTIFIED IN A PATIENT WITH RESTENOSIS OF THE SUPERFICIAL FEMORAL ARTERY. CLINICAL CASE AND REVIEW OF THE LITERATURE

The article describes the clinical case of the first revealed vera polycythemia in a 67-year-old man admitted to a hospital in the hematological department of the Republican Clinical Hospital named after. G.G. Kuvatov, Ufa, about the restenosis of the superficial femoral artery. On admission, the patient’s main complaints were pain in the left leg, shortness of breath with physical exertion, headache, unstable blood pressure, numbness of hands, fatigue, general weakness. In addition, the patient was troubled by severe itching. When entering the objective status of the patient, attention was drawn to the hyperemia of the face and neck, injection of sclera, acrocyanosis, cyanotic shade of the oral mucosa, amputation stump of the lower left third of the thigh, necrotic area on the skin of the distal part of the middle finger of the right leg. After receiving laboratory and clinical data, as well as on the basis of patient complaints, a history of the disease and a clinical picture, the final clinical diagnosis was established: the vera polycythemia II B stage. Against the background of ongoing therapy, the patient noted improvement in general condition, stabilization of blood pressure, reduction of pain in the right leg, reduction of dyspnea, itching of the skin, improvement of sensitivity in the hands. According to laboratory data, positive dynamics was also revealed. This clinical observation emphasizes the need for timely diagnosis and continuous monitoring of the treatment of vera polycythemia with the help of clinical and laboratory-instrumental research methods, which is a prerequisite for correct prognosis of the course of the disease and for achieving maximum effectiveness of the therapy