Heart Rhythm Disorders Research Articles

Experience With Regional Anesthesia for Carotid Endarterectomy at the N.V. Sklifosovsky Research Institute for Emergency Medicine

Acute cerebrovascular accident is one of the major causes of death and disability of patients around the world. In 30-40% of cases, the cause of ischemic stroke is an extracranial lesion of the brachiocephalic vessels. Carotid endarterectomy is the main technique for preventing cerebrovascular accident in carotid artery stenosis. General anesthesia with endotracheal intubation has been the method of choice since the widespread introduction of this type of surgical intervention into clinical practice and in most centers remains so to this day. At the same time, many authors report, that the use of general anesthesia with endotracheal intubation has limitations in a number of patients, namely, in the presence of an embologenic plaque in the operated internal carotid artery, severe coronary artery disease, decompensated aortic and / or mitral stenosis, low ejection fraction, heart rhythm and conduction disorders, severe chronic diseases of the respiratory system, as well as patient refusal for general anesthesia.THE AIM of the study was to show the possibilities of using regional anesthesia for carotid endarterectomy in a high-risk patient.RESULTS The use of regional anesthesia allows surgeons to avoid instability or abrupt changes in hemodynamics in the intraoperative period. Indications for its use are also cases of critical contralateral stenosis of the internal carotid artery when it is necessary to carefully consider the advisability of installing an internal stent.CONCLUSION The use of regional anesthesia made it possible to successfully perform carotid endarterectomy without cardiovascular events, neurological deficit and postoperative complications in a patient with relative contraindications to general anesthesia.

Anxiety, age, education and activities of daily living as predictors of the occurrence of frailty syndrome in patient with heart rhythm disorders

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac arrhythmias associated with psychological changes that occur in the conducting system and frequent coexistence of coronary artery disease and hypertension are more common in elderly patients than in younger ones. Aim of the study was to evaluate the relationships between anxiety and depression and the presence of frailty syndrome in patients with heart rhythm disorder who had been qualified for pacemaker implantation. Methods 171 consecutive patients (mean age 73,91 ± 6,72; 48,5% woman) with qualified to pacemaker implantation were included into the study. Patients were divided according type of heart rhythm disorders: 90 patients with atrio-ventricular blocks (AVB) and 81 with sinus node dysfunction (SND). To evaluate frailty syndrome we used Tilburg Frailty Indicator (TFI), to recognize anxiety and depression Hospital Anxiety and Depression Scale (HADS) was used. Obtained data were analyzed and multiple regression model using stepwise input was created. Results Frailty syndrome was diagnosed in 54,46% of the included patients. Average general TFI score was 4,60 ± 2,34: in the physical component 2,90 ± 1,65; in the psychological component 0,69 ± 0,76 and 1.05 ± 0,74 in the social components. Age, number of years education anxiety and activities of daily living were found to be important predictors of the higher level of frailty syndrome. Detail results are presented in table below. Conclusion Anxiety, age, education and the activities of daily living can be predictors factors of the occurrence of frailty syndrome in patients with heart rhythm disorders who have been qualified for pacemaker implantation.

Systemic inflammatory response in cardiac surgery: possibilities of using colchicine

