PATHOGENESIS OF ARTERIAL HYPERTENSION IN DIABETES MELLITUS AND ADVERSE EFFECTS OF HYPOTENSIVE MEDICATIONS USED

Pathogenesis of arterial hypertension in diabetes mellitus and adverse effects of hypotensive medications used

About so called “inflammatory cardiomyopathy”

According to the latest literature data, the authors analyze pathogenesis of viral myocardial impairment, leading to pathological complex process, called “viral myocarditis”. Ethiopathogenetic role of viruses in various cell and molecular myocardial abnormalities is described. A critical review of a new term, “inflammatory cardiomyopathy”, proposed by some foreign researchers, is performed, as “cardiomyopathy” is related only to diseases of unknown ethiology

TREATMENT OF PAROXYSMAL ATRIAL FIBRILLATION

Treatment of paroxysmal atrial fibrillation

VALIDATION OF THE MECG-DP-NS-01 MONITOR IN OSCILLOMETRY AND AUSCULTATION MODES IN PREGNANCY, ACCORDING TO ESH IP-2, BHS AND AAMI PROTOCOLS

Background: Arterial hypertension in pregnancy is a major cause of maternal death and perinatal mortality. According to the Russian recommendations, only devices that have been evaluated according to international protocols may be used for ambulatory blood pressure monitoring in pregnancy.Aim: Validation of the MECG-DP-NS-01 upper arm blood pressure monitor manufactured by the DMS Advanced Technologies Ltd., in oscillometry and auscultation modes for ambulatory blood pressure monitoring in pregnancy, according to the ESH International Protocol revision 2010 (ESH-IP2), the BHS protocol revision 1993 and the AAMI standard.Materials and methods: A group of 39 pregnant women at various gestation time (from 9 to 40 weeks, 29.2 ± 9.9 weeks) aged 25 to 43 years (31.9 ± 4.3 years) was recruited for the validation study. Expert and device blood pressure measurements were taken for each patient according to the international protocols.Results: The MECG-DP-NS-01 upper arm blood pressure monitor produced by the DMS Advanced Technologies Ltd. for ambulatory blood pressure monitoring was validated in oscillometry and auscultation modes in pregnancy, according to the BHS protocol revision 1993, the ESH-IP2 and the AAMI standard. The device met an A/A grading for the BHS protocol revision 1993 both in the oscillometry and auscultation modes. The device maintained its A/A grading throughout the low-pressure, medium-pressure and high-pressure ranges.Conclusion: The MECG-DP-NS-01 met all the requirements and, fulfilling the standards of the protocols, is recommended for ambulatory blood pressure monitoring in pregnancy according to BHS protocol revision 1993, ESH-IP2 and AAMI standard. According to the Declaration of Blood Pressure Measuring Device Equivalence signed by the manufacturer, there are no differences that will affect blood pressure measuring accuracy between the MDP-NS-02s “Voshod” upper arm blood pressure monitor produced by the DMS Advanced Technologies Ltd. and the MECG-DP-NS-01, which passed the ESH-IP2, BHS and AAMI protocols

GESTATION OF PATIENTS WITH EISENMENGER’S SYNDROME: IS IT ALWAYS CONTRAINDICATED?

The management of gestation and labor in a patient with Eisenmenger’s syndrome due to multiple defects of inter-ventricular septum was described. The possibility of gestation prolongation in the patient with the said pathology was discussed, supporting clinical-and-laboratory and instrumental criteria of the objective patient’s condition were proposed being worked out collectively and based on the individual course features of the disease and gestation

Clinical cases of myocardial infarction in pregnant women: the role of hereditary thrombophilia

Acute myocardial infarction during pregnancy is a threatening complication with high maternal and perinatal mortality. According to the literature, hereditary thrombophilia is commonly associated with obstetric disorders and susceptibility to venous thrombosis, whereas arterial part of the vasculature, including coronary, is rarely involved. The article describes two clinical cases of pregnant women with acute myocardial infarction and post-infarction cardiosclerosis, in whom hereditary thrombophilia, associated with the gene PAI-1-675 polymorphism, was diagnosed. Mothers of both patients had suffered myocardial infarction at a young age, while past history of only one pregnant woman was remarkable for multiple perinatal losses. Myocardial infarction may manifest with intense headache mirroring systemic angiospasm.Based on the clinical observations of acute myocardial infarction in pregnancy, one could conclude that measurements of troponin levels that might be false negative should be done repeatedly, while the signs of transmural myocardial injury at ECG can evolve into those of an intramural myocardial infarction. Miscarriage and fetoplacental insufficiency have been found in the patients with combination of hereditary thrombophilia and myocardial injury. Coronary artery damage in pregnant women can be the result of hereditary thrombophilia, most often associated with the PAI-1-675 gene polymorphism, as well as its combination with the heterozygous state of other genes.The absence of past perinatal losses and venous thromboembolism in pregnant women with myocardial infarction does not exclude hereditary thrombophilia, and additional work-up of the patient and the proband family is mandatory to exclude the underlying pathology. The course of myocardial infarction may not require an intracoronary intervention, and treatment may consist of non-fractionated or low molecular weight heparin and calcium antagonists

OSTEOGENESIS IMPERFECTA AND PREGNANCY: PROBLEMS EVOLVING BY THE TIME OF DELIVERY

The article describes a case of pregnancy in a patient with osteogenesis imperfecta. It is of note that both local and foreign medicine this disorder is a contraindication to pregnancy due to a high risk of maternal and fetal complications. The authors review literature on pre-pregnancy planning and preparation, pregnancy management, types of deliveries and approaches to anesthesia in female patients with osteogenesis imperfecta. Special attention is paid to anesthesiological complications during delivery, ways of their management and correction. Due to a high inheritance rate of this disorder, genetic consulting and extracorporeal fertilization methods are of great importance

PARTICULARS OF PREGNANCY MANAGEMENT AND DELIVERY IN PATIENTS WITH A HISTORY OF CORRECTIVE SURGERY FOR BLAND-WHITE- GARLAND SYNDROME

The article describes clinical cases of two pregnant women with a history of corrective surgery for Bland-White-Garland syndrome. During pregnancy, long-term results of surgery may translate into heart arrhythmias that occasionally are life threatening, into myocardial ischemia symptoms associated with a high probability of coronary artery bypass graft thrombosis. In both cases, there was a risk of preliminary pregnancy termination and development of fetoplacental insufficiency