Aim. To reveal the peculiarities of peripheral and central vestibular disorders in patients with mild dizziness in initial and reversible cerebrovascular diseases and estimate the efficacy of dizziness therapy with betahistine dihydrochloride (Betaserc, Solvay Pharma).

Material and methods: 40 patients (all women) with dizziness were studied. Neurological and otoneurological examination was done; central hemodynamics and number of vascular indices were analyzed. Therapy with Betaserc in daily dose of 48 mg was held during 2 months.

Results. Dysfunction of both peripheral and central parts of vestibular analyzer was revealed in all patients. Most patients complained on diminished hearing, buzzing in ears and head, imbalance while walking. All patients mentioned the performance impairment, easy fatigability, change of mood. Therapy with Betaserc improved the condition of 97% patients with dizziness, the intensity of associated acoustic disturbances considerably reduced.

Conclusion. Betaserc is an effective drug for dizziness therapy in patients with initial and reversible cerebrovascular diseases.

62 chronic heart failure (CHF) patients with iron-deficient anemia (IDA) were studied. Standard CHF therapy (angiotensin converting enzyme inhibitors, β-blockers, diuretics, cardiac glycosides) was accompanied with the correction of iron deficiency by intravenous injection of Venofer and subsequent Ferro-Folgamma prescription (average daily dose of iron 137,75±5mg). After treatment serum iron level increased by 95,5% and hemoglobin level – by 9,8%. Left ventricular ejection fraction increased by 32,2% and physical activity tolerance – by 47,6%. Before treatment 32 CHF patients with IDA (51,6%) had III functional class (FC) of CHF according to NYHA and 16 patients (25,8%) – IV FC. After treatment I FC was observed in 18 CHF patients (29%), II FC – in 26 patients and only 18 patients demonstrated III FC of CHF.

Aim. To study effects of sympathomimetic agents on electrocardiogram (ECG) indexes in patients with bronchial asthma (BA) in exacerbation stage complicated by respiratory insufficiency and sympathomimetic agents overdose.

Material and methods. 40 patients with persistent BA of various severities with respiratory insufficiency and sympathomimetic agents overdose were investigated. ECG was performed and P wave, QRS, duration and dispersion of corrected QT interval (QTc) were analyzed.

Results. Mean QTc dispersion correlated with asthma severity and was 76,8±5,9 ms1/2, 87,9±5,1 ms1/2, 87,8±3,1 ms1/2 in patients with mild, moderate and severe BA, respectively. Significant correlation between QTc dispersion and BA duration was found. QTc dispersion level was directly connected with duration of use of β-agonists and their overdose. Average QTc dispersion in patients who used more than 20 daily doses of inhaled β-agonists was 89,0±5,8 ms1/2.

Conclusion. Increase in QTc dispersion directly depends on BA duration and severity. β-agonist overdose results in growth of QTc dispersion, which has arrhythmogenic potential.

Aim. To evaluate different tactics of initial antihypertensive therapy.

Material and Methods. 120 patients with mild-to-moderate arterial hypertension were included and randomized into three groups: “A”, “B”, and “C”. 5 drugs from the main antihypertensive classes were used: indapamide, bisoprolol, amlodipine, fosinopril, and rilmenidine as well as fixed drug combination of fosinopril and hydrochlorothiazide. Patients included in group “A” received initial therapy according to individual leading pathogenic variant of hypertension. Patients from group “B” received standard stepped antihypertensive therapy with gradual dose increase and further addition of second (third) drug. Patients in group “C” were immediately administrated fixed drug combination and later added other drugs. Visits were scheduled after 2, 4, 6, 8, 10, etc weeks of treatment up to achievement of target blood pressure (BP).

Results. In group “A” 33 patients (82,5%) achieved target BP after 6 visits, in group “B” - 37 patients (92,5%) after 8 visits and in group “C” - 100% of patents after 6 visits. Thus, in group “C” there was less number of visits and respectively lower number of therapy changes in order to achieve target BP. No significant discrepancies between group “A” and “B” were observed.

Conclusion. Tactics of initial antihypertensive therapy with usage of fixed drug combination results in more effective and fast achievement of target BP.

