Aim. To make an analysis of mistakes and their reasons in acute coronary syndrome treatment.

Material and methods. 312 medical charts of patients with acute coronary syndrome, who were hospitalized and died in the hospital, were analyzed.

Results. Pharmacotherapy quality expertise revealed defects in 143 cases of fatal outcomes (45,8%). Among all mistakes 60,8% cases were causedby incorrect choice of drugs, and in 88,1% cases prescription of drugs didn’t meet the requirements of up-to-date recommendations.

Conclusion. Systematic analysis of mistakes in providing cardiologic emergency service and their reasons will allow to increase in quality of service at all stages.

Aim. To study antidepressant usage in treatment of anxious and depressive disorders in real internal medicine practice.

Material and methods. Retrospective analysis of 290 charts of patients, which were observed in Pskov region hospital from 2004 to 2005 was held. All patients suffered from different internal diseases and were treated with antidepressants because of anxious and depressive concomitant disorders.

Results. Arterial hypertension observed in 28% of patients, ischemic heart disease – in 20%, heart failure – in 14%, cerebrovascular and peripheral nervous system diseases – in 18% and gastroduodenal diseases – in 20% of patients. Amitriptyline took the first place (49%) among antidepressant prescriptions. Next antidepressants according to prescription popularity were paroxetine (22%) and tianeptine (12%). Rate of other antidepressant prescriptions were not higher than 5%. There were differences in antidepressant prescriptions between physicians of different specialties.

Aim. To study the effect of treatment with metabolic corrector mildronate on lipid profile, inflammatory factors and endothelium function in patients with ischemic heart disease (IHD).

Material and methods. 60 patients with IHD (stable exertional angina, II-IV functional class) were included in to the study. They were split in two groups. Patients of the main group (n=30) were treated with mildronate (1000 mg per day during 3 months) combined with standard therapy. Patients of the second group (n=30) received the standard therapy only. Total cholesterol (TC), triglycerides (TG), cholesterol of low density lipoproteid (LDL-C), cholesterol of high density lipoproteid (HDL-C), aspartate aminotransaminase (AST), alanine aminotransaminase (ALT), creatine kinase (CK), C-reactive protein (CRP), interleukin-6 (IL-6), lipoprotein (α) (Lp(α)), NO3 were determined. Besides endothelium dependent vasodilatation of brachial artery was studied.

Results. TC, HDL-C and TG levels did not differ before and after treatment with mildronate, but LDL-C level significantly reduced (from 3.06±1.32 to 2.7±1.0 mmol/l, p<0.05) in IHD patients after 3 months of mildronate treatment. There was significant decrease in CRP level (from 1.5±1.8 to 1.0±1.1 mg/l, р<0.01) and absent of IL-6 level difference (before treatment – 3.7±2.3 and after treatment – 3.4±1.8 pg\ml, p>0.05). The significant change of Lp(α) was not found in both groups. Increase in endothelium dependent vasodilatation was noted after mildronate treatment. Besides increase in NO3 level in blood was detected (from 33.5±10.0 to 44.1±32.3 µmol/l, р<0.05).

Conclusion. Data of the study demonstrated that metabolic correctors exert positive influence on lipid profile and inflammatory factors in patients with IHD. 

Aim. To study a clinical equivalence of two medications of bisoprolol in patients with arterial hypertension (AH) 1-2 grades.

Methods. Efficacy and tolerability of original (Concor, NYCOMED, Merck KGaA) and generic (Bisogamma, WORWAG PHARMA GmbH & Co) bisoprolol were investigated in open-label cross-over randomized comparative study. 32 patients (15 males and 17 females) with AH of 1 (66%) and 2 (34%) grades aged of 60 y.o. on average were involved. After 2 weeks of wash-out period original or generic bisoprolol 5 mg daily was prescribed. If necessary a dose of drug was doubled in two weeks. In patients with significant bradycardia (heart rate <55 bp/min) or atrioventricular block (1-2 degree) hydrochlorothiazide (HCT) 12.5-25 mg per day was added. There was another 2-week wash-out period between two active treatment periods.

