Problems In Cardiology Research Articles

Dynamics of uric acid concentration against the background of early dapagliflozin use in patients with acute decompensation of heart failure

Background. Acute decompensation of heart failure (ADHF) is an urgent problem of modern cardiology due to unfavourable prognosis and high frequency of repeated hospitalizations. The risk of acute kidney injury in patients with ADHF, which significantly worsens clinical outcomes, is high, including due to elevated uric acid levels. Aim. To evaluate the effect of sodium-glucose cotransporter type 2 inhibitor dapagliflozin in patients with ADHF with reduced left ventricular ejection fraction (LVEF) on uric acid levels. Materials and methods. The study included 122 patients with ADHF and reduced LVEF (28±6%), III FC 97 (79.5%) patients and II FC 25 (20.5%). All patients received therapy for ADHF according to available guidelines. Patients were divided into two groups: the first group standard therapy, patients in the second group were added dapagliflozin at a dose of 10 mg to standard therapy. Dapagliflozin was administered on average on the 2nd day (1–3) from admission to the hospital on condition of stable haemodynamics. The duration of follow-up was 6 months. The level of uric acid, creatinine, glomerular filtration rate, NT-proBNP, CRP and ST2 at the time of inclusion in the study and 6 months after hospital discharge were analysed. Results. In patients with ADHF and reduced LVEF, a uric acid level equal to or greater than 667.9 μmol/L during hospitalisation predicted a high risk of death during the 6-month follow-up period. Decrease of uric acid level was observed only on the background of dapagliflozin therapy 472 (366–594) μmol/L initially, 326 (275–419) μmol/L when ADHF compensation was achieved (p0.001), after 6 months the significant changes remained – 359 (263–410) μmol/L (p0.001). Against the background of dapagliflozin therapy there was a significant decrease in NT-proBNP level after 6 months from 2059 pg/ml (1456–4204.5) to 1101 pg/ml (415.8–3371.5); p0.006; decrease in ST2 concentration after 6 months from 24. 4 ng/ml (15.1–35) to 19.4 ng/ml (13.3–30.1); p0.041; decrease in SRP after six months from 2.9 mg/L (1.2–7.1) to 2.1 mg/L (0.9–2.8); p0.015; no worsening of renal function was noted. Conclusion. It can be concluded that dapagliflozin has a favourable safety and efficacy profile when used in patients with ADHF and hyperuricemia.

EARLY MANIFESTATIONS OF HEART FAILURE AND ACTIVITY OF SYSTEMIC INFLAMMATION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION DEPENDING ON RISK FACTORS

