Vol 24, No 1 (2022)


Acute decompensated heart failure. What has changed in the clinical guidelines in 2021?

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


In September 2021, the European Society of Cardiology issued new guidelines on the management of patients with heart failure (HF). In the current version, experts have focused on the 4 most common variants: acute HF decompensation, acute pulmonary edema, cardiogenic shock, and isolated right ventricular failure. There has been a change in approaches to the initial management of patients with acute HF decompensation towards a decrease in the evidence-based use of peripheral vasodilators and a "return" to loop diuretics as the basis of treatment. This raises the question of monitoring the efficacy of diuretic therapy. The paper presents an algorithm proposed by the European Society of Cardiology.

Consilium Medicum. 2022;24(1):7-12
pages 7-12 views

Chronic heart failure – modification of treatment paradigm

Nasonova S.N., Zhirov I.V., Tereshchenko S.N.


The relevance of chronic heart failure (CHF) remains high. Despite significant advances in basic therapy for CHF patients, the prognosis remains poor. The prescription of inhibitors of sodium-glucose cotransporter type 2 dapagliflozin made it possible to change the paradigm of treatment of patients with CHF with low left ventricular ejection fraction.

Consilium Medicum. 2022;24(1):13-19
pages 13-19 views

Topical issues concerning modern lipid-lowering therapy

Susekov A.V.


Hypercholesterolemia (high levels of atherogenic lipoproteins) is the main modifiable cardiovascular risk factor in most of the populations, including the Russian population. 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) have been used in clinical practice for more than 40 years and have a substantial evidence-based proof of efficacy and safety. Unfortunately, the most of the patients with high cardiovascular risk, including the Russian Federation, still receive initial statin doses and only in 10% of the cases we can reach the recommended target level of low-density lipoprotein cholesterol. This article deals with the current principles of statin therapy according to the latest guidelines and shows updated information concerning the optimization of statin therapy in the elderly and in patients with chronic kidney disease. This article, as well, shows the safety of applying HMG-CoA reductase inhibitors (impact on muscles, liver and cognitive impairments). In addition, the review presents the algorithms for the combination therapy of statins and ezetimibe.

Consilium Medicum. 2022;24(1):20-27
pages 20-27 views

Rational drug therapy of chronic heart failure: the role of mineralocorticoid receptor antagonists: review

Safronova N.V., Zhirov I.V., Tereshchenko S.N.


Mineralocorticoid receptor antagonists (MRAs) are part of basic medical therapy for heart failure. The clinical efficacy of MRAs has been proven by randomized clinical trials. To review comparative efficacy and tolerability data between the two main MRAs, spironolactone and eplerenone, in patients with systolic heart failure.

Consilium Medicum. 2022;24(1):28-35
pages 28-35 views

How to level the risk of bleeding while taking anticoagulant therapy in patients with atrial fibrillation?

Berns S.A., Barbarash O.L.


Atrial fibrillation (AF) is one of the most common types of cardiac arrhythmias, while AF is the main risk factor for ischemic stroke. For a long time, vitamin K antagonists, primarily warfarin, have been the standard for the prevention of thromboembolic complications in patients with AF. 5 years ago, dabigatran, rivaroxaban and apixaban occupied the 2nd place in the structure of anticoagulant prescribing (AC), giving way to warfarin. The well-known reason for the inadequate use of AC is the risk of bleeding. There are a large number of validated scales for assessing the risk of hemorrhagic complications, in particular HAS-BLED, ABC, HEMORRHR2HAGES, ATRIA, ORBIT, but the estimated high risk of bleeding should not be the only and absolute limitation to the appointment of AC. Despite the real risk of bleeding on the background of taking AC in patients with AF, an integrated approach taking into account not only the risk factors of the thromboembolic complications, but also hemorrhagic complications, with an emphasis on the existing comorbidities, the presence of comorbidity, old age, etc., will allow an individual approach to the choice of AC and its dose, contributing to the optimization of the management of such kind of patients.

Consilium Medicum. 2022;24(1):36-41
pages 36-41 views

Horse Chestnut Extract. Update-2022

Bogachev V.Y., Boldin B.V., Turkin P.Y.


Horse chestnut is known as a venotonizing agent of plant origin. The main active ingredient of chestnut common extract is aescin. It has anti-edema, anti-inflammatory and venotonizing properties. The aescin medicinal agent should be used for chronic vein disease, hemorrhoidal disease and post-traumatic edema. The pharmacological properties of chestnut horse extract allow the inclusion of medications based on it in the rehabilitation program of patients who have suffered a new coronavirus infection (COVID-19).

Consilium Medicum. 2022;24(1):42-48
pages 42-48 views

Pentraxin-3 – a promising biological marker in heart failure: literature review

Alieva A.M., Teplova N.V., Batov M.A., Voronkova K.V., Valiev R.K., Shnakhova L.M., Pinchuk T.V., Rakhaev A.M., Kalova M.R., Nikitin I.G.


According to many studies, inflammation plays a very significant role in the pathogenesis of heart failure. Many studies have demonstrated an increase in circulating levels of inflammatory markers and cytokines such as C-reactive protein, tumor necrosis factor-a (TNF-a), and interleukins. C-reactive protein is produced in the liver in response to stimulation by various cytokines, mainly interleukin-6, and is a member of the pentraxin superfamily. Pentraxin-3, which is a long pentraxin, has a C-terminal domain of pentraxin similar to the classic short pentraxins, but differs from them in the presence of an unrelated long N-terminal domain. Various cell types can produce pentraxin-3 when exposed to primary inflammatory signals such as interleukin-1, tumor necrosis (TNF-a), oxidized low density lipoprotein, and microbial fragments (eg, lipopolysaccharide, lipoarabinomannans). Data in experimental animal models have demonstrated that pentraxin-3 can play cardioprotective and atheroprotective roles through its influence on the inflammatory process. Pentraxin-3 has been studied in several clinical protocols as a potential biomarker for cardiovascular disease.