To evaluate manifestations of systemic inflammatory response (SIR) and the effect of the colchicine therapy on SIR severity in patients with ischemic heart disease (IHD) after coronary artery bypass grafting (CABG) with extracorporeal circulation (EC). This study included 100 patients aged 62+6.3 years with stable IHD and multivessel coronary atherosclerosis scheduled for CABG with EC. Patients of group 1 (n=50) were administered with a single dose of colchicine (Colchicum-Dispert) 500 µg 4 hours before surgery followed by 500 µg twice a day for 10 days after surgery. Patients of group 2 (n=50) received a standard treatment, including nonsteroid anti-inflammatory drugs after surgery. Severity of the inflammatory response was evaluated by measuring blood cytokines. In the postoperative period, patient of group 1 showed a tendency toward a lower incidence of pleurisy and heart rhythm disorders in the form of paroxysmal atrial fibrillation (AF) (p=0.18). Levels of the anti-inflammatory cytokines, interleukin-10 (IL-10) and interleukin-6 (IL-6), were significantly increased in both groups at 6 hours after surgery (p<0.05); at the same time, in group 1, IL-10 remained increased also at 10 days after surgery (р=0.0002). No significant time-related changes in the proinflammatory cytokines, tumor necrosis factor α (TNF-α) and interleukin 1β (IL-1β), were observed. At 3 days post-CABG, there were significant increases in tissue inhibitors of matrix metalloprotease 1 (TIMP-1) (р<0.0001) and matrix metalloproteinase 9 (MMP-9) (р<0.001); at the same time, patients of group 1 had lower MMP-9 concentrations than patients of group 2 (p<0.05). At 10 days of postoperative period, these values were comparable with the background values. Increases in neopterin compared to preoperative values were found in both groups on days 3 and 10 after surgery (р <0.0001). CABG with EC is associated with the activation of SIR. The colchicine therapy at a dose of 500 µg 4 hours prior to surgery and 500 µg twice a day for 10 days after surgery reduces manifestations of SIR, which is clinically evident as a tendency to reduced incidence of pleurisy and arrhythmias, and does not result in the development of serious complications. The dynamics of matrix metalloproteinases indicates that the colchicine treatment is promising for decreasing the risk of CHF progression and myocardial remodeling in patients with IHD.

Role of nursing in the implantation of the injectable holter

Abstract Funding Acknowledgements Type of funding sources: None. Main funding source(s): No Introduction The injectable Holter monitor is a useful tool in the evaluation of patients with recurrent syncope of unknown etiology and in patients with suspected embolic paroxysmal AF. This device monitors heart rhythm for 2-3 years. In our center, the implantation and follow-up of this type of patient is carried out exclusively by nursing, with three centers in Andalusia performing this type of procedure. The objective is to describe the injectable holter implant procedure prepared by nursing. Material and Method Through the bibliographic search in the CUIDEN and PubMed databases, a procedure for the implantation of an injectable Holter monitor by nursing has been developed. The types of Holter that are implanted in the Hemodynamics Unit, the implantation procedure, as well as the necessary material are described. When an injectable Holter monitor is implanted in a patient, a series of steps are followed, such as checking them the next day, conducting health education, as well as delivering the remote monitoring device. Results Since 2010, 266 devices have been implanted, with the nursing staff being fully responsible for both implanting and monitoring them. In the insertion procedure, the previous preparation of the patient, information, the necessary material for the implant, procedure and activation of the device by means of a programmer are highlighted. After the implant, monitoring and remote control are performed by the nursing staff for functional tests. Conclusions The complete approach to the implantation and follow-up of the injectable Holter monitor by nursing has allowed us to grow, helping closely in the diagnosis and treatment of heart rhythm disorders. The utility in the early detection of cardiac events in the injectable Holter monitor is a leap in the quality of life of patients, in the optimization of resources and in response time.

Ablation as First-line Therapy for Atrial Fibrillation.

AF is a chronic and progressive heart rhythm disorder characterised by exacerbations and remissions. Contemporary guidelines recommend antiarrhythmic drugs (AADs) as the initial therapy for the maintenance of sinus rhythm. However, these medications have modest efficacy and are associated with significant adverse effects. Several recent trials have evaluated catheter ablation as an initial therapy for AF, demonstrating that cryoballoon catheter ablation significantly improves arrhythmia outcomes (e.g. atrial tachyarrhythmia recurrence and arrhythmia burden), produces clinically meaningful improvements in patient-reported outcomes (e.g. symptoms and quality of life), and significantly decreases healthcare resource usage (e.g. hospitalisation), without increasing the risk of serious adverse events. Moreover, in contrast to antiarrhythmic drugs, catheter ablation appears to be disease-modifying, significantly reducing the progression of disease. These findings are relevant to patients, providers, and healthcare systems, helping inform the initial choice of rhythm-control therapy in patients with treatment-naïve AF.

