Consilium Medicum

Atrial fibrillation is the most common heart rhythm disorder in patients with chronic heart failure. One of the most effective antiarrhythmic drugs for the treatment and prevention of a wide range of supraventricular and ventricular tachyarrhythmia is amiodarone. In the group of patients with paroxysmal atrial fibrillation and low left ventricular ejection fraction, it is the drug of choice when conducting a „rhythm control“ strategy. Patients receiving amiodarone often develop an adverse event – amiodarone-induced thyrotoxicosis, which exacerbates the course of cardiovascular pathology. In this article, we consider a clinical case of amiodarone-induced thyrotoxicosis in a 30-year-old patient with dilated cardiomyopathy and agranulocytosis that developed against the background of thyrostatic therapy.

Background. Despite the global trend towards a decrease in mortality from cardiovascular pathology of atherosclerotic genesis, this group of diseases continues to occupy a leading position in the structure of disability and mortality among the population of many countries.

Aim. Identification of noninvasive markers of arterial wall lesions associated with the presence of arterial hypertension (AH) and coronary heart disease (CHD) in persons younger than 55 years.

Materials and methods. The study included 81 people. Three groups were distinguished from them: 1st (n=31) – a control group of practically healthy individuals, average age – 43 (40; 48) years; 2nd group (n=21) – patients with coronary heart disease without a history of cardiovascular diseases (CVD), average age – 45,5±6,1; group 3 (n=29) – patients with AH without CHD, average age – 47 (35; 50) years. The parameters of a biochemical blood test were determined, volumetric sphygmography and a sample with post-occlusive reactive hyperemia were performed.

Results. In groups of patients with CHD and AH, negative changes in the lipid profile and higher glucose levels were recorded compared to healthy individuals. According to the results of volumetric sphygmography, the pulse wave velocity in arteries of predominantly elastic type (R/L-PWV) in group 1 was 10.1±1.7 m/s, in group 2 – 12.9±1.8 m/s, in group 3 – 13.1 (12; 14) m/s (р_1–2=0.029; р_1–3<0.001); cardio-ankle vascular index (CAVI) – 6.5±0.7, 7.7 (7; 8.7) and 7.8 (7.3; 8.4), respectively (р_1–2<0.001; р_1–3<0.001). According to the data of the test with post-occlusive reactive hyperemia, a comparably high frequency of pathological values of flow-dependent vasodilation (FDV) and reactivity index (RI) was demonstrated in patients with CHD and AH (р_1–2<0.05; р_1–3<0.05). A multifactorial model of noninvasive diagnosis of CHD in individuals without a history of CVD, including non-high-density lipoprotein cholesterol, R/L-PWV, and FDV, has been developed. For patients with AH, glucose, lipid metabolism, R/L-PWV, pulse wave velocity in muscle-type arteries (B-PWV), augmentation index (AI), biological age, CAVI, FDV, RI were the risk factors for the presence of the disease in the anamnesis.

Conclusion. The results obtained confirm the importance of an integrated approach in the screening diagnosis of CVD.

Atherosclerosis is a chronic condition that is the main underlying cause of cardiovascular disease. Inflammation is one of the key factors in the pathogenesis of atherosclerosis and its complications. This review explains an up-to-date understanding of the immunological mechanisms of atherogenesis and biomarkers of inflammation, as well as available treatments for low-intensity chronic inflammation. Information is provided on the perspective directions of anti-inflammatory therapy for atherosclerosis being studied.

To date, the problem of rhabdomyolysis remains relevant in Russia. Despite the introduction of modern methods of diagnosis, prevention and treatment, mortality remains high, up to 40%, especially with the addition of acute kidney injury. This article presents a clinical case of rhabdomyolysis, which arose as a result of the combined effects of non-traumatic (toxic effects of methadone, alcohol) and traumatic (vibration and non-physiological position during sleep) factors. This syndrome eventually led to the development of acute kidney damage up to anuria. In this clinical case, intensive infusion and detoxification therapy, including hemodialysis procedures, was carried out, which led to an almost complete restoration of the functional state of the kidneys. Thus, early diagnosis of rhabdomyolysis and AKI based on anamnesis, timely laboratory and instrumental diagnosis can prevent severe kidney damage up to terminal uremia and fatal consequences.

Proton pump inhibitors (PPIs) are the most effective drugs for treating acid-related diseases. In recent decades, the use of PPIs has increased exponentially. From gastroenterological practice, PPIs are being actively introduced into other specialties, in particular in cardiology and rheumatology, where they are used to protect the mucous membrane of the gastrointestinal tract and prevent gastrointestinal bleeding during long-term antithrombotic therapy and long-term use of non-steroidal anti-inflammatory drugs. For a long time, PPIs were considered completely safe drugs for both short-term and long-term use. However, modern clinical guidelines note that when prescribing PPIs in large doses for a long period, the possibility of side effects should be taken into account. In recent years, a number of foreign reviews have been published that examine the relationship between PPIs and a number of diseases/conditions, including the question of a possible association of PPI use with an increased risk of cardiovascular complications, but note the inconsistency of these data. We searched the PubMed and Scopus information databases for publications on the safety of PPI use, including sources up to 12/01/2023. In this review, we examined the possible cardiovascular risk of long-term use of PPIs. Analysis of publications, despite a number of contradictions, allows us to conclude that the cardiovascular risk with long-term use of PPIs is real and must be taken into account when prescribing PPIs for a long period and to comorbid/multimorbid patients.