Biomarkers of heart failure: current state of problem

There is constant increase in patients with heart failure every year worldwide. Early diagnosis and prediction of deterioration could upgrade management of patients and slow down the progression of heart failure.The brain natriuretic peptide precursor (NT-proBNP) is considered to be the universal biomarker, although it has several limitations. The search of ideal biomarker is directed into molecular biology and genetics. Microribonucleic acids (microRNAs) regulate different processes in human body, present myocardial specificity, and plasma stability. It has been proven in different trials that diagnostic and prognostic level of microRNAs is equal to NT-proBNP. Potential opportunities of the method are not only diagnosis but therapeutic targets for heart failur

Familial hypercholesterolemia: case series of a rare condition

Introduction. Cardiovascular events at a young age are often the first manifestation of a genetic disorder such as familial hypercholesterolemia. High cholesterol levels, xanthomas and xanthelasmas, as well as a positive family history of cardiovascular disease, make it possible to identify a group of patients subject to genetic research. The identification of a specific mutation helps to determine further strategy not only for a patient, but also to his or her immediate relatives, thereby effectively conducting both secondary and primary prevention of atherosclerosis complications.Brief description. Using the example of patients from the Krasnodar Lipid Center, the relevance of genetic testing and cascade screening is demonstrated. We show problems of delayed diagnosis and low medical adherence, as well as the ways to optimize care for patients with genetic lipid metabolism disorders.Discussion. The rise in the incidence of cardiovascular events at a young age in developed countries prompts the search for more improved screening and diagnostic methods for familial hypercholesterolemia. The optimal age of initiation of lipid-lowering therapy in children with established familial hypercholesterolemia is also discussed. While secondary prevention appears to be clearer, there is still insufficient achievement of low-density lipoprotein cholesterol targets in patients with a previous cardiovascular event

Spontaneous left coronary artery dissection in the postpartum period: a case report

Spontaneous coronary artery dissection is a rare disease that threatens the patient life. Often this pathology complicates the course of pregnancy or the postpartum period. The rare occurrence and difficulties in diagnosis are the reason for the lack of data and the impossibility of developing a single algorithm for diagnosing and treating spontaneous coronary artery dissection.The article provides a brief literature review and a case report of spontaneous coronary artery dissection in the postpartum period, and discusses a number of aspects of treatment tactics

Echocardiographic phenomenon “RAC-sign” in the anomalous course of circumflex artery: a case report

Coronary artery (CA) anomalies are a group of congenital heart defects  with a diverse clinical performance, from lifelong asymptomatic to severe consequences such as sudden cardiac death. In some cases,  CA anomalies become  an incidental finding during echocardiography.  If there is a suspicion of CA anomaly, a radiographic investigation (computed tomography (CT) angiography or magnetic resonance imaging) should be performed to clarify the anatomy and indications for surgical correction.A case of diagnosing a tubular structure with hyperechoic  walls in mitral valve projection during echocardiography  is presented. The performed CT angiography confirmed the abnormal origin of circumflex artery from the right sinus of Valsalva with its retroaortic course. This echocardiographic  sign is described in the English-language literature as Retroaortic Anomalous Coronary sign (RAC-sign)

ВАРИАНТЫ КЛИНИЧЕСКОГО ТЕЧЕНИЯ ВАЗОСПАСТИЧЕСКОЙ СТЕНОКАРДИИ

Vasospastic angina (angina inversa, variant angina or Prinzmetal angina) is a rare variant of the course of coronary artery disease. Despite a good understanding of its underlying mechanisms (prolonged coronary spasm resulting from endothelial dysfunction) and contributing factors (smoking, exposure to cold weather, cocaine, autoimmune diseases, etc.), the treatment of each individual patient remains a source of discussion. To date, these patients are commonly treated with drugs, especially calcium antagonists and nitrates. The article presents clinical cases of patients with vasospastic angina and discusses their treatment depending on the individual clinical pattern. Early diagnosis of vasospastic angina allows preventing in some cases fatal complications and save patients’ life.Вазоспастическая стенокардия (ангиоспастическая, вариантная или стенокардия Принцметала) – редко встречающийся вариант течения ишемической болезни сердца. Несмотря на хорошую изученность механизмов ее возникновения (длительный спазм коронарных артерий, являющийся следствием эндотелиальной дисфункции) и провоцирующих факторов (курение, холод, прием кокаина, аутоиммунные заболевания и др.), вопросы лечения каждого отдельно взятого пациента остаются предметом дискуссии. На сегодняшний день предпочтение в лечении таких пациентов отдается медикаментозным препаратам, прежде всего антагонистам кальция и нитратам. В работе представлены случаи вазоспастической стенокардии и обсуждаются особенности их лечения в зависимости от клинического варианта ее течения. Диагностика вазоспастической стенокардии в ранние сроки позволяет предотвратить в ряде случаев фатальные осложнения и спасти жизнь пациенту

ANOMALIES OF CORONARY ARTERIES. "ARTERY-COLLAR"

Anomalies of coronary arteries are very diverse. Due to angiography evolution, possibilities for their detection became more frequent, and it always attract attention of experts. In the present article, we describe a clinical case with a rare and insufficiently explored anomaly – presence of the single coronary artery

CLARENCE WALTON LILLEHEI (1918–1999): WORK TO EXHAUSTION, PLAY UP TO THE END!

The history of cardiovascular surgery development strikes with courage of the ideas. Takeoff and falling, success and defeats — all these were on the way of formation of cardiac surgery, but without mistakes and failures dynamic development of medicine is generally impossible.One of the outstanding cardiac surgeons, whose name will remain in the history forever is Walton Lillehei, the person whose keynote was «work to exhaustion, and play up to the end». Despite vicissitudes of life, he was not afraid to take the risk, understanding that in case of success, hundreds of lives would be saved. But at the same time his activity was not thoughtless passion, and on the contrary, each step of his, attempt of improvement or development of something new, whether it was surgical technique or introduction of a new device, had the soil of long researches and clinical observations

Difficult diagnostics of a rare cause of pulmonary hypertension: a case report

Pulmonary hypertension is a syndrome difficult for differential diagnosis, which is the outcome of various pathological conditions. With the exclusion of the most common causes of pulmonary hypertension (left heart disorders and pulmonary embolism), further search for cause often becomes an insoluble problem. Sezary syndrome is classified as a rare type of cutaneous T-cell lymphomas. Early diagnosis of this syndrome is important for the initiation of adequate therapy, since cases of complete recovery or long-term remission in patients with Sezary syndrome are very rare. A case report of Sezary syndrome verification in cardiology practice is described

CORONARY ARTERY ANOMALY. CORONARY-PULMONARY FISTULA

True coronary and pulmonary fistulas occur quite seldom. Most often this defect is a casual finding at diagnosis of other cardiac diseases. Hemodynamics of this defect is caused by the affected coronary artery shunt into the cardiac chamber or the great vessel. Before introduction in modern diagnosis methods of high-precision ultrasonic devices and cardiac treatment to verify such anomaly as a coronary artery fistula, it was impossible. In our study we present a clinical case with right and left coronary artery fistulas into a pulmonary artery and a left atrium