Trastornos del ritmo cardiaco en pacientes con síndrome de Tako-tsubo

ObjectivesThis study sought to evaluate the incidence, prognosis and treatment of heart rhythm disorders (HRD) in Tako-tsubo syndrome (TTS). BackgroundTTS is associated with HRD. The HRD prognostic value is not well characterized in TTS yet. MethodsThe HRD of patients included in the National Registry of Tako-tsubo syndrome, admitted between 2002 and 2018 and coming from 38 hospitals throughout the country, was analyzed. We analyzed any heart rhythm disorder in patients presented before admission, at admission and in long-term follow-up. ResultsAll types of HRD were described in 259 (23.5%) cases, from a cohort of 1,097 consecutive patients with TTS. HRD was more associated with diabetes mellitus, smoking, hyperuricemia, sleep apnea, anemia with a worse LVEF on admission. The most frequent HRD was a new onset of atrial fibrillation. During hospitalization, patients with HRD showed more complications such as shock on admission, major bleeding, acute renal failure, and combined infections. At follow-up, they presented higher mortality and more major adverse cardiac events, but with a non-significant correlation. ConclusionsThe incidence of HRD in patients with TTS is not infrequent. TTS, when associated with HRD, presents more complications and a worse prognosis both in hospital and in the long term.

Electrophysiological mapping of the epicardium via 3D-printed flexible arrays.

Cardiac electrophysiology mapping and ablation are widely used to treat heart rhythm disorders such as atrial fibrillation (AF) and ventricular tachycardia (VT). Here, we describe an approach for rapid production of three dimensional (3D)-printed mapping devices derived from magnetic resonance imaging. The mapping devices are equipped with flexible electronic arrays that are shaped to match the epicardial contours of the atria and ventricle and allow for epicardial electrical mapping procedures. We validate that these flexible arrays provide high-resolution mapping of epicardial signals in vivo using porcine models of AF and myocardial infarction. Specifically, global coverage of the epicardial surface allows for mapping and ablation of myocardial substrate and the capture of premature ventricular complexes with precise spatial-temporal resolution. We further show, as proof-of-concept, the localization of sites of VT by means of beat-to-beat whole-chamber ventricular mapping of ex vivo Langendorff-perfused human hearts.

Impaired Renal Vein Flow in Atrial Fibrillation: A Potential Risk for Renal Dysfunction.

BACKGROUND Atrial fibrillation (AF) is one of the most common heart rhythm disorders. Identification and early treatment of AF risk factors can improve mortality and morbidity rates. This study aimed to compare the renal venous stasis index (RVSI) and intra-renal venous flow (IRVF) patterns evaluated by intra-renal Doppler ultrasonography in patients with AF and sinus rhythm (SR). MATERIAL AND METHODS A total of 68 patients, 34 with AF (lasting >12 months AF) and 34 with SR (no previous diagnosis of AF and no AF attack in 24-h Holter monitoring) were included in the study. The RVSI was calculated, and the IRVF patterns were determined using intra-renal Doppler ultrasonography. High RVSI was defined as >0.12 RVSI. In addition, echocardiography and a 6-min walk test were performed. A model including diabetes mellitus, hypertension, creatine, Pro-BNP, left ventricular ejection fraction, presence of AF, and systolic pulmonary artery pressure was created to evaluate the effects of variables on high RVSI. RESULTS The RVSI value was significantly higher in patients with AF than in those with SR (P=0.004). The SR group exhibited a higher prevalence of the continuous flow pattern, which is one of the IRVF patterns (P=0.015). In contrast, the biphasic flow pattern was observed more frequently in patients with AF (P=0.003). The presence of AF was found to predict the high RVSI (P=0.002, OR=14.134, 95% CI 2.083-71.277). CONCLUSIONS The presence of AF may affect the IRVF and cause an increase in RVSI.

