Is rheumatism an actual problem today? Some would say, unlikely. But in developing countries, whose share in the world population is two-thirds, rheumatism, heart valve disease, and streptococcus infection of upper respiratory tract, remain problems still unsolved. Even in the U.S., rheumatism threat still exists, proved by late 1980s outbreak in military recruits and schoolchildren. In all countries, the number of heart valve prosthetic surgeries is very high. At the same time, indications for this intervention should be clarified, especially for patients with Stage IV heart failure and asymptomatic patients. Rheumatism prevalence in Russia is the highest after China, India and some Pacific Region countries' rates. In Mordovia, incidence of rheumatism and heart valve pathology for adults is higher, and for children is significantly lower than overall rates for Russian Federation. Data on focal infection in children and adolescents raise an issue of possible role of inadequate rheumatology training among pediatric service and primary health care professionals. Therefore, rheumatism problem remains actual, in Russia and Mordovia as well, and should be studied further. Modern telemedicine centers, with updated laboratory and instrumental equipment, rheumatology registries, and informational electronic portal, might become an effective organizational basis for primary and secondary prevention.

The aim of the study was to specify electrocardiography changes and physical stress reactions inpatients with autonomous dyshormonal cardiopathy (ADC) of various genesis. In total, 175 ADC women were included: with menopause and pathological climax (n = 52), myoma uteri (n = 45), premenstrual syndrome, PMS (n = 36), and postcastrational syndrome (n = 42). Twelve-lead ECG was registered in supine position, 24-hour ECG monitoring was performed with ICAR system, veloergometry (in seated position) - with Formula veloer-gometer (Biomedica). Workload was increased permanently and gradually: starting from 25 Vt, by 25 Vt every 3 minutes. According to ECG data, no group, regardless of ADC genesis, demonstrated significant heart rate (HR) increase or depolarization/repolarization rates. The most typical ECG changes for all 4 groups were decreased or inverted T waves in left chest leads only or in all chest leads (prevalence 35, 71-40, 38 %). Myoma patients tolerated physical stress better than women in artificial menopause. All ADC patients demonstrated adequate HR and systolic blood pressure (СРВ) reaction to physical stress. Diastolic BP increase for PMS women was twice as high as in other groups. At the workload peak, repolarization processes improved, in some cases normalizing. Supraventricular and ventricular extrasystolia was most prevalent in myoma and PMS patients. Only ECG, Hotter monitoring and veloergometry in complex give complete data on myocardial electrophysiology in cardiopathy of any genesis. Therefore, no single test can be excluded from this diagnostic complex.

A comparison of long-term angioplasty vs coronary bypass surgery results, together with assessment of dyslipidemia, diabetes mellitus, and systemic inflammation effects on recurrent angina rate, was performed during a five-year follow-up period. In 1989-2005, long-term results for 793 coronary bypass patients and 272 angioplasty patients, followed up for 5 years, were analyzed. Statistical analysis was performed with Analysis ToolPak - VBA. Comparing to in-hospital period, in 5 years after the intervention, the number of patients with recurrent angina substantially had increased. Long-term recurrent angina rates were influenced by increased levels of total cholesterol, low-density lipoprotein cholesterol, alpha-lipoprotein, C-reactive protein, and diabetes mellitus. Comparing to conservative treatment, intervention was associated with quality of life improvement, decreased angina rate and mortality. During five-year follow-up, endovascular re-intervention is as effective as coronary bypass surgery, but the need for possible 2-6 angioplasty should be taken into account.

A comparison of long-term angioplasty vs coronary bypass surgery results, together with assessment of dyslipidemia, diabetes mellitus, and systemic inflammation effects on recurrent angina rate, was performed during a five-year follow-up period. In 1989-2005, long-term results for 793 coronary bypass patients and 272 angioplasty patients, followed up for 5 years, were analyzed. Statistical analysis was performed with Analysis ToolPak - VBA. Comparing to in-hospital period, in 5 years after the intervention, the number of patients with recurrent angina substantially had increased. Long-term recurrent angina rates were influenced by increased levels of total cholesterol, low-density lipoprotein cholesterol, alpha-lipoprotein, C-reactive protein, and diabetes mellitus. Comparing to conservative treatment, intervention was associated with quality of life improvement, decreased angina rate and mortality. During five-year follow-up, endovascular re-intervention is as effective as coronary bypass surgery, but the need for possible 2-6 angioplasty should be taken into account.

The number of patients with infective endocarditis (IE) has been growing in the recent years, justifying further studies on diagnostic IE criteria. The article is devoted to C-reactive protein role (CRP) in IE diagnostics. It has been demonstrated that high CRP level is a marker of serious infective and toxic disease manifestations, associated with primary IE, severe myocardial damage, right heart chamber IE. Dynamic CRP measurement helps to control therapy effectiveness and assess clinical prognosis in IE patients.

The first-wave results of the Federal Program «Arterial Hypertension Prevention and Treatment in the Russian Federation» are presented. Randomized representative cluster samples from non-organized male and female population aged 15- 75+ years, residing in seven Federal Regions, have been studied (response rate above 80 %). Overall age-adjusted prevalence of arterial hypertension (AH) in Russia was 39, 5 % (in females, F, 40, 4 %, in males, M, 37, 2 %). AH awareness was as high as 77, 9 % (F 80, 3 %, M 75 %). Treatment rate was 59, 4 % (F 63, 1 %, M 53, 1 %), and effective treatment rate -just 21, 5 % (F 22, 5 %, M 20, 5 %). ACE inhibitors are the most frequently administered antihypertensive drugs (70, 7 %).