Consilium Medicum. 2022;24(1):53-59
pages 53-59 views

Collagen-associated side effects of fluoroquinolones: aneurysm and aortic dissection (systematic review)

Leonova M.V.


Well known for fluoroquinolones cause the development of collagen-associated side effects – tendopathies – with the risk of tendon rupture and retinal detachment, which is associated with the damaging effect and degradation of type I and type III collagen. The aorta is also rich in collagen type I and type III up to 80–90%, which has the potential to play a role in the development of aortopathies in cases of fluoroquinolone use. Since 2015, the first publications of research results on the collagen-associated effect of fluoroquinolones on the development of aneurysm and aortic dissection, often called aortopathy, began to appear. A systematic review of observational studies and 5 meta-analyzes of the development of a novel side effect of fluoroquinolones is presented. An absolute incidence of this side effect of 1.1% and a twofold increased relative risk of developing aneurysm/aortic dissection (RR 2.04–2.23), aortic aneurysm (RR 1.74–2.83), and aortic dissection (RR 1.88–2.79). When analyzing age subgroups, an increase in the risk of aneurysm/aortic dissection was noted already from the age of 35 years and was more significant in elderly patients (over 65 years). Analisys of the course duration of fluoroquinolone use (3–14 days or >14 days) was carried out in two studies and showed an increase in the risk of aneurysm/aortic dissection with increasing duration of fluoroquinolone therapy (RR 1.72 versus RR 1.92). The risk of developing a fluoroquinolone-associated aortopathy was highest during the first 30 days after the course use of fluoroquinolones, with a slight decrease within 60–90 days after the course. The signal was confirmed by the FDA pharmacovigilance system (USA) during the analysis of cases of aneurysm/aortic dissection against the background of fluoroquinolones use. International regulatory authorities (FDA and EMA) have announced official documents warning of an increased incidence of rare but serious cases of aortic dissection or ruptured aortic aneurysm with oral fluoroquinolones. Fluoroquinolones should not be given to patients at increased risk unless other treatment options are available. The increased risk category includes patients with a history of aortic or other blood vessel aneurysm, high blood pressure, and the elderly.

Consilium Medicum. 2022;24(1):66-70
pages 66-70 views


Geriatric syndrome of falls in comorbid patients: paradox of normotension in the elderly

Tkacheva O.N., Runikhina N.K., Merkusheva L.I., Luzina A.V., Sharashkina N.V., Ostapenko V.S., Lysenkov S.N.


Background. Falls as geriatric syndrome in elderly age are associated with high health risks, including serious injury, prolonged hospital stays, and medical and follow-up costs. The prevalence of falls in comorbid elderly patients without hypertension remains uncertain.

Aim. To study the incidence of falls in the comorbid elderly with or without hypertension.

Materials and methods. The study included 5240 outpatients aged 60 and over with three or more chronic diseases treated at Moscow polyclinics with verified diagnoses according to medical records in 2015–2018. The exclusion criteria were acute illness, exacerbation of chronic diseases, disease decompensation, severe sensory impairment and dementia. Student's t-criterion was used to compare quantitative variables between groups and Fisher's exact test was used to compare binary variables.

Results. The age of study participants was 71.0 ± 0.1 years, 72.4% – women. The vast majority of patients (99.3%, n=5202) has been diagnosed with arterial hypertension or essential hypertension, and 0.7% of patients (n=38) had no such diagnoses. The incidence of falls in hypertensive patients was 16.4% (n=857), while 42.1% (n=16) of patients without hypertension reported falls (p=0.00018; odds ratio 3.69; 95% confidence interval 1.80–7.38).

Conclusion. The paradox of the greater frequency of falls in the group of elderly patients who experienced no blood pressure elevation episodes compared with hypertensive patients has not been fully understood yet and can indicate that the risk of falls in patients who experienced no blood pressure elevation is higher; however, further research is required.

Consilium Medicum. 2022;24(1):49-52
pages 49-52 views

The effect of active diuretic therapy on the sodium balance in patients with acute decompensation of chronic heart failure

Davydov V.V., Arehina E.L.


Background. Active dehydration of patients with acute decompensation of chronic heart failure (АDCHF) was often accompanied by the development of hyponatremia. This increased the time of hospitalization and worsened the prognosis. The complication was associated with the side effects of furosemide.

Aim. To compare the effect of dehydration and the state of sodium balance after using different methods of parenteral administration of furosemide at an early stage of treatment of АDCHF.

Materials and methods. Patients with АDCHF (n=125) were divided into two groups. Group 1 received furosemide as bolus injections, group 2 as an extended intravenous infusion. The process of dehydration was controlled by the amount of urine and body weight loss per day. The effect was considered satisfactory if the body weight decreased by 1.0–2.0 kg per day. The plasma sodium level was studied on 1, 5, 10 days.

Results. In group 2, the satisfactory effect of dehydration was observed 1.7 times more often than in group 1 (p<0.05). In group 2 patients on the 5th day of therapy, the number of cases of hyponatremia was 2.3 times less (p<0.05). Hyponatremia developed little in patients with a satisfactory effect of dehydration. On the 10th day, the number of cases of hyponatremia in the groups did not significantly differ.

Conclusion. Prolonged intravenous infusion of furosemide allowed more control of the dehydration process and the plasma sodium level at an early stage of therapy in patients with АDCHF.

Consilium Medicum. 2022;24(1):60-65
pages 60-65 views

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