Holiday heart syndrome: frequency and mechanism of development

Holiday heart syndrome is a heart rhythm disorder (usually atrial fibrillation) resulting from alcohol consumption by people who are generally healthy. As a rule, holiday heart syndrome is associated with binge alcohol consumption, while chronic alcoholism is characterized by a slightly different picture of cardiac disorders. The main symptom is palpitations - an irregular heartbeat that feels like skipped or extra heartbeats. Other symptoms are chest pain or pressure, shortness of breath, and fainting. Typically, symptoms resolve spontaneously within 24 hours. An irregular heartbeat can be serious. If the heart palpitations continue for more than a few hours, the patient should seek medical care. Some heart rhythm disorders (arrhythmias) associated with binge holiday heart syndrome can lead to sudden death, which may explain some of the sudden deaths commonly reported in alcoholics. Atrial fibrillation is the most frequent kind of arrhythmia in holiday heart syndrome.

The effect of the autonomic nervous system on the formation of cardiac arrhythmias in childhood (review)

Heart rhythm disorders (HRDs) are one of the most complex and urgent problems in both adult and pediatric cardiology. One of the important points of research in the field of arrhythmology is the study of the mechanisms of HRD formation. The mechanisms that trigger arrhythmias in children have their own peculiarity associated with the age-related aspects of the formation of both the cardiovascular system and the systems responsible for its regulation, primarily the autonomic nervous system (ANS). The article presents current literature data on the contribution of the ANS to the formation of arrhythmias and the information content of its markers depending on age.

Safety of Outpatient Commencement of Sotalol for the Management of Heart Rhythm Disorders

Safety of Outpatient Commencement of Sotalol for the Management of Heart Rhythm Disorders

Correlation between Prolonged Aortic Cross Clamp and New Onset Cardiac Arrhythmia after Cardiac Surgery

Objectives: Cardiac arrhythmia involves a wide range of abnormalities associated with heart rhythm and rate disorders. It mainly refers to an irregular rhythm of the heart. It has been demonstrated through various clinical studies that aortic cross-clamp time during cardiac surgeries are independent predictors of the morbidity and mortality, and prolonged cross-clamp (XCL) time have been linked to the low cardiac output. Present study was aimed to examine the correlation between the prolonged aortic cross clamp time (XCL) in low-risk patients and the incidence of cardiac arrhythmia during cardiac surgery within 48 hours postoperatively. Methods: A retrospective study was carried out from March 2020 to February 2021 including 100 patients who underwent elective cardiac surgery as low-risk patients. The duration of XCL and new-onset cardiac arrhythmia was monitored within the first 48 hours postoperatively. Result: This study revealed a significant relationship between new onset Arrhythmia and prolonged cross clamp time (more than 90 min). It also revealed a weak correlation (r = 0.26) between the aortic cross clamp time and new onset of cardiac arrhythmia after cardiac surgery (average XCL time 60 min). Therefore, this study suggested XCL time one of important predictors of cardiac arrhythmia postoperatively. Conclusion: Prolonged aortic cross-clamp time was found to minimally affect the incidence of arrhythmia in cardiac surgery within 48-hour post-operatively in low-risk cardiac patients. Patients with cross clamp time of over 90min were observed to be the most affected by the Arrhythmia with a high prevalence rate, which further buttress on the fact that extended/prolonged XCL affect cardiac arrhythmia after cardiac surgery.

Arrhythmias after COVID-19 Vaccination: Have We Left All Stones Unturned?

SARS-CoV-2 vaccination offered the opportunity to emerge from the pandemic and, thereby, worldwide health, social, and economic disasters. However, in addition to efficacy, safety is an important issue for any vaccine. The mRNA-based vaccine platform is considered to be safe, but side effects are being reported more frequently as more and more people around the world become treated. Myopericarditis is the major, but not the only cardiovascular complication of this vaccine; hence it is important not to underestimate other side effects. We report a case series of patients affected by cardiac arrhythmias post-mRNA vaccine from our clinical practice and the literature. Reviewing the official vigilance database, we found that heart rhythm disorders after COVID vaccination are not uncommon and deserve more clinical and scientific attention. Since the COVID vaccine is the only vaccination related to this side effect, questions arose about whether these vaccines could affect heart conduction. Although the risk-benefit ratio is clearly in favor of vaccination, heart rhythm disorders are not a negligible issue, and there are red flags in the literature about the risk of post-vaccination malignant arrhythmias in some predisposed patients. In light of these findings, we reviewed the potential molecular pathways for the COVID vaccine to impact cardiac electrophysiology and cause heart rhythm disorders.