Acute myocardial infarction and heart failure (HF) resulting from this condition remain complex and not fully understood problems in cardiology. It is important to detect early manifestations of HF and optimize treatment to prevent pathological myocardial remodeling and the occurrence of adverse events. The increase in systemic inflammation activity (SIA) and the presence of comorbidities in patients contribute to the development of HF. The aim of the study- to investigate the impact of risk factors (RF) such as arterial hypertension (AH), diabetes mellitus (DM), history of COVID-19, and obesity on the occurrence of HF and SIA in patients with ST-elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention. Materials and Methods. The study involved 50 patients from the cardiology and reperfusion therapy department of St. Panteleimon Hospital in Lviv (66,00 (52,43-78,35) % men and 34,00 (21,65-47,57) % women), with an average age of 62,01±10,30 years. Blood levels of NT-proBNP (a biomarker of HF) and C-reactive protein (CRP) (a biomarker of SIA) were analyzed on the day of hospitalization for STEMI (the first day from the onset of clinical symptoms, stenting of the infarct-related coronary artery). Results were evaluated using descriptive statistical analysis methods (mean and standard deviation; median and percentile, fractions and their 95 % confidence intervals, calculated by the Wald and Fisher methods), unpaired Student's t-test, and Pearson correlation analysis. Results. The average NT-proBNP levels in the studied patients were 0,50 (0,30; 2,60) ng/ml, and CRP levels were 10,50 (6,00; 20,80) IU/ml (p<0,05, compared to normal parameters). NT-proBNP levels significantly (p<0,05) exceeded the upper reference limit in the presence of AH (0,50 (0,30; 3,30) ng/ml); DM (0,61 (0,30; 4,37) ng/ml); history of COVID-19 (0,61 (0,32; 3,36) ng/ml) (as well as without this RF – 0,49 (0,15; 1,37) ng/ml); obesity (0,31 (0,19; 380) ng/ml). The average NT-proBNP levels in patients with a history of COVID-19 were significantly (p<0,05) higher compared to those in patients without it. CRP levels in blood were significantly (p<0,05) higher than normal values in patients with AH (11,05 (5,60; 25,90) IU/ml); DM (15,20 (7,06; 25,20) IU/ml) (as well as without this RF – 9,50 (5,54; 18,20) IU/ml); history of COVID-19 (12,52 (8,20; 19,65) IU/ml) (as well as without it in history – 9,99 (5,60; 20,06) IU/ml); obesity (9,63 (6,52; 35,00) IU/ml) (as well as without this RF – 10,50 (5,81; 18,40) IU/ml). Average CRP levels in patients with DM and a history of COVID-19 were significantly (p<0,05) higher compared to those without these RFs. The correlation between NT-proBNP and CRP levels was direct – strong in the presence of DM (r=0,78; p=0,012) and history of COVID-19 (r=0,70; p=0,001), medium strength in patients with AH (r=0,55; p=0,0004). Conclusions. In patients with STEMI who underwent myocardial revascularization, early manifestations of HF and a significant increase in SIA occur within the first day of the disease, promoted by such risk factors as AH, DM, history of COVID-19, and obesity. In the presence of DM and history of COVID-19, CRP should be considered an early marker of HF occurrence alongside NT-proBNP, as indicated by a strong direct correlation between these indicators in this category of individuals.

A Retrospective Evaluation of Patients Who Had Den¬tal Treatments Under General Anesthesia

Aim: This retrospective study aimed to evaluate the demographic and operational data of uncooperative healthy individuals and individuals with special needs who underwent dental treatments under sedation and general anesthesia. Methods: Data of 458 patients with special needs and 77 healthy noncooperative patients who were examined at XXX University Faculty of Dentistry between January 2022 and May 2023 and underwent dental treatments under general anesthesia were examined retrospectively. Demographic data of the patients, American Society of Anesthesiologists (ASA) scores, mallampati (MP) scores, disability status, if they have systemic diseases, type of anesthesia (sedation/general anesthesia), anesthetic agents and analgesia used, operation duration and dental treatments, were evaluated. Results: The average age of 535 patients who received dental treatment was 13.5±9.9 years and 58.1% (n=311) of the patients were male and 41.9% (n=224) were female. According to ASA scores, the distribution was 15.7% ASA I, 77.6% ASA II, and 6.7% ASA III. While 14.4% of the patients were systemically healthy, 16.7% had epilepsy, 12.9% had cerebral palsy, 12.1% had mental retardation, and 7.1% had Down syndrome. Of 7.1% had various comorbidities such as cardiological problems. Sedation was applied to 7.3% (n=39) of the patients, and general anesthesia was applied to 92.7% (n=496). The average anesthesia duration was 74.5±34.6 minutes. While the average restorative treatment applied to the patients was calculated as 6.45±3.9, tooth extraction 5.25±4.3, fissure sealant 2.44±2.5, pulp treatment 1.62±0.9; Trauma splint was applied to 3 patients. Conclusions: While pre-anesthesia evaluation is very important in determining the risks in dental general anesthesia and sedation applications, the operating conditions and the general and oral health of the patients are effective in the dental treatment decision.

