Vol 23, No 10 (2021)


Professor Grigory Antonovich Zakhar'in. Unknown clinical lecture notes

Fomin V.V., Panferov A.S.


Grigory Antonovich Zakhar'in is the founder of the famous Moscow therapeutic school. He had a special way of lecturing, in which he analyzed clinical cases and demonstrated an example of communication with a patient. The disciples of G.A. Zakhar'in mentioned the extraordinary value and informativeness of such classes. Lectures compiled from recently discovered manuscripts are published for the first time.

Consilium Medicum. 2021;23(10):690-735
pages 690-735 views

Chronic kidney disease: unappreciated risk factors and new clinical guidelines

Fomin V.V., Kotenko O.N.


Traditional and new risk factors of chronic kidney disease are discussed. The importance of risk factors for chronic kidney disease in Russian clinical guidelines 2021 was demonstrated.

Consilium Medicum. 2021;23(10):736-741
pages 736-741 views

Myocarditis: diagnosis and treatment in a period of pandemic

Blagova O.V., Kogan E.A.


The novel coronavirus infection pandemic, officially declared in early 2020 and has been continuing till now, led to a significant increase in the rate of myocarditis, drew the attention of multi-discipline specialist to this problem and set new accents in it. In the acute phase of COVID-19, the rate of myocarditis in the most severe (dead) patients is estimated to be 7.2%, however, its real prevalence in different course of the disease is unknown; life-time diagnostics is complicated by the difficulties of transporting patients to expert centers for cardiac magnetic resonance imaging and endomyocardial biopsy. A troponin test is not sufficiently specific; chest pain, arrhythmias, and pericardial effusion are most common findings indicating heart damage (up to 20%). Cardiovascular signs and symptoms generally correlate with D-dimer levels and prognosis. In the acute phase of the disease, elevated anticardiac antibody titers are detected in almost 3/4 of patients, that reflect the systemic immune response and is one of the important mechanisms of heart damage. SARS-CoV-2 RNA is revealed in the myocardium both during COVID-19 and up to 6–8 months after it, that is accompanied by the morphological and clinical signs of subacute/chronic post-COVID myocarditis. Its main manifestations are arrhythmias and heart chamber dilation with impaired contractility. COVID-19 can lead to a significant worsening of symptoms of pre-existing myocarditis if there is no basic therapy, but in patients taking immunosuppressive therapy, its course is relatively favorable and usually does not lead to an exacerbation of myocarditis. A novel coronavirus (SARS-CoV-2) is an etiological factor not only for acute myocarditis in the initial (infectious) phase of the disease, but also for subacute (within 1 to 3 months) and chronic post-COVID myocarditis, which are due to not only the virus persistence in the myocardium, but, mainly, due to autoimmune reactions, which requires the determination of indications for immunosuppressive therapy, its volume and duration.

Consilium Medicum. 2021;23(10):742-749
pages 742-749 views

Acute heart failure: classification, diagnosis, general approaches to treatment

Zhirov I.V., Nasonova S.N., Khalilova U.A., Osmolovskaya Y.F., Chaikovskaia O.I., Zhirova I.A., Gimadiev R.R., Kochetov A.G., Tereshchenko S.N.


Acute heart failure (HF) is a syndrome requiring urgent treatment. Due to drastic increase in the number of HF patients this problem is still of great importance for modern public health care and has a significant impact on morbidity and mortality. This article presents modern approaches to the classification of this condition, describes diagnostic algorithms, and discovers general methods of acute HF therapy. Two clinical axes are described – the presence of stasis in one or two circuits of blood circulation and peripheral hypoperfusion, on the basis of which the individual approaches to treatment strategy of patients with this symptom complex are developed.

Consilium Medicum. 2021;23(10):750-755
pages 750-755 views

Neopterin is a biomarker of chronic heart failure (review of modern literature)

Alieva A.M., Pinchuk T.V., Voronkova K.V., Shnakhova L.M., Ettinger O.A., Akhmedova M.F., Valiev R.K., Kalova M.R., Gasanova E.T., Nikitin I.G.


Inflammation plays a role in the pathogenesis of heart failure. Neopterin, pteridine, synthesized mainly by activated macrophages, is a marker of inflammation, activation of the immune system, and an active participant in cardiovascular disease. Measuring neopterin levels can help track the evolution of specific inflammatory conditions. In addition, neopterin was associated with cardiac dysfunction after cardiac surgery and improved the accuracy of predicting the risk of postoperative cardiac dysfunction. In this review, we provide current insights into neopterin and its relationship to heart failure.

Consilium Medicum. 2021;23(10):756-759
pages 756-759 views

The use of renin-angiotensin system blockers in patients with COVID-19

Rodionov A.V.


The COVID-19 pandemic poses a lot of questions for doctors regarding the treatment of both the coronavirus disease itself and the comorbidities. It is known that SARS-CoV-2 enters the cells through the angiotensin-converting enzyme (ACE)-2 receptor, which raises the question about permissibility of the use of renin-angiotensin system (RAS) blockers, and specifically ACE inhibitors, in these patients. Numerous cohort studies, single randomized controlled trials and their meta-analyzes have demonstrated the safety of the use of RAS blockers in COVID-19 patients, as well as their organoprotective effect. It remains unclear whether these drugs have their own beneficial effect on the course of COVID-19. The selection of a particular RAS blocker in patients with coronavirus infection and cardiovascular comorbidities should be based on the pharmacokinetic and pharmacodynamic features of the drugs, as well as the analysis of comorbidity and the assessment of possible drug interactions.