Conceptualization and Investigation of Multicomponent Polymer Networks as Prospective Corticosteroid Carriers.

Dexamethasone (DXM) is a highly potent and long-acting synthetic glucocorticoid with anti-inflammatory, anti-allergic, and immunosuppressive effects. However, the systemic application of DXM can cause undesirable side effects: sleep disorders, nervousness, heart rhythm disorders, heart attack, and others. In the present study, multicomponent polymer networks were developed as potential new platforms for the dermal application of dexamethasone sodium phosphate (DSP). First, a copolymer network (CPN) comprising hydrophilic segments of different chemical structures was synthesized by applying redox polymerization of dimethyl acrylamide onto poly(ethylene glycol) in the presence of poly(ethylene glycol) diacrylate (PEGDA) as a crosslinker. On this basis, an interpenetrating polymer network structure (IPN) was obtained by introducing a second network of PEGDA-crosslinked poly(N-isopropylacrylamide). Multicomponent networks obtained were characterized by FTIR, TGA, and swelling kinetics in different solvents. Both CPN and IPN showed a high swelling degree in aqueous media (up to 1800 and 1200%, respectively), reaching the equilibrium swelling within 24 h. Additionally, IPN showed temperature-responsive swelling in an aqueous solution as the equilibrium swelling degree decreased considerably with an increase in the temperature. In order to evaluate the networks' potential as drug carriers, swelling in DSP aqueous solutions of varied concentration was investigated. It was established that the amount of encapsulated DSP could be easily controlled by the concentration of drug aqueous solution. In vitro DSP release was studied in buffer solution (BS) with pH 7.4 at 37 °C. The results obtained during DSP loading and release experiments proved the feasibility of the developed multicomponent hydrophilic polymer networks as effective platforms for potential dermal application.

Electrocardiogram signals classification using random forest method for web-based smart healthcare

<span>Coronary heart is the highest cause of death in Indonesia reaching 26%. Therefore, to prevent the high mortality rate of coronary heart disease (CHD), early detection of CHD can be carried out. One way is to examine the electrocardiogram/electrocardiograph (ECG) recording. ECG hardware has been made in previous studies to record ECG signals. ECG research is an important study because it can detect cardiovascular disease. Cardiovascular diseases can be classified as arrhythmic diseases. Arrhythmia is a disorder that occurs in the heart rhythm. The method used to recognize and classify ECG signal patterns is the R-R interval (RRI) method. In this study, the ECG signal is classified as normal and abnormal. Abnormal means that a person has a heart rhythm disorder. The classification method used is random forest. The advantage of the random forest classifier is that it can handle noise and missing values and can handle large amounts of data. The accuracy of the ECG signal classification using the Random forest method is 96%. The contribution of this research is that early detection of heart rhythm disorders using an ECG can be monitored through the smart healthcare web.</span>

Remote Monitoring of the QT Interval During Polychemotherapy

Aim To evaluate the incidence of prolonged corrected QT interval (QTc) by remote single-channel electrocardiogram (ECG) monitoring in primary oncological patients with elective polychemotherapy (PCT).Material and methods This study included 49 oncological patients with elective PCT. A single-channel portable CardioQVARK electrocardiograph was used to record single-channel, one-lead ECG between the first and second courses of PCT.Results Analysis of QTc interval detected a prolonged QTc interval >500 msec in 8.2 % of cases, prolonged QTc >480 msec in 18.3 % f cases, and prolonged QTc interval >60 msec compared to baseline in 12.2 % of cases.Conclusion Remote recording of single-channel ECG using a portable electrocardiograph is an effective method for recording and detecting various forms of heart rhythm disorders.

