Introduction. Patients with multivessel coronary artery disease who develop acute non-­ST-segment elevation myocardial infarction (NSTEMI) complicated by cardioge­nic shock (CS) are recommended to employ a strategy for urgent blood flow restoration in the infarct-­related coronary artery. To reduce perioperative risk in such ca­ses, percutaneous coronary intervention (PCI) under mechanical circulatory support (MCS) is possible, of which intra-­aortic balloon counterpulsation (IABC) is the most common and accessible. However, given the ambiguity of the existing evidence base, the place and significance of using IABP in the early CS stages remain controversial.

Brief description. This case report describes a 74-year-old patient with stab­le multivessel coronary artery disease and a diagnosed abdominal aortic aneurysm without dissection. He was admitted electively for coronary artery bypass grafting. In the preoperative period, despite clinical well-being, he developed NSTEMI, complicated by stage B CS with a significant decrease in left ventricular ejection fraction to 20%, necessitating emergency myocardial revascularization. A multidisciplinary team decided to perform PCI of the infarct-­related coronary artery using IABC (due to the absence of available alternative methods) despite a contraindication — abdominal aortic aneurysm. As a result of PCI, an optimal angiographic outcome (TIMI 3) was achieved. Timely placement of the IABC prior to PCI stabilized systemic hemodynamics and prevented the progression of shock. There were no complications with IABC placement or operation.

Discussion. The use of the IABC in this case proved justified, despite conflicting data from modern studies. This case highlights the importance of a personalized approach in the management of patients with severe coronary stenosis in an urgent situation.

Introduction. Porcelain aorta is a rare condition encountered in clinical practice, and associated complications such as mitral regurgitation and/or severe multifocal atherosclerosis are even rarer. These patients typically have a high functio­nal class, and the underlying disease is discovered incidentally. Surgical treatment of these patients is challenging and not always feasible. Adequate medical therapy is the primary, and in some cases, the only, available treatment option.

Brief description. We present a case of a 67-year-old woman with a history of nonspecific aortoarteritis at a young age. The patient has a long history of hypertension, which worsened after COVID-19. Outpatient testing revealed grade 4 mitral regurgitation and 70-80% bilateral carotid atherosclerosis. Hospitalization was recommended for further diagnosis and treatment. On the first day after hospitalization, her condition worsened with anginal pain. A coronary angiography was performed, revealing severe calcification of the aorta and coronary arteries with stenoses of up to 80%. Given the severe calcification, endovascular intervention for myocardial revascularization was deemed technically impossible. A chest computed tomo­graphy revealed total aortic calcification in the area examined. On-pump surgery of the underlying pathology was deemed technically impossible due to the inability to cannulate and clamp the aorta. Conservative therapy was effective, and the patient was discharged in a stable condition for follow-up at a local outpatient clinic.

Discussion. Long-term nonspecific aortoarteritis can lead to complex combined pathology of the entire arterial system, rendering the patient inoperable. Timely dia­gnosis and appropriate therapy can significantly reduce the risk of these conditions and improve the quality of life of inoperable patients.

Introduction. Chronic myocarditis often progresses to dilated cardiomyopathy, which is one of the causes of heart failure (HF) and life-threatening conditions associated with a high risk of sudden cardiac death. Endomyocardial biopsy (EMB) is the gold standard for diagnosing myocarditis in patients with progressive HF and recurrent life-threatening arrhythmias, but its use in clinical practice remains very limi­ted. Nevertheless, timely diagnosis of inflammatory myocardial damage using EMB data is crucial, as it enables early initiation of etiotropic and pathogenetic therapy.

Brief description. This case describes a patient with viral myocarditis resulting in dilated cardiomyopathy (DCM), which manifested with congestive heart fai­lure and a marked reduction in cardiac contractility. The patient was followed for 4 years. He had been hospitalized multiple times due to decompensated heart failure (HF), paroxysmal episodes of nonsustained ventricular tachycardia, and an episode of acute heart failure. To verify the diagnosis, EMB was performed, which enabled a definitive diagnosis. Thanks to the timely identification of the etiologic factor, antiviral therapy for myocarditis was administered. The subsequent course of HF was fluctuating, with periods of decompensation following recurrent pneumonia and compensation with intensive heart failure therapy and antiviral treatment.