Angiotensin 1-7 – a peptide that increases the resistance of the heart to ischemia and reperfusion: narrative review

Background. The high mortality rate among patients with acute myocardial infarction (AMI) is an important problem of modern cardiology. In recent years, there has not been a significant decrease in mortality in AMI. Drugs used to treat AMI are not effective enough, so there is a need to develop fundamentally new drugs that can significantly increase the heart’s tolerance to ischemia/reperfusion (I/R). Angiotensin 1-7 peptide, which can increase cardiac tolerance to I/R by activating Mas receptor in myocardial tissue, could become a prototype of such drugs. The following enzymes are involved in the formation of the cardioprotective effect of angiotensin 1-7: NO-synthase, soluble guanylyl cyclase, phosphoinositide 3-kinase, extracellular signal-regulated kinases-1/2, Akt kinase and, possibly, protein kinase G. Indirect data indicate that the hypothetical end effector in the cardioprotective impact of angiotensin 1-7 could be mitochondrial or sarcolemmal ATP-sensitive K+ channel.Aim: To review 1-7 role in increasing the heart resistance to ischemia and reperfusion. The literature search was carried out in the PubMed database with queries “angiotensin 1-7 receptors”, “stress”, “angiotensin 1-7”, “mas receptor”, “cardioprotective effects of angiotensin 1-7”.

ADVANCES IN DIAGNOSIS AND TREATMENT OF CONGENITAL HEART DISEASE: A COMPREHENSIVE REVIEW

The purpose of this article is to provide a comprehensive review of recent advances in the diagnosis and treatment of congenital heart disease (CHD). CHD, which affects about 1% of live births worldwide, is still a major problem in pediatric cardiology. The most prevalent congenital cardiac defects—Ventricular Septal Defect (VSD), Tetralogy of Fallot (TOF), Coronary Artery Fistula, Coarctation of the Aorta (CoA), Aortic and Pulmonary Stenosis, Valve Insufficiency, Double Outlet Right Ventricle (DORV), Ebstein Anomaly, Transposition of the Great Arteries (TGA), Anomalous Venous Return, and Hypoplastic Left Heart Syndrome (HLHS) are all thoroughly examined in this review. The review examines current diagnostic and treatment strategies, highlighting the benefits, drawbacks, sensitivity, and specificity of several imaging modalities, including as CT, MRI, and echocardiography. It also discusses the historical evolution of treatment outcomes, emphasizing the tremendous advances in patient care and surgical procedures that have significantly mproved survival rates and quality of life for CHD patients.

Показатели качества жизни у мужчин, имеющих хроническую ишемическую болезнь сердца при коморбидной ассоциации с метаболическим синдромом

The leading position in the structure of causes of death from cardiovascular diseases is occupied by coronary heart disease, which is the most serious problem of modern cardiology and medicine in general. Mortality rates from coronary heart disease are now on the decline, thanks to advances in diagnosis, treatment, and risk factor management. Chronic diseases have an important and adverse effect on the quality of life, and it is well known that its improvement is the ultimate and important goal of modern medicine. Aim. The study of quality of life indicators and factors influencing its decline in men with chronic coronary heart disease, with comorbid association with metabolic syndrome. Materials and methods. 115 men with chronic ischemic heart disease were examined, of which 67 had metabolic syndrome. Metabolic syndrome was diagnosed based on the criteria of clinical recommendations of the All-Russian Scientific Society of Cardiology in 2009. The quality of life and the degree of its decline were determined using the methodology developed by A.G. Gladkov et al. (1982) adapted by T.A. Ayvazyan et al. (1989). Results. Among the surveyed men with chronic coronary heart disease and metabolic syndrome, quality of life indicators of varying degrees of decline were found in more than 70% of the surveyed. A decrease in quality of life in men with chronic coronary heart disease with metabolic syndrome was more often observed in individuals with a five-component combination of metabolic syndrome. The most frequent metabolic syndrome clusters among men with different levels of quality of life decline were three- and four-component combinations, including abdominal obesity, arterial hypertension and dyslipidemia disorders. Conclusion. It was found that in men with chronic coronary heart disease, the decrease in quality of life was largely due to the presence of the metabolic syndrome.

Current approaches to the treatment of hypertensive patients in view of modern guidelines

The issues of diagnosis and treatment of hypertension (HTN), as well as the prevention of its complications, are an urgent problem in cardiology. On June 21, 2023, the Journal of Hypertension published guidelines on HTN from the European Society of Hypertension (ESH), which were first presented to the public at the annual European Hypertension Meetings on June 24, 2023 in Milan. This publication describes the highlights and key updates of the guidelines and outlines its clinical significance. Russian experts also discussed current problems of pathogenesis, diagnosis and treatment of HTN.

