Vol 23, No 10 (2021)

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.

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.

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.

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.

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.