Aim. To evaluate satisfaction in hospital treatment among cardiological patients and to compare the received data with results of the program Massachusetts Health Quality Partners (MHQP) Statewide Patient Survey, which is noted for high representation of the data (analysis of 12680 patient questionnaires obtained from 51 medical institutions of the state of Massachusetts).

Material аnd methods. Questioning of patients in internal medicine clinic was carried out. We used Picker Institute questions, the same questionnaire which was used in program MHQP.

Results. 376 patients took part in questioning. Preferences of cardiological patients did not differ from preferences of other therapeutic patients. On such criteria as respect for a patient, organization of treatment, rendering the information and physical comfort, satisfaction of our and American patients is quite comparable. Estimation of emotional support is somewhat lower at domestic patients. Involvement of a family to the treatment process is not sufficient both in our clinic, and in the American hospitals. All the patients were mostly unsatisfied in the process of discharge.

Conclusion. The estimations of hospital treatment made by patients from clinics of different countries are similar very much. The process of discharge has got the lowest estimation by the surveyed patients. The form of final conversation and its environment require further analysis and correction.

Aim. To study clinical efficacy of a new domestic metabolic drug Eltacine in patients with chronic heart failure (CHF).

Material and methods. 134 patients with CHF of I-III functional classes were randomized in two parallel groups of patients receiving Eltacine or placebo additionally to standard therapy. Common clinical and laboratory investigations were used as well as 6-minute-walking test and Echocardiography. Besides Holter monitoring with determination of heart rate variability, peroxidal oxidation of lipids (POL) and cell anti-oxidant protection were implemented.

Results. Eltacine increased in tolerance to physical burden, improved cardiac haemodynamics, parameters of POL and cell anti-oxidant protection, improved the patient quality of life.

Conclusion. The efficacy and safety of Eltacine as metabolic and antioxidant therapy was shown in patients with CHF.

Data of large-scale research that shows comprehensive abilities of an angiotensin converting enzyme (ACE) inhibitors in clinical practice were represented. The traditional usage of ACE inhibitors in patients with arterial hypertension and chronic heart failure has extended recently. The study results demonstrate the efficacy of ACE inhibitors in slowing down of disease progression related to atherosclerosis and prove the possibility of a new clinical approach. Evidences support new strategic abilities of a number of ACE inhibitors (ramipril, perindopril), which are associated with vasoprotection.

So-called “metabolic” direction has been developing intensively during last decades. Its aim is the theoretical and practical analysis of the role of metabolic disorders in initiation and progression of many diseases. The pathogenic peculiarities of acute coronary syndrome (ACS) which result in developing of secondary mitochondrial dysfunction are considered as a subject of this review. The methods of laboratory diagnosis of mitochondrial dysfunction and possibilities of its pharmaceutical correction in patients with ACS are reviewed.

Review is devoted to the pathogenesis of microcirculatory ischemia. Microcirculatory dysfunction has been identified in different groups of patients including syndrome X, diabetes mellitus 2 type, coronary heart disease. In coronary patients after transluminal angioplasty microcirculatory dysfunction is the reason of phenomenon of “non-reflow”. In result the procedure of revascularization is less effective. Therapy by statins can be beneficial for patients with microcirculatory ischemia.

The classification of calcium antagonists is presented. There were considered the results of large randomized trials, which were devoted to study of influence of dihydropyridine calcium antagonists on the risk of cardiovascular complications. The place of dihydropyridine calcium antagonists in modern recommendations on treatment of arterial hypertension and ischemic heart disease is defined. The clinical importance of differences between various presentations of dihy-dropyridine calcium antagonists is stressed.

There were presented results of clinical trials on β-adrenoblockers usage in patients with chronic heart failure (CHF) as well as data of own study on nebivolol efficacy and tolerability in 113 patients with ischemic heart disease, complicated with CHF. It is emphasized that therapy with β-adrenoblockers positively influences on cardiac hemodynamics and CHF symptoms, significantly reduces mortality risk and the frequency of hospitalizations. The usage of β-adrenoblockers is indicated in CHF of any stage. Efficacy of metoprolol, bisoprolol and carvedilol had been proven in CHF therapy. Nebivolol was effective in elderly patients with CHF.

Comments on European Guidelines on the management of stable angina pectoris (2006).

On the anniversary of academician M.M. Mirrakchimov.

Higher Certifying Commission News.

Russian National Congress of cardiologists and Congress of cardiologists of CIS States.