Consilium Medicum. 2021;23(10):760-764
pages 760-764 views

Diagnostics and management of patients with type 2 myocardial infarction

Reznik E.V., Golubev Y.Y., Mikhaleva L.M.


Myocardial infarction (MI) is an acute myocardial injury (confirmed by increasing|decreasing of cardiac troponin T and/or I) in conditions of proven acute myocardial ischemia, manifested by clinical symptoms of acute ischemia and/or ischemic changes on the ECG. Type 2 MI is a form of MI that is not associated with coronary atherothrombosis, secondary to a condition that results in an imbalance between myocardial oxygen intake and oxygen consumption. Type 2 MI can be caused by coronary artery spasm, coronary microvascular dysfunction, embolism, dissection of coronary arteries, aorta, bradyarrhythmia, tachyarrhythmia, respiratory failure with severe hypoxemia, anemia, blood loss, hypotension/shock of other etiology, severe hypertension, surgical interventions. Type 2 MI accounts for 2–70% of all cases of MI. More often type 2 MI occurs in women, elderly, severe, comorbid patients. Type 2 MI is ST segment elevation MI in 3–24% of patients and non-ST elevation MI in others. Coronary angiography (and autopsy) in type 2 MI reveals coronary atherosclerosis in 25–90%, but there is no coronary artery thrombosis. Mortality in patients with type 2 MI is generally higher than in patients with type 1 MI. This article is devoted to the problem of diagnosis and management of patients with type 2 myocardial infarction.

Consilium Medicum. 2021;23(10):765-771
pages 765-771 views

Evaluation of laboratory effectiveness of clopidogrel after elective endovascular procedures in patients with the history of the new coronavirus infection (COVID-19)

Kuchkina N.V., Tsereteli N.V., Chernysheva I.E., Vorobyeva E.I., Zubkova I.V., Semitko S.P., Iosseliani D.G., Fomin V.V.


Aim. To evaluate the impact of antiplatelet agent clopidogrel on the aggregation platelet activity in patients with the history of the new coronavirus infection (COVID-19).

Materials and methods. The impact of clopidogrel on platelet aggregation was studied in 47 patients with coronary heart disease after coronary artery stenting. The patients were assigned to 2 groups: group 1 comprised the patients who were not affected by COVID-19 (n=31), while group 2 comprised the patients who had COVID-19 (n=26) 3 months – 1 year (mean, 5±1.3 months) before being included in the study.

Results. The use of clopidogrel contributed to platelet aggregation decrease to the target levels in both groups. Platelet aggregation, assessed by Born technique, was 22.9 and 22.7% in groups 1 and 2, respectively. Platelet aggregation, assessed by the technique of optical transmission agregometry (system VerifyNow, P2Y12), was 152.3 and 147.2 PRU in groups 1 and 2, respectively. The data obtained in each group were not significantly different and attested to high laboratory effectiveness of clopidogrel. Besides, we did not find reliable differences in the levels of inflammation marker: C-reactive protein, fibrinogen, leucocytes, as well as of D-dimer, in the studied groups.

Conclusion. In 3 months – 1 year after COVID-19, the laboratory effectiveness of Clopidogrel used in standard dosage of 75 mg/day is compliant with target indices and does not differ from the effectiveness in patients with no history of COVID-19. At this stage of our study, the obtained results do not imply the necessity of changing the protocol of double antiplatelet therapy after coronary artery stenting in stable patients with coronary artery disease, who suffered COVID-19 three months – 1 year before being included in the study, and show the necessity of further investigations.

Consilium Medicum. 2021;23(10):772-776
pages 772-776 views

Interaction of drugs and coffee

Pereverzev A.P., Ostroumova O.D.


Coffee is the most widely consumed beverage in the world. About 80% of the world's population consumes coffee and other coffee products on a daily basis. For residents of Finland, Norway, Iceland and North America this figure reaches 90%. Coffee consists of a large number of chemical constituents, including caffeine, chlorogenic acids, diterpenes and trigonellins, which are the most biologically active and most important constituents of the beverage. Taking coffee together with drugs can affect their pharmacokinetic profile, changing the absorption process, the degree of dissolution, pH of the gastrointestinal tract (GIT), affecting the state of permeability of the membranes of the GIT cells, on the transit time of food through the GIT, as well as for due to the formation of insoluble complexes and inhibition of glucose-6-phosphatase. Coffee can reduce intestinal absorption of inorganic compounds (iron, calcium preparations), as well as some organic compounds (glucose, vitamin D, etc.) if taken simultaneously with coffee. Drinking large amounts of coffee due to active diuresis can also increase the elimination of electrolytes (including sodium, chlorides) and vitamins from the body. Another potential type of interaction between drugs and coffee is the pharmacodynamic type (at the level of receptors and pharmacological effects). For example, the instructions for the medical use of drugs – adrenergic receptor antagonists (for example, salbutamol, salmeterol, epinephrine) and methylxanthines (aminophylline, theophylline) contain information that the joint intake of coffee contributes to additional stimulation of the central nervous system and increases their toxicity. Healthcare practicionars should know and be sure to take into account the potential interactions between drugs and coffee and ensure an appropriate time interval between taking drugs and coffee, which will avoid the development of potential complications of pharmacotherapy.

Consilium Medicum. 2021;23(10):777-783
pages 777-783 views

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