Stages of motor development in children with cyanotic congenital heart defects after surgical treatment

Background. The article deals with the actual problem of pediatric neurology, pediatric cardiology, and pediatric cardiac surgery, in particular, the peculiarities of neurodevelopment in children with congenital heart defects (CHD). The purpose is to conduct a study of stages of stato-motor development (SMD) in patients with cyanotic congenital heart defects after surgical treatment and to determine the influence of pathogenic factors on neurodevelopmental delay. Materials and methods. Thirty-five patients with cyanotic CHD underwent examination and surgical treatment at the Center for Pediatric Cardiology and Cardiac Surgery of the Ministry of Health of Ukraine: 20 children — with transposition of the great vessels (TGV) and 15 children — with tetralogy of Fallot (TOF). The control group consisted of 35 healthy patients whose motor development corresponded to their age. Gestational age, body weight at birth, Apgar score, saturation, and duration of artificial blood circulation during surgical treatment for CHD were considered. Assessment of motor development was carried out with the help of the following scales: Munich Functional Developmental Diagnosis (G.J. Köhler, H.D. Egelkraut) and section 2 of the Hammersmith Infant Neurological Examination. Data were processed using the software Microsoft Excel version 16.0.12527.21236. Results. The gestational age of the studied group of patients with cyanotic CHD was 38 weeks, body weight — 3,500 g, which corresponded to the control group. Patients of the first subgroup with TGV were diagnosed with lower saturation indicators (р = 0.0001), a lower 1-minute Apgar score (p = 0.028) and a longer duration of artificial blood circulation — 146.00 ± 29.03 (р = 0.043) compared to the second subgroup with TOF. SMD delay was diagnosed in 29 % of cases, namely 12 % with TGV and 17 % with TOF. The average period of sitting with delayed SMD was 8.4 ± 2.2 months (p = 0.002), walking — 18.4 ± 6.3 months (p = 0.0001). Subsequently, children with TGV continue to develop without a significant delay compared to the TOF subgroup. Conclusions. 1. Patients with cyanotic CHD are born at 38 weeks of gestation, with sufficient body weight without a significant difference depending on the type of CHD and compared to the control group of healthy children. The predominance of the male gender is typical in cyanotic CHD. However, children with transposition of the great vessels are characterized by a lower 1-minute Apgar score and lower indicators of saturation at birth compared to those with tetralogy of Fallot. 2. Based on the conducted study, a delay of SMD was found in 29 % of patients with cyanotic CHD, namely 17 % with TOF and 12 % with TGV. The average duration of sitting with delay was 8.4 ± 2.2 months and walking was 18.4 ± 6.3 months. 3. Surgical treatment was carried out according to the detected indications, for transposition of the great vessels on the first day and for tetralogy of Fallot at 8 months of life. No pathogenic influence of the duration of artificial blood circulation and aortic clamping during cardiosurgical treatment on SMD in children was found. An increase in the duration of artificial blood circulation was noted during arterial switch operation in children with TGV, but no significant difference was found in children with SMD delay. 4. Timely early surgical treatment of critical CHD — TGV on the first day after birth, a developed route for pregnant women, techniques of performing operations — ensure a better SMD of this subgroup in the future. In patients with TOF, taking into account the long period of hypoxia before the start of surgical correction, neuropsychiatric disorders of varying degrees are more often noted. The development of an individual rehabilitation program is provided for this category of children.

Music therapy in tertiary neonatal intensive care: A matter of unlikely allies?

Over the past decades, music therapy in the neonatal intensive care unit (NICU) has been proven effective in physiological and psychological outcomes, including sucking, behaviour, stress reduction, neurodevelopment and promoting emotional bonding. However, not every NICU administers music therapy in their ward. Research on music therapy for neonates and their caregivers has lately accumulated, increasing the evidence of health benefits on brain development and across a variety of NICU-related pathologies, including neurological, cardiological, pulmonary and gastrointestinal problems. Conclusively, we will present the studied methods of music therapy for clinical benefits in neonatal intensive care.