Discussion. This case is consistent with inflammatory DCM, in which cardiac inflammation (or myocarditis) is the direct cause of myocardial dysfunction, causing damage that leads to remodeling and DCM. The development of intercurrent infections in the setting of HF can trigger a compensation breakdown, but adequate therapy allows for effective restoration of cardiac function.

Conclusion. In the presented case, identification of the etiologic factor based on EMB data allowed for timely antiviral treatment, and the use of quadruple the­rapy for HF enabled stable heart failure compensation.

Introduction. The combination of Brugada syndrome and hypertrophic cardiomyo­pathy is extremely rare, characterized by a high risk of adverse outcomes, and rai­ses numerous questions regarding the management of these patients.

Brief description. We present a case of a girl with a combined hypertrophic cardiomyopathy and Brugada ECG pattern. The disease onset occurred at age 4, when examination revealed left ventricular myocardial hypertrophy and a transient coved-type ECG pattern in the right precordial leads. The electrocardiographic changes were initially considered secondary to hypertrophic cardiomyopathy. At the age of 7, following the onset of specific complaints and receipt of whole-­genome sequencing results, Brugada syndrome was confirmed. The combination of the two conditions required adjustments to therapy and management.

Discussion. Our case presents a combination of genetically verified hypertrophic cardiomyopathy and Brugada syndrome. Similar cases have not previously been described in pediatric literature. The combination of two rare, potentially fatal conditions requires the physician to carefully select therapy, particularly beta-blockers, as well as monitoring and subsequent management.

Introduction. Despite recent advances in the diagnosis and treatment of pulmonary arterial hypertension (PAH), including those associated with systemic connective tissue diseases (CTDs), late diagnosis persists in clinical practice. Newly diagnosed patients with PAH associated with CTDs experience significant functional and hemodynamic impairment and a high mortality risk. The prognosis for this category of patients is significantly worse than for other PAH types. PAH is a rare but severe complication of systemic lupus erythematosus, the exact etiopathogenesis of which remains unknown.

Brief description. This article presents a case of a 54-year-old female patient diagnosed with coronary artery disease, coronary artery stenting, and a primary complaint of shortness of breath, which, in fact, masks the manifestation of CTDs. Echocardiography-­based diagnosis of pulmonary hypertension was long interpreted as a manifestation of heart failure, despite the absence of left heart remodeling. Further examination confirmed systemic lupus erythematosus and associated pulmonary arterial hypertension (PAH), followed by the initiation of PAH-specific therapy with improved dynamics of the main risk criteria.

Discussion. This case emphasizes the need for a thorough collection of complaints and medical history, not only related to obvious cardiovascular symptoms but also those of other systems and organs. In addition, a more detailed assessment of echocardiographic parameters with differential diagnosis of common causes of dyspnea from less common ones should be performed.

Lamin A/C gene (LMNA) variants, responsible for encoding the nuclear lamin A and C proteins, are the second most common cause (after titin gene variants) of familial dilated cardiomyopathy (FDC). Lamins A and C are structural proteins that play a critical role in maintaining nuclear integrity and stability, as well as in regulating nuclear function.

The clinical manifestations of pathogenic LMNA variants range from a dila­ted cardiomyopathy phenotype to arrhythmogenic cardiomyopathy with conduction disturbances and atrial and/or ventricular arrhythmia. Laminopathy is associated with an increased risk of sudden cardiac death, even in asym­ptomatic carriers without cardiomyopathy signs. Early-stage LMNA-related cardiomyo­pathy is characterized by atrial myopathy with clinical manifestations of bradyarrhythmia and/or atrial tachyarrhythmia with impaired left atrial (LA) function without left ventricular dilation and systolic dysfunction, which develop in the late disease stages.

In the present case series, relatives with a family history of sudden cardiac death were diagnosed with atrial electromechanical dysfunction with normal LA dimensions, ejection fraction, and left ventricular geometry. Three features — interat­rial block, bradyarrhythmia, and decreased LA strain — pointed to atrial myo­pathy as the first warning sign of early familial cardiomyopathy manifestation. Thus, in the case of the proband, an asymptomatic 36-year-old man, the detection of advanced interatrial block on an electrocardiogram initiated a series of investigations, including speckle-­tracking echocardiography, Holter monitoring, magnetic resonance imaging, and genetic screening. The identified specific features — familial bradyarrhythmic syndrome, decreased peak LA strain and longitudinal interventricular septum strain, linear septal fibrosis — suggested genetic cardiomyopathy. Targeted sequencing identified a new likely pathogenic variant in the LMNA gene (c.276del; p.Asp93Thrfs*3), and a diagnosis of cardiolamino­pathy associated with a deletion in exon 1, leading to a frameshift variant, was established. Cascade screening and segregation analysis confirmed the dia­gnosis of laminopathy in two additional family members (one — asymptomatic; the other — with symptoms of an unrecognized "hot phase" of cardiomyopathy for one year) with atrial myopathy features.