METHODS OF PHYSICAL REHABILITATION OF PATIENTS WITH ISCHEMIC STROKE

The purpose of our research is to develop and justify the functional method of using physical rehabilitation tools in restoring the motor functions of patients with ischemic stroke in the area of the internal carotid artery, taking into account the psychological state of the patient, the ontogenetic features of the restoration of his/her postural and dynamic functions, and the biomechanical laws of the formation of compensatory changes in the motor system of the individual. Research methods. In the system of measures for physical rehabilitation of patients with ischemic stroke, one of the most important points it is control of the patient’s level of adaptation capabilities. Risk factors from the side of the cardiovascular system are: the degree of atherosclerosis, arterial hypertension, especially the increase in blood pressure over 200 mm Hg. art and diastolic is – more, than 110 mm Hg. art, increased blood viscosity, blood pressure fluctuations, for example, with heart rhythm disorders. Patients, having been included into the research, were selected by the method of randomization using a Table of random numbers (Paired Design Technology was used by us). Patients of the control group received a complex of rehabilitation measures using physical exercises (according to the classical method, proposed by us. To assess the psychological status of the patient, the eight-color test of M. Lüscher was used. The results of the research. According to all patients of the experimental and control groups, during the entire period of inpatient treatment, the following data were analyzed daily: well-being, frequency and nature of pain sensations, other complaints (shortness of breath, palpitations, sleep and mood disorders, tolerability of restorative treatment procedures). A clinical, functional and psychological examination was conducted for all patients before and after the complex rehabilitation course. Conclusions. The study of the initial state of voluntary motility of ischemic stroke patients at the beginning of the physical rehabilitation course showed the presence of disorders of static and dynamic motor function of the arm, leg, coordinated action of the arms and legs, head, trunk, but quite different in their explanation in the studied groups of patients. The state of motor functions of patients with ischemic stroke is characterized in such a way: on the affected side, the maximum values of the volume of active and passive movements of strength and muscle tone are diagnosed in the “hemiparesis” subgroup, the smallest one – is in the “hemiplesia” subgroup. On the side of the lesion lacuna, the most pronounced muscle strength and tone are diagnosed in the subgroup “hemiparesis”, the largest amount of active and passive movements, in turn, there are in the subgroup “plesia + paresis”, “hemiparesis”.

Prevalence and characteristics of arrhythmias during the pregnancy

Abstract Funding Acknowledgements Type of funding sources: None. Background Arrhythmias in pregnancy has been increasing due to the aging of the pregnant women and psychosocial and economic conditions in developing countries. Some of them are benign and do not require special treatment while others will be needed treatment in order to improve subjective feelings. Aim of the study was to evaluate the prevalence and characteristics of cardiac arrhythmias in pregnant women with hypertension and without other cardiac structural pathologies. Material and Methods 110 pregnant women with hypertension were analyzed during 2018-2021 years. Mean age of the pregnant women were 28.65±11.45 years. Electrocardiogram, echocardiography and if necessary 24 hour Holter monitoring was recorded and analyzed along with other clinical and instrumental data. All statistical analysis were performed using STATA software. Results The most frequent type of heart rhythm disorder was supraventricular arrhythmia 34%, followed by premature contractures (24%) and paroxysmal atrial fibrillation (12%). 24% of supraventricular tachycardia was detected in the first trimester, 35% in second trimester and 41% in the last trimester. Among premature contractures only 26% was detected in the first trimester. 29% of premature contractures was detected in the second and 44% in the third trimester of the pregnancy. Regarding the atrial fibrillation, it was detected in 6 (46%) pregnant women in the first trimester, 4 (31%) in the second trimester and 3 (23%) in the third trimester. Pregnant women with supraventricular arrhythmias tended to have higher level of diastolic blood pressure than those without it (88.12±8.2 mmHG vs. 84.25±9.3 mmHg, P=0.034). Pregnant women with premature contractures tended to have higher level of systolic blood pressure than those without it (132.3±11.4 vs. 126.34±12.65 mmHg, P=0.031). Atrial fibrillation was not associated with blood pressure levels. Conclusion Supraventricular arrhythmias and premature contractures are common in the third trimester of the pregnancy. High systolic blood pressure is associated with premature contractures whilst high diastolic blood pressure with supraventricular arrhythmias.