REVASCULARIZATION WITHOUT DES: A CASE REPORT ABOUT METALLIC–LESS REVASCULARIZATION TECHNIQUES

Abstract Rational 56 years old patient, admitted to our service for myocardial infarction without ST elevation. In medical history he had dyslipidaemia, hypertension and familiarity for cardiovascular disease, without previous cardiological problems. The patient went to the ER for chest pain, started after his work shift. When admitted to the ER, the patient was still symptomatic for chest pain, with resolution after 3 hours after somministration of analgesics, with normal pressure and heart rate. An ECG was performed, without relevant findings, at the blood exams significative movement of cardiac troponins. At the echocardiogram apical hypokinesia of left ventricle with preserved ejection fraction. Technical Resolution Coronarography was performed, with evidence of severe diffuse atheromatic disease of the left anterior descending artery (LAD) at the proximal segment and sub–occlusive stenosis at the middle segment. Due to the diffuseness of the atherosclerotic disease on the LAD, which would have required a complete stenting of the artery, which using classical Drug Eluted Stents would have led to a complete metallization of the artery, in such a young patient who does not have medical history suggesting a progression of the atheromatic disease, metallic–less techniques were chosen. The two lesions were pre–dilatated with a non–compliant (NC) balloon. The proximal lesion was treated with a bioresorbable scaffold (BVS) Magmaris 3x25 mm, post–dilatated with a NC balloon, without complications. The distal segment was treated with a Drug Eluting Balloon (DEB) Pantera Lux 2.5x20 mm, expanded for 90 seconds, with evidence of focal dissection, not flow limiting.At the clinical follow–up performed at one and three months, the patient was asymptomatic for angina, without any cardiovascular event. Clinical Implications When facing coronaropathy in a young patient, it is a good option to treat the coronary with techniques that do not leave metallic material in the arteries, which exposes young patients to a higher rate of complications if compared to older patients. When it is preferred to use this kind of techniques, the options can be DEB or BVS. As seen in this case report, often the DEB can lead to complications. It’s well–known that every DEB complication needs a DES to fix it. However, little is proven and studied about the use of BVS on de–novo lesions and on coronary injuries as complications of “conventional” PCI, as well as those derived from DEB delivery.

Analysis of the contribution of obstructive sleep apnea/hypopnea syndrome and glycemic level variability to the development and progression of cardiac arrhythmias in patients with type 2 diabetes mellitus

In this review, information is presented within the triad: obstructive sleep apnea/hypopnea syndrome (OSA), glycemic variability, and cardiac arrhythmias in patients with type 2 diabetes mellitus (DM2). Epidemiological aspects, pathogenetic relationships, possible instrumental and laboratory diagnostic methods, as well as approaches to personalized therapy are analyzed. Research is being actively conducted in certain areas of the designated triad, however, no studies have been found that include simultaneous monitoring of indicators reflecting these disorders in patients with DM2. Many issues are still controversial. Sleep disturbances in patients with DM2 are actively studied, but more often questionnaires are used for diagnosis, rather than instrumental methods. There is insufficient data examining the effect of hypoxia on the progression of complications in patients with DM2. Rhythm disturbances are being actively studied in patients with DM2 in combination with various cardiological problems. Of greatest interest is the study of rhythm disturbances in patients with DM2 without concomitant comorbid conditions of the cardiovascular system, in order to identify early signs of diabetic cardiovascular autonomic neuropathy and cardiomyopathy, as well as additional early risk factors for the development and progression of cardiovascular diseases. Most of the studies are devoted to the study of the association of OSA and various arrhythmias in cardiac patients. However, there is no data on the combined effect of glycemic variability and OSA on the development of cardiac arrhythmias in patients with DM2. Additional studies are needed to identify the features of the effect of OSA on cardiac arrhythmias in patients with DM2.

Peptides Are Cardioprotective Drugs of the Future: The Receptor and Signaling Mechanisms of the Cardioprotective Effect of Glucagon-like Peptide-1 Receptor Agonists.