Atherosclerotic cardiovascular diseases (ASCVD), including acute coronary syndrome, significantly contribute to morbidity and mortality worldwide. Lipid-lowering therapy (LLT) can reduce up to two-thirds of the ASCVD burden. The International Lipid Expert Panel (ILEP) guidelines are based on the principles of "lower is better," "longer is better," and "earlier is better" for low-density lipoprotein cholesterol management. In real-world practice, most patients fail to achieve their lipid goals. Four out of five patients with very high and extremely high risk do not achieve target lipid levels, increasing the risk of cardiovascular events. The guidelines outline ways to improve the effectiveness of lipid therapy in patients with various cardiovascular risks. For patients with very high and extremely high risk, combination therapy with two or even three drugs is recommended to achieve target levels.

The aim of this article is to familiarize clinicians with the 2024 International Lipid Expert Group guidelines.

The high prevalence of obesity and overweight increases the risk of comorbidities such as type 2 diabetes, cardiovascular disease, and steatohepatitis, potentially reducing life expectancy by 5-20 years. In early 2025, experts from the American College of Cardiology (ACC) published an expert consensus statement on medical weight management to optimize cardiovascular function. The expert statement focuses primarily on new classes of incretin-based drugs, which have literally burst into clinical practice for obesity treatment from glucose-lowering therapy and compete with bariatric surgery in terms of weight loss effects. According to the document, positive changes in cardiovascular risk markers and satisfactory tolerability provide grounds for using incretin therapy for obesity as a first-line treatment. However, interdisciplinary studies are needed to identify ways to discontinue incretin therapy without further weight gain, as published stu­dies do not provide definitive conclusions on therapy safety and its pleiotropic cardiovascular effects.

Modern guidelines note significant differences of opinion regarding one element of cardiac auscultation — the so-called fifth point of auscultation. This article provides the origins of this concept and substantiates its diagnostic value.

The left atrium (LA) plays a key role not only in left ventricular filling but also influences overall cardiac function. Decreased LA function is associated with heart fai­lure, as there is a dynamic relationship between the LA and left ventricular functioning. Therefore, assessing LA function is very important. Noninvasive assessment of LA function is possible using computed tomography, magnetic resonance imaging, and echocardiography. Echocardiography is the first-line method for assessing LA function and has following advantages over other methods: widespread availability, relative affordability, and safety. However, until recently, the potential of echocardiography were limited. With the advent of speckle tracking echocardiography (STE), phase analysis of left atrial function has become possible. The study aim was to summarize current data on potential of STE in the preclinical diagnosis of diastolic dysfunction.

Despite the emergence of new classes of medications for heart failure (HF), the global prevalence of HF continues to grow. Over the past decades, the number of heart transplants as a radical treatment for end-stage HF has increased significantly. A new class of drugs, sodium-glucose cotransporter 2 (SGLT-2) inhibitors, have demonstrated efficacy in reducing cardiovascular mortality in patients with HF. It is of interest to study these drugs in donor heart recipients for their impact on cardiovascular risk and complications after orthotopic heart transplantation (OHT). This review presents the results of limited studies of SGLT-2 inhibitors in donor heart recipients with type 2 diabetes and prediabetes, as solid organ transplant recipients were excluded from most clinical trials, including due to adverse events. SGLT-2 inhibitors (empagliflozin and dapagliflozin) have de­monstrated safety and the ability to manage cardiovascular risk in patients after OHT. However, further study of this group of drugs is required, focusing on the prevention of complications after OHT.

Polymorphisms of the ADRB2 gene encoding β2-adrenergic receptors play an important role in the regulation of the autonomic nervous system and hemodynamic responses to exercise. The Arg16/Gly16 rs1042713 and Gln27/Glu27 rs1042714 alleles differ in expression and function, as confirmed by in vitro and in vivo studies, and influence the development of arrhythmias and conduction disorders in professional athletes. The Gly16 allele can cause myocardial electrical instability and arrhythmias, especially du­ring chronic exercise. The Arg16 allele is associated with increased baseline sympathetic activity and a more intense hemodynamic response to stress, which may also be a risk factor for myocardial electrical instability. Further research is needed to better understand the role of ADRB2 genetic variants as proarrhythmic markers in athletes.