THE IMPACT OF BORTEZOMIB-CONTAINING CHEMOTHERAPY REGIMEN ON MYOCARDIAL BIOELECTRICAL ACTIVITY IN PATIENTS WITH MULTIPLE MYELOMA AND CONCOMITANT CORONARY ARTERY DISEASE

Introduction. The mortality rate in oncology has been steadily decreasing since the 1990s, leading to increased life expectancy among cancer survivors. However, chemotherapy-related toxicity, including cardiotoxicity, remains a concern in the selection of chemotherapy drugs. Multiple myeloma, a type of cancer, has increased in prevalence and morbidity rates in recent decades. The specific treatments for multiple myeloma can have cardiotoxic effects, such as arterial hypertension, heart failure, acute coronary syndrome, and heart rhythm and conductivity disorders.
 Objective. This study aims at investigating the unique characteristics of myocardial bioelectric activity in patients with progressive multiple myeloma and concomitant coronary artery disease undergoing bortezomib-containing chemotherapy.
 Materials and Methods. A total of 42 multiple myeloma patients were examined, 22 (52.5%) of them were diagnosed to have concomitant coronary artery disease. Patients were divided into two groups based on the presence of coronary artery disease. All patients received bortezomib-containing chemotherapy regimens. Assessments were conducted in three time periods: before the chemotherapy, in 84 days, and in 140 days. General and biochemical blood counts were analyzed, and heart rhythm and conductivity disorders were assessed using 12-lead electrocardiography.
 Results: The risk of developing anaemia did not significantly differ between the two groups during the first examination. A trend of increased conductivity disorder rates was observed in multiple myeloma patients with concomitant coronary artery disease compared to those without heart disorders. After the fourth chemotherapy course, there was a tendency for increased heart rhythm disorder rates in multiple myeloma patients with concomitant coronary artery disease compared to the previous examination, although supraventricular rhythm disorders were more frequently observed during the third examination.
 Conclusions. Multiple myeloma onset was associated with similar rates of rhythm disorder development in patients with and without concomitant coronary artery disease, but combined rhythm disorders were observed only in patients with concomitant coronary artery disease. There has been found a tendency for increased heart rhythm disorder rates after the fourth chemotherapy course in multiple myeloma patients with concomitant coronary artery disease. Additionally, there has been a trend of increased conductivity disorder rates in multiple myeloma patients at high cardiovascular risk compared to those without concomitant heart disorders

Perioperative care about a patient with multimorbidity.

The assumption of accelerated postoperative recovery according to the ERAS (Enhanced Recovery After Surgery) method is good condition of the patient prepared for surgery and gently operated on. Application of ERAS in postoperative care in the situation of patient with multimorbidity requires an individual approach and greater pre-operative preparation. During the healing process, the operation causes a systemic inflammatory reaction in the body, which is proportional to the size of the surgery trauma. There is fluid movement between the intravascular and interstitial spaces, increased protein catabolism, increased susceptibility to infectious complications and increased risk of decompensation of chronic diseases. The mandatory content of the pre-operative examination is a functional cardiopulmonary reserves assessment, nutritional risk screening, update of diagnostic summary and optimization of chronic medication before surgery. Prehabilitation and nutritional preparation before the planned operation is influenced by the time urgency of the operation, but even in the case of cancer, short-term nutritional preparation is indicated., Medical workplaces are the most suitable for parenteral and enteral pre-operative nutrition however some surgical departments perform the preparation themselves if necessary. The GDT (Goal Directed Therapy) regimen with a higher degree of hemodynamic monitoring and intervention is applied in the postoperative care of hemodynamic unstable risk patients. Next to decompensation of a chronic disease is mainly heart rhythm disorders (most often atrial fibrillation), cardiac complications including coronary event, stroke, acute delirium.