Results. Systolic and diastolic blood pressure (SBP, DBP) as well as heart rate (HR) were decreased significantly after two weeks of treatment with original bisoprolol (∆SBP=13.8±8.9, ∆DBP=8.5±8.6 mmHg and ∆HR=9.9±13.7 bp/min). Generic medication also significantly reduced SBP, DBP and HR (∆SBP=10.1±10.3, ∆DBP=7.1±7.2 mmHg and ∆HR=9.3±9.4 bp/min). Target SBP/DBP levels were achieved in 62.5%/71.9% of patients in Concor group and in 43.7%/62.5% of patients in Bisogamma group. There was a tendency to additional SBP decrease in patients treated with bisoprolol at a dose of 10 mg and with HCT in Concor group (–5.1±7.4 mmHg; p<0.09) and in Bisogamma group (–5.2±7.9 mmHg; p<0.06). After 4 weeks of treatment target SBP/DBP levels were achieved in 90.1%/96.9% of patients in Concor group and 75%/84.4% patients in Bisogamma group. The investigated parameters did not change significantly in a period between the 4 and 6 weeks of treatment. Monotherapy with Concor and Bisogamma was effective in 84.4% in 62% of patients, respectively (p<0.05). After 6 weeks of treatment target SBP and DBP levels were achieved in 96.9% of patients in the both groups. Average daily doses of original and generic bisoprolol were 6.5 and 7.2 mg, respectively.

Conclusion. Generic bisoprolol demonstrated lower antihypertensive efficacy and similar tolerability in comparison with original bisoprolol. 

Aim. To compare effects of monotherapy with magnesium and combined therapy with magnesium and β-blocker on primary mitral valve prolapse (MVP) with heart rhythm disorders.

Material and methods. 71 patients with primary MVP 1-2 degree and heart rhythm disorders were involved in the study. The patients were split into three groups. Group I (25 persons) received monotherapy with magnesium orotate at a dose of 1-3 g per day; group II (28 persons) received combined therapy with magnesium orotate and betaxolol. The control group (18 persons) received no therapy. Initially and after 12 weeks of observation all the patients underwent electrocardiography (ECG), ECG-Holter monitoring, echocardiography and autonomic balance assessment by A.M. Vein’s questionnaire.

Results. In 12 weeks of treatment groups I and II showed positive dynamics in the MVP manifestations, including significant reduction in severity of the autonomic dysfunction syndrome, ECG positive dynamics, antiarrhythmic effect, decrease in the degree of prolapse, diminution of mitral regurgitation and left auricle volumes. More substantial hemodynamic effects were found in the group of patients who received combination therapy.

Conclusion. Combined therapy has proven advantages in comparison with magnesium monotherapy in terms of daily quantity of extrasystoles, reduction in heart rate, decrease in autonomic disfunction and normalization of intracardiac hemodynamics.

Aim. Optimization of therapy in patients with arterial hypertension (HT) 1-2 grade considering heart rate variability (HRV) and efficacy of metoprolol tartrate in long-acting presentation (Egilok retard) during 96 weeks of usage.

Material and methods. 33 patients with mild to moderate HT were treated with Egilok retard. Doses were titrated from 50 to 200mg\daily. If the target level of blood pressure (BP) wasn’t reached, hydrochlorothiazide (12,5-25 mg\daily) was added. Ambulatory BP and ECG monitoring with HRV analysis were carried out before start and after 24, 48, 96 weeks of therapy, echocardiography - after 48 and 96 weeks. Life quality was estimated by four-grade scale.

Results. After 96 weeks 20 patients continued this therapy (60, 6%). Monotherapy provided of BP target level in 13 patients (65%), combined therapy – in 7 (35%). The high patient compliance to the treatment was based on considerable and stable antihypertensive effect, absence of side effects and improvement of life quality during 96 weeks as well as consideration of HRV type. It was suggested to split patients in groups with high, normal and low levels of HRV. It was mostly difficult to reach BP targets in patients with low HRV level. They took combined therapy in 62% (p>0,005). 7 patients demonstrated normalization of disturbed diastolic function which means heart remodelling regress. The longer therapy with Egilok retard showed more significant cardioprotective effect.