Regular high-intensity physical activity in professional athletes often leads to remo­deling of the left ventricle and the formation of a "sports" heart. In addition, a common reaction of the cardiovascular system to intense, regular and prolonged exercise is the activation of the renin-angiotensin-aldosterone system, which also contributes to the formation of a certain phenotype of the heart muscle and an increase in cardiovascular risk. The aim of the review was to analyze current data on the role of rs4646994 of the ACE gene and rs2070744 of the NOS3 gene polymorphisms in the development of left ventricular remodeling and exercise-induced hypertension in professional athletes. A systematic literature search was used in PubMed, Scopus, Web of Science, eLIBRARY.RU and Cyberleninka. Original studies, systematic reviews, and meta-analyses of ACE and NOS3 polymorphisms in athletes were analyzed. The DD genotype of the rs4646994 ACE polymorphism is a risk factor for left ventricular remodeling and exercise-induced hypertension in professional athletes. The rs2070744 NOS3 polymorphism can modify vascular reactivity. Further prospective studies are needed to determine the clinical significance of genetic testing in sports medicine.

First aid for hypertension (HTN) has significant potential for preserving public health, reducing the burden on healthcare, and mitigating economic losses. The study aim was to rationale initiating the practice of first aid for HTN and to identify a promi­sing list of first aid interventions for this condition, based on published data, clinical guidelines for HTN, and the provisions of the Russian Federation’s regulatory framework. We showed that first aid for HTN remains largely unaddressed by the scientific and medical community. The current regulatory framework governing first aid in Russia does not define acute and significant elevations in blood pressure as a condition requiring first aid, which reduces the likelihood of widespread first aid training and provision for this condition. An analysis of literature and clini­cal guidelines identified measures that can be translated into practical first aid for hypertension and are proposed for discussion by the professional community.

Aim. To evaluate the effects of fluid deficit, diuretic therapy, and osmotic stress on changes in the plasma osmolyte profile (osmolarity, sodium, and urea concentrations) and their association with clinical outcomes, including muscle catabolism.

Material and methods. This systematic review was conducted in accordance with PRISMA-2020. The search was conducted in October 2025 in SciSpace, PubMed, EMBASE, Google Scholar, the Cochrane Library, Web of Science, and the ClinicalTrials.gov, WHO ICTRP, and EU-CTR registries (1680 records + 124 registries + 45 additional sources). After removing duplicates (n=118) and a two-stage screening, 18 following studies (2017-2025) were included: 7 clinical studies, 6 experimental studies, 3 review studies, and 2 mixed studies. Adults aged 18 years or older with markers of dehydration or osmotic stress were included in the analysis. Key parameters included plasma osmolarity, the proportion of Na+ and urea in eOSM, copeptin/vasopressin levels, amino acid profile, muscle catabolism, hemodynamics, and renal function. Risk of bias was assessed using ROB 2.0 and ROBINS-I.

Results. The systematic review included 18 studies, of which 6 clinical studies were included in the quantitative meta-analysis. A meta-analysis showed that fluid deficit, diuretic therapy, and SGLT2 inhibitor therapy were associated with an increase in plasma osmolarity (SMD 0,63 [0,19; 1,07], random-effects model; I2=93,8%). An increase in urea concentration (SMD 0,44 [0,12; 0,75]) and a decrease in sodium concentration (SMD -0,17 [-0,27; -0,06], p=0,0029) were observed. Analysis of the relative contribution of urea to plasma osmolarity, available in 2 studies, revealed an increase in its share (SMD 1,00 [0,64; 1,36]).

Conclusion. Metabolic aestivation is a universal adaptive water-saving program in humans, activated by dehydration, high salt load, and diuretic therapy. Osmolyte redistribution in favor of urea is accompanied by muscle catabolism, increased blood pressure, myocardial remodeling, and may contribute to HF progression and sarcopenia. Systematic review indicates the need to monitor osmolarity, Na⁺ and urea contribution, and vigilance when restricting fluid intake in patients recei­ving diuretics. Monitoring for metabolic aestivation signs can improve therapy safety and prognosis in cardiovascular and cardiorenal diseases.