The authors assessed dynamics of 24-hour blood pressure monitoring (BPM), structural and functional cardiac parameters, heart rate variability (HRV), renal function, carbohydrate, lipid, and purine metabolism, potassium level, as well as cognitive-mnestic function and quality of life (QoL), during 12-week indapamide monotherapy (Indap, PRO MED CS Praha, Czech Republic) in elderly patients with arterial hypertension (AH). The study included 25 patients aged 60-74 years, with Stage I-II AH. All participants underwent 24-hour BPM, echocardiography, renal function and HRV assessment, measurement of biochemical parameters, QoL and cognitive-mnestic functions at baseline and after 12 weeks of therapy. Target office BP level was achieved in 86 % of the patients. According to 24-hour BPM results, systolic BP significantly decreased in 24 hours, in daytime and nighttime, diastolic BP - in nighttime only (at baseline - 68, 9±1, 79 mm Hg, after 12-week treatment - 63, 74±1, 83 mm Hg). Circadian BP profile had normalized. Left ventricular myocardial mass reduced from 224, 31±12, 83 to 209, 11±9, 58 g, by 7 %. Moreover, 24-hour microalbuminuria significantly reduced - from 189+21, 2 to 123±20, 3 mg/d (p<0, 05). Prevalence of compromised renal functional reserve decreased by 4, 8 %. Lndap therapy did not affect autonomous homeostasis. Biochemical parameters of carbohydrate, lipid, and purine metabolism did not change significantly during indapamide treatment. Potassium level decreased slightly: from 4, 61±0, 12 to 4, 17±0, 12 mmol/l. QoL, measured by MOS SF-36 questionnaire, improved from 45, 9±3, 0 to 47, 9±3, 2 points. Lndap treatment was also associated with cognitive-mnestic function improvement by 2 %>. Lndap is a highly effective antihypertensive agent for treating Stage I-II AH elderly patients. Lt also demonstrates organoprotective effects and improves QoL.

The aim of the study was to investigate effects of glycoprotein P-coding gene MDR1 polymorphic marker C3435T on digitalis intoxication symptoms and plasma digoxin concentration increase in patient with persistent atrial fibrillation (AF). In 103 AF patients, genotyping by gene MDR1 polymorphic marker С3435T was performed in polymerase chain reaction (PCR). Balance plasma digoxin concentration was measured by polarizing fluoro-immune assay in 29 participants. Results: Plasma digoxin concentration was higher in TTgenotype patients, comparing to CC and CT genotype individuals (l,77 ± 0,17vs 1,17 ± 0,21, p = 0,02; 1,77 ± 0,17 vs 1,37 ± 0,30, p = 0,037, respectively). Glycoside intoxication syndromes were more prevalent in TTgenotype than in CC and CT genotypes (57 % vs 13 %, p = 0,0001, OR = 6,4, CI 1, 9-21,9). Therefore, TT genotype of glycoprotein P-coding gene MDR1 polymorphic marker C3435T, was associated more frequent symptoms of glycoside intoxication and higher plasma digoxin levels.

The aim of the study was to achieve target blood pressure (BP) level in metabolic syndrome (MS) patients receiving two antihypertensive medications, in order to compare systemic metabolic effects of the latter. This open study included 20 patients (12 females, 8 males), mean age 54 ± 3 years, diagnosed with MS by NCEP ATP III (2001) criteria. After a wash-out period, all participants were administered spirapril (6 mg/d). Four weeks later, if target BP was not achieved, nifedipine retard was added (40 mg/d). After 3 months of the therapy, in 18 patients (90 %) target BP level was achieved: in 11, with spirapril monotherapy (6 mg/d); in other 9 patients, with spirapril and nifedipine retard (40 mg/d). In total, systolic BP decreased by 11 %, diastolic BP - by 14 % from the baseline levels. Combined antihypertensive therapy was associated with decrease in triglycerides level by 28 %, increase in high-density lipoprotein cholesterol (CH) level by 6 %. Total CH, low-density lipoprotein CH levels and atherogenicity index remained the same. Fasting and two-hour post-load glucose levels (oral glucose tolerance test) did not change, and fasting immuno-reactive insulin concentration significantly decreased by 34 %. As a result, insulin resistance marker level decreased by 35 %. The treatment was well-tolerated, transitory adverse effects did not result in therapy withdrawal. Therefore, combination of ACE inhibitor, spirapril, and dihydropyridine calcium antagonist, nifedipine retard, can be regarded as one of effective and safe antihypertensive combinations in MS patients.

Understanding and further investigation of interacting various functional and structural factors, increasing fatal ventricular tachyarrhythmia risk, is an important task. By solving it, we could develop new approaches in prevention and treatment of sudden cardiac death. The review describes the role of non-invasive ECG methods role in coronary heart disease patients, as these methods can provide valuable information on individual predisposition for life-threatening arrhythmias.