Conclusion. Long-term therapy with Egilok retard provides improvement of life quality and significant cardioprotective effect. Beta-blocker therapy can be optimized by consideration of HRV patient type.

Vertigo is observed in 30% of people above 65 y.o. and in 50% of peoples above 80 y.o. This disorder significantly affects patient quality of life and can be a reason of incidences, trauma and even disability. Vertigo is classified as systemic or non-systemic. It can be consequence of different disturbances. Physician of any clinical specialty can face with this problem. Identification of the vertigo cause is a quite difficult problem, but success of treatment depends on it. First of all treatment strategy should be directed to elimination of the vertigo cause.

A review is devoted to a comorbidity of myocardial infarction and anxious and depressive disorders. In the first part data concerning prevalence of depression in myocardial infarction, pathophysiological mechanisms connecting depression and ischemic heart disease (IHD) are given. Influence of concomitant depressive disorders on clinical state and forecast of patients after myocardial infarction is discussed. The second part of the review (Rational Pharmacother. Cardiol. 2007, 4) will be devoted to the anxious disorders in myocardial infarction as well as to influence of anxious and depressive disorders on life quality of patients with myocardial infarction. Besides, contemporary approaches to the therapy of anxious and depressive disorders in patients with IHD will be discussed.

The clinical, cell and genetic factors are distinguished among reasons for resistance to antiplatelet drugs. There are many methods to detect sensitivity to antiplatelet drugs, but they all have disadvantages. Moreover, there is no unified approach for interpretation of received results, and no recommendations for their practical use. It is necessary to work out unified procedure to assess platelet function, to define indications for its usage and to work out unified criteria of resistance. Individualized approach and each patient’s peculiarities consideration are essential when prescribing antiplatelet therapy.

Results of current studies devoted to relationship between stress and cardiovascular morbidity and mortality were analyzed. The types of stressful reactions are presented: acute and chronic stress as well as models of working stress. Pathophysiological modes of interactions of stress and cardiovascular diseases are presented. Effective methods of stress correction are described. Clinical and prognostic importance of therapy approaches is discussed.

Data of studies devoted to application of angiotensin converting enzyme (ACE) inhibitors in acute myocardial infarction are reviewed. The reasons of ambiguous results are discussed. A point of view that different ACE inhibitors may have the various efficacy and safety in patients with acute myocardial infarction is suggested.

Conception of total cardio-vascular risk plays important role in defining tactics of arterial hypertension therapy according to the new European recommendations. Choice of antihypertensive therapy is based on meta-analysis of large clinical studies with hard end points. It is recommended to use five classes of antihypertensive drugs in mono- and combined therapy. Angiotensin converting enzyme (ACE) inhibitors keep important place in the therapy of arterial hypertension accompanying with risk factors and associated diseases. Enalapril is one of the widely used ACE inhibitors, its efficiency was proved in prospective clinical studies. In high risk patients monotherapy with Enam (enalapril, Dr. Reddy’s) decreases blood pressure and leads to positive metabolic changes. This results in significant risk reduction of cardio-vascular complications.

Comments to the latest European Guidelines for the Management of Arterial Hypertension (2007).

Recent European Guidelines for the Management of Arterial Hypertension (2007): what is new in approach to choice of drug?

Maximal reduction of cardiovascular complications risk – the main task of modern therapy for high risk patients. Randomized study on comprehensive control on arterial hypertension and dyslipidaemia.

A report of the American College of Cardiology, American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for practice guidelines.

Comments on American College of Cardiology, American Heart Association and European Society of Cardiology Guidelines (2006) for the management of patients with atrial fibrillation.

Comments on American College of Cardiology, American Heart Association and European Society of Cardiology Guidelines (2006) for the management of patients with atrial fibrillation.

In memory of Academician Lubov I. Olbinskaya.

In memory of Professor Irina G. Fomina.