The high mortality rate among patients with acute myocardial infarction (AMI) is one of the main problems of modern cardiology. It is quite obvious that there is an urgent need to create more effective drugs for the treatment of AMI than those currently used in the clinic. Such drugs could be enzyme-resistant peptide analogs of glucagon-like peptide-1 (GLP-1). GLP-1 receptor (GLP1R) agonists can prevent ischemia/reperfusion (I/R) cardiac injury. In addition, chronic administration of GLP1R agonists can alleviate the development of adverse cardiac remodeling in myocardial infarction, hypertension, and diabetes mellitus. GLP1R agonists can protect the heart against oxidative stress and reduce proinflammatory cytokine (IL-1β, TNF-α, IL-6, and MCP-1) expression in the myocardium. GLP1R stimulation inhibits apoptosis, necroptosis, pyroptosis, and ferroptosis of cardiomyocytes. The activation of the GLP1R augments autophagy and mitophagy in the myocardium. GLP1R agonists downregulate reactive species generation through the activation of Epac and the GLP1R/PI3K/Akt/survivin pathway. The GLP1R, kinases (PKCε, PKA, Akt, AMPK, PI3K, ERK1/2, mTOR, GSK-3β, PKG, MEK1/2, and MKK3), enzymes (HO-1 and eNOS), transcription factors (STAT3, CREB, Nrf2, and FoxO3), KATP channel opening, and MPT pore closing are involved in the cardioprotective effect of GLP1R agonists.

Dermatitis artefacta in a 60 year old man: a case report

IntroductionDermatitis artefacta (DA), also known as factitial dermatitis, is a condition among factitious disorders, whereby self-induced skin damage is the means used to satisfy a conscious or unconscious desire to assume the sick role, particularly in those with an underlying psychiatric diagnosis or external stress. DA should be distinguished from malingering, in which skin damage may be inflicted for the purpose of secondary gain.ObjectivesReview what dermatitis artefacta and factitious disorders in general consist of and the challenges they present.Methods Presentation of a patient’s case and review of existing literature, in regards to factitial dermatitis and factitious disorders.Results In general, in regards to factitious disorders in literature, the majority of patients were female with mean age at presentation at thirty. A healthcare or laboratory profession was reported most frequently, as well as a current or past diagnosis of depression was described more frequently than personality disorder in cases reporting psychiatric comorbidity, and more patients elected to self-induce illness or injury than simulate or falsely report it. Patients were most likely to present with endocrinological, cardiological and dermatological problems. In our patient’s case, common factors described previously are dermatological lesions, comorbid psychiatric disorder and the beginning of the disorder at an earlier age. Specifically, when it comes to DA, the hallmarks of diagnosis include self-inflicted lesions in accessible areas of the face and extremities that do not correlate with organic disease patterns. Importantly, patients are unable to take ownership of the cutaneous signs.Management in these cases is challenging, and different modalities may be employed, including topical therapies, oral medications, and cognitive behavioural therapy; adopting a multidisciplinary team approach has been shown to be beneficial in allowing patients to come to terms with their illness in an open, non judgmental environment.ConclusionsDA is a rare cutaneous condition that must be considered when the clinical presentation is atypical and investigations do not yield an alternate diagnosis. Few are referred to psychiatric services and even fewer accept care. They have a protracted course, complicated by repeated hospitalizations, ultimately leading to their premature deaths. Clear guidelines on the management of these patients need to be set to protect both patients and providers in light of the ethical and legal considerations.Disclosure of InterestNone Declared

ECG-based risk stratification of sudden cardiac death and life-threatening ventricular arrhythmias

Risk stratification of sudden cardiac death and life-threatening ventricular arrhythmias remains an unsolved problem of modern cardiology. Technological progress in the field of electrocardiography and cardiac monitoring enables discovering and researching potential ECG risk predictors based on novel methods of ECG data analysis.

Wide QRS complex tachycardia: differential diagnosis and acute treatment

The methodical guidelines are devoted to the pressing problem of clinical cardiology – the diagnosis and treatment of wide QRS complex tachycardia, requiring an individualized approach to patients’ management. The basic principles of determination of wide QRS complex tachycardias and their electrophysiological mechanisms are reviewed. The etiology of wide QRS complex tachycardias, their clinical picture and ECG criteria for differential diagnosis, particularly between ventricular tachycardia and supraventricular tachycardia with aberrant ventricular conduction, are outlined. The basic principles of wide QRS complex tachycardias diagnosis are discussed, and the ECG signs of the certain «wide» are presented. The results of the studies, aimed at the development of the diagnostic criteria and algorithms for differential diagnosis of wide QRS complex tachycardias, are analyzed. The acute treatment of narrow and wide QRS complex tachycardias are presented. The antiarrhythmic drugs and their use are given, and the principles of catheter treatment of tachycardia are stated. The guidelines are addressed to cardiologists, internists, the functional diagnostics physicians, general practitioners (family physicians), interns.

