Terapevt Arkh
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А clinical case of a young patient with recurrent ischemic strokes is presented. The problems of diagnostic embolic strokes are discussed. We set out the algorithm for identifying patients, in whom patent foramen ovale is the most probable cause of embolic stroke. ⋯ Hypothesis of probable source of cardioembolism from patent foramen ovale is presented. Recommendations for the secondary prevention of recurrent ischemic stroke, associated with patent foramen ovale, are provided. We also considered the issues of antithrombotic treatment.
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To explore the features of vectorcardiograms (VCG) of patients with essential hypertension complicated by chronic heart failure with reduced left ventricular ejection fraction (CHFrLVEF). ⋯ AF, LBBB, increased module of the maximum QRS vector and sQRS-Ta, and decreased P/S index are present in hypertensive patients with CHFrLVEF as compared with patients without CHF.
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Cardiogenic shock (CS) is one of the main causes of death in patients with acute myocardial infarction (AMI). Mortality from CS remains high, despite the introduction of myocardial revascularization and the use of modern medication. The use of mechanical circulatory support (MCS) is promising, it could reduce mortality in patients with AMI and CS.
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[Remote electrocardiogram telemonitoring after endovascular interventions on the coronary arteries].
To evaluate the effectiveness of a new system for telemetric electrocardiogram (ECG) monitoring in patients after endovascular interventions (EI) on the coronary arteries (CA). ⋯ Carrying out telemetric ECG-monitoring after EI on the CA improves the quality of observation after the procedure, promotes early discharge of patients, makes the intervention more comfortable and safe. The introduction of this technique into clinical practice will make it possible to more widely use the outpatient approach when carrying out EI, and to increase the turnover of specialized beds and the efficiency of the work of medical institutions.
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On December 13, 2021, an expert council was held to determine the position of experts of different specialties regarding the reasons for the low level of diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) in real clinical practice in a pandemic of a new coronavirus infection and possible ways to improve detection in patients with pulmonary embolism (PE) ) in history. The reasons for the low level of diagnosis of CTEPH are the insufficient level of knowledge of specialists, especially primary care physicians; lack of clear regulatory documents and expert centers for the management of this category of patients. Primary diagnosis of CTEPH in a pandemic can be strengthened through the widespread use of telemedicine for consultations of primary care physicians with specialists from expert centers; to maximize the role of echocardiography and computed tomography (CT) as differential diagnostic tools for dyspnea, in particular in patients with COVID-19. ⋯ The regulatory documents should designate the circle of responsible specialists who will be engaged in long-term monitoring of patients with PE. Educational programs are needed for primary care physicians, cardiologists, and other physicians who come into the field of view of patients with CTEPH; introduction of a program to create expert centers for monitoring and managing patients with the possibility of performing ventilation-perfusion lung scintigraphy, cardiopulmonary stress test, CT, right heart catheterization. It seems important to build cooperation with the Ministry of Health of Russia in order to create special protocols, procedures for managing patients with PE and CTEPH.