The article provides a summary of the 2021 European Society of Cardiology (ESC) Guidelines for the diagnosis and treatment of acute and chronic heart failure (CHF). The most significant changes for general practitioners, internists and primary care cardiologists, from our point of view, regards etiology, terminology, as well as algorithms for diagnosing and treating CHF in accordance with phenotypes, new indications to a number of drugs, in particular sodium-glucose cotransporter type 2 inhibitors (dapagliflozin and empagliflozin) with assignment of class I recommended therapy and vericiguat. The article discusses the diagnostic criteria for different heart failure phenotypes, the potential of treating patients with heart failure mildly reduced and preserved ejection fraction.

The article discusses modern approaches and features of management, as well as predicting the risk of complications in patients with cardiac arrhythmias, in particular, atrial fibrillation, and the potential of using conservative and interventional treatment methods for heart failure (HF), taking into account updates and achievements in clinical practice. Epidemiological data, algorithms for managing patients with HF and atrial fibrillation, prevention of thromboembolic events, results of studies comparing the effectiveness of different strategies for atrial fibrillation treatment, catheter ablation compared with drug therapy in patients with HF are presented.

Introduction. The data of epidemiological studies indicate maintaining high prevalence of heart failure (HF) and an unfavorable prognosis for such patients, which creates the need to change the treatment approach. A feature of the case presented is the young age of the patient and a significant effect that was achieved with quadruple therapy for HF with reduced ejection fraction (EF) after myocarditis.Short description. A three-year follow-up of a patient with HFrEF was carried out. In 2019, at the age of 21, the patient had acute myocarditis, diagnosed according to magnetic resonance imaging. The outcome was postmyocarditis cardiosclerosis, complicated by HFrEF. She had two episodes of HF decompensation, followed by hospitalizations in a cardiology hospital. During the treatment, a quadruple therapy was initiated (angiotensin receptor-neprilysin inhibitor, beta-blocker, mineralocorticoid receptor antagonist, sodium-glucose cotransporter 2 inhibitor), against which a significant improve was noted in the form of decrease in congestion symptoms, natriuretic peptide level from 1956 to 501,4 pg/ml, an increase in LVEF from 33% to 39%. The patient is currently on the waiting list for a donor heart transplant.Conclusion. The case report focuses on the complexity of not only the timely diagnosis of myocarditis, but also the treatment of its consequences. The appointment of quadruple therapy for a patient with HF after myocarditis has improved the patient’s clinical condition before heart transplantation. However, this approach needs to be confirmed in a larger number of patients.

The review discusses the relationship between chronic heart failure and diabetes mellitus type 2, metabolic phenotypes of patients w ith chronic heart failure with preserved left ventricular ejection fraction (HFpEF), features of the pathophysiological interaction between diabetes mellitus and HFpEF. Chronic inflammatory condition, metabolic disorders and comorbidities are the pathophysiological basis of HFpEF. The review discusses the concept of diabetic cardiomyopathy, its molecular mechanism and current possibilities of treating this pathology, considering the impact on the prognosis.