HA-ResNet: Residual Neural Network With Hidden Attention for ECG Arrhythmia Detection Using Two-Dimensional Signal.

Arrhythmia is an abnormal heart rhythm, a common clinical problem in cardiology. Long-term or severe arrhythmia may lead to stroke and sudden cardiac death. The electrocardiogram (ECG) is the most commonly used tool to diagnose arrhythmia. However, the traditional diagnosis relies on experts for manual interpretation, which is time-consuming and laborious. In recent years, many automatic arrhythmia detection methods have emerged due to advancements in deep learning. These methods can reduce manual intervention and improve diagnostic efficiency. However, extracting useful features from raw ECG signals for arrhythmia detection is still challenging due to the low frequency of ECG signals and noise distribution. In this paper, we propose a novel hidden attention residual network (HA-ResNet) for automated arrhythmia classification. In this model, the one-dimensional ECG signals are first converted into two-dimensional images and fed into an embedding layer to obtain the relevant shallow features in ECG. Then, a hidden attention layer combining Squeeze-and-Excitation (SE) block and Bidirectional Convolutional LSTM (BConvLSTM) is used to further capture the deep Spatio-temporal features. We evaluate our HA-ResNet on two public datasets and achieve F1 scores of 96.0%, 96.7%, and 87.6% on 2s segments, 5s segments, and 10s segments, respectively, which significantly outperform the existing state-of-the-art approaches. The experimental results demonstrate the effectiveness and generalization of our method.

Case report: role of cardiac MRI in the diagnosis of myocarditis

Diagnosis of myocarditis remains one of the most difficult clinical problems in cardiology. In connection with the coronavirus infection COVID-19 caused by the acute respiratory virus SARS-CoV-2, non-invasive diagnosis of myocarditis is an urgent task. The most informative method for diagnosing myocarditis is magnetic resonance imaging [1,2]. The arsenal of MRI includes a number of pulse sequences that make it possible to identify and evaluate the process of inflammation in its various phases. Various pulse sequences (T2-weighted images or T2-mapping, delayed contrast, T1-mapping) allow not only to diagnose the disease, but also to determine the stages of damage. The ability of MRI to differentiate ischemic and non-ischemic lesions [3] is used in emergency cardiology for various myocardial injuries.The peculiarity of this clinical case is the use of MRI diagnostics in a patient with a typical clinical picture of acute coronary syndrome in the emergency department of cardiology. The data of the contrast MRI of the heart allowed the patient to make the correct diagnosis.

Features of Application of the Optimized Physical Rehabilitation Program in Patients with Coronary Heart Disease

Multisymptomatic coronary heart disease (CHD) remains a leading problem in cardiology. A person’s ability to perform physical work determines their quality of life, especially in patients with existing symptoms of damage to the cardiovascular system. The most advanced approach in the physical rehabilitation of patients with CHD is the use of ergometric testing indicators.
 The aim. To study the influence of the developed method of cycling training on the indicators of cardiopulmonary exercise (CPX) in patients with CHD.
 Materials and methods. We examined 65 men with CHD, I-II functional class stable angina pectoris, mean age 44.6 ± 1.39 years (from 32 to 60 years). The diagnosis was made on the basis of clinical findings, electrocardiography and laboratory examination according to the generally accepted criteria of the European Society of Cardiology.
 Results. The treatment results were evaluated two weeks after the completion of the physical rehabilitation program. Qualitative assessment was performed by using the CPX test with the recording of cardiac bioelectric potentials from 12 leads. The criteria for discontinuation of the test were generally accepted provisions based on WHO recommendations.
 While developing a physical rehabilitation program and predicting the timing of a functional recovery, several factors have to be taken into account that significantly affect the patient’s motor activity and determine the pace and outcome of the rehabilitation process as a whole. Long-term, regular physical activity in patients with CHD with limited coronary reserve have an impact on the mechanisms of cardiac function regulation, synchronization and optimization of the activity of the muscular, cardiovascular and respiratory systems. Systematic training sessions reduce the volume of drug therapy and can improve the patients’ quality of life.
 Conclusions. The use of the proposed individualized uniform interval cycling training combined with the intake of citrulline malate leads to a significant improvement in the achieved load capacity, heart rate, duration of work, total volume of completed work, inotropic reserve index, optimization of coronary blood circulation and improvement of bioenergy metabolism in the myocardium.

Anorectal Malformations and Late-Term Problems.

Anorectal malformation is a disease with different subtypes and anatomical and functional multisystemic involvement that requires a unique approach in each age group. Anomalies associated with vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities (VACTERL) association require detailed investigation and management. Beginning from the neonatal period, treatment is carried out with different surgical procedures. The clinical course of these patients may be associated with medical problems, accompanying congenital anomalies, perioperative management, or late sequelae. Constipation and fecal-urinary incontinence are the most common problems encountered in long-term follow-up. Renal failure is the most important cause of long-term mortality. In addition, these patients need to be under control until adulthood due to cardiological, spinal, genital, gynecological, and endocrine problems. In this follow-up, many pediatric disciplines such as neonatal intensive care, cardiology, nephrology, gastroenterology, and endocrinology cooperate with pediatric surgeons and pediatric urologists.

Safety of dapagliflozin initiation in acute decompensated heart failure patients with reduced left ventricular ejection fraction

Background. Chronic heart failure (CHF) is an immediate cardiological problem. At the same time, acute decompensated heart failure (ADHF) is associated with an extremely unfavorable prognosis and low survival of patients.
 Aim. To evaluate the safety of sodium-glucose cotransporter-2 inhibitor dapagliflozin early administration in patients with ADHF with a reduced left ventricular ejection fraction (LVEF) regardless of type 2 diabetes mellitus (diabetes).
 Materials and methods. We used standard CHF therapy and intravenous diuretic therapy in combination with 10 mg dapagliflozin in 43 patients with NYHA class IIIV ADHF. The study mainly included 39 (90.7%) male patients, the mean age was 6012 years (5663), diabetes was in 14 (32.6%) patients. Dapagliflozin was prescribed by a mean of 2 days (13) from admission to the hospital. The parameters were analyzed at the time of inclusion in the study and when CHF compensation was achieved.
 Results. The median of the length of hospital stay was 7 days (610). LVEF significantly increased during hospitalization from 276 to 307% (p0.001) and the level of NT-proBNP decreased: from 3700 pg/ml (17455331) to 1366 pg/ml (10252878); p=0.007. A decrease in the marker was observed in 90% of patients. Hypotension (decrease in systolic blood pressure BP less than 90 mmHg) was observed in 10 (23.3%) patients. A statistically significant decrease in BP was found: systolic and diastolic BP on admission was 114 mmHg (100126) and 70 mmHg (7080), respectively, when CHF compensation was achieved 110 mmHg (98120) and 70 mmHg (6178); p=0.047 and p=0.013, respectively. The increase in hematocrit during hospitalization was also statistically significant from 43.53.6 to 46.14.9% (p0.001) and this was found in 67% of patients. A total of 4 (9.3%) patients had acute renal injury (decrease in estimated glomerular filtration rate GFR by 25% or more). At the same time, there was no decrease in GFR of less than 15 ml/min/1.73 m2. There was no statistically significant decrease in GFR and an increase in creatinine levels during hospitalization (p=0.214 and 0.173, respectively). Urinary tract infections were observed in 1 (2.3%) patient, transient hypoglycemia in 2 (4.7%) patients, which did not lead to the discontinuation of dapagliflozin. Diabetic ketoacidosis, allergic reactions, syncope, lower extremity amputations were not observed in patients taking dapagliflozin.
 Conclusion. It can be concluded that dapagliflozin has a favorable safety profile when used in patients with ADHF, regardless of the presence or absence of diabetes.