The aim: The study was designed to establish the prevalence of acute heart failure in patients with acute myocardial infarction, to determine the sex-age characteristics of acute myocardial infarction course in case of complications by acute heart failure of high classes (Killip III and Killip IV). Materials and methods: We analyzed medical records of inpatients of the myocardial infarction department of the municipal non-profit enterprise Vinnytsia Regional Center for Cardiovascular Pathology in 2019. The survey covered 828 medical records of patients with acute myocardial infarction, average age (64.6 ± 0.38), including 569 (64.7%) males and 311 (35.3%) females. Results: 129 (15.6%) patients with acute myocardial infarction were diagnosed high-class acute heart failure. Patients with high-class acute heart failure were statistically significantly elderly individuals of the average age (69.0 ± 1.3), (p <0.001), including 53.7% of males, and 46.3% (p <0.001) female patients. Patients with acute myocardial infarction complicated by acute heart failure were hospitalized within 2 hours of symptoms` onset with statistically significantly higher probability (p = 0.004). Patients with acute myocardial infarction complicated by acute high-class heart failure were statistically significantly more likely diagnosed with concomitant hypertension, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease than individuals with uncomplicated acute myocardial infarction. Acute myocardial infarction patients` mortality was 3.4%, while the one in patients with acute heart failure was 38% (p <0.001). Conclusions: Patients with complicated myocardial infarction are characterized by statistically significantly higher comorbidity and increased lethality.

Aim – to study the frequency of acute heart failure (AHF) in patients with Q-myocardial infarction (MI), to establish the clinical and functional features of the course and risk factors for high-grade heart failure in patients with Q-MI.Materials and methods. The data of 308 middle-aged Q-MI patients (62.9±0.6) years old, including 215 men (69.8%) and 93 women (30.2%), who were treated in a specialized cardiology department, were analyzed. Among the examined patients, an analysis of the combination of Q-MI with AHF of different classes according to Killip was performed. All patients underwent a general clinical examination, ECG, echocardiography and lung ultrasound, coronary ventriculography, additional laboratory examination (quantitative troponin I, D-dimer, CPK-MV, CRP, NT-proBNP). Statistical analysis of the results was performed in the "Statistica 7.0" system. The results. Among all examined, 161 (52.3%) persons had AHF class I according to Killip, 44 (14.3%) – class II, 55 (17.8%) – class III, and 48 (15.6%) patients - class IV. When dividing by age and sex, no significant difference was found between different classes of AHF. Men predominated in all groups - from 61.8% in the group of MI+AHF of class III to 73.3% in the group of MI+AHF of class I. In all groups the majority of those examined were patients who were hospitalized within 2 to 6 hours of the onset of the pain syndrome - 63.4% in group I, 45.4% in group II, 49.1% in group III, and 56.2% in group IV. Hospitalized within 6-12 hours among all MI patients was 19.2%, slightly more in groups of AHF I and II (20.5% and 22.7%) than in groups III and IV (16.4% and 14, 7%), (р=0.34). The smallest part of patients - 7.2% - was hospitalized within more than 12 hours from the onset of the pain syndrome, from 3.7% in the group of MI and AHF I to 12.7% in the group of AHF III (p=0.32). The average BMI was (29.6±0.3) kg/m2, the highest BMI was determined in the group of MI and GOS AHF – (30.5±0.4) kg/m2, the lowest – in the group of MI and AHF I – (29 .1±0.4) kg/m2 (р=0.24). Arterial hypertension (AH) among persons with AHF I occurred in 85.1% of cases, with AHF II - in 100%, in the group of AHF III - in 90.9%, in AHF IV - in 89.6% (р=0,66). When comparing the data of patients with MI and AHF of high degrees - Killip III-IV (group II) it was found that they were significantly older than people with MI without signs of AHF of high gradations (p=0.016). It was found that patients with MI and high-grade heart failure differed from people with class I-II heart failure by higher BMI - (30.4±0.5) versus (29.1±0.2) kg/m2, respectively (p=0.046), as well as a longer history of hypertension - 52.4% of patients in group II had hypertension for more than 10 years, while in group I - 36.1% (p=0.006). There is a significantly higher frequency of all forms of atrial fibrillation (AF) in the anamnesis in patients with high-grade heart failure - 12.6% versus 3.9% in group I (p=0.0004) and a higher frequency of chronic obstructive pulmonary diseases - 10.7 % against 4.4% (p=0.035).Conclusions. Patients with AHF classes III and IV differ from people with HF I and II classes in the frequency of AF cases, while other concomitant diseases are present in all groups without a significant difference. Patients with MI complicated by high-grade AHF differ from the group of MI without high-grade AHF by older age, higher BMI, a longer history of hypertension, and a higher frequency of AF and COPD. Stable angina pectoris in the anamnesis is noted more often in persons without high gradation of AHF.

Мета роботи. Оцінити рівень знань лікарів медичних закладів Вінницької області щодо основ проведення серцево-легеневої реанімації (СЛР); визначити ключові питання, що потребують більш детального відпрацювання під час проведення тренінгів із СЛР. Матеріал і методи. Кафедрою пропедевтики внутрішньої медицини Вінницького національного медичного університету ім. М.І. Пирогова спільно з лікарями Вінницького регіонального центру серцево-судинної патології ініційовано проведення семінарів-тренінгів для лікарів лікувально-профілактичних закладів Вінницької області на тему «Гострий коронарний синдром: тактика ведення пацієнтів. Серцево-легенева реанімація». Вінницької області. В анонімному анкетуванні за оригінальним опитувальником ,що включав 10 питань щодо основ проведення СЛР, взяли участь 165 лікарів з 11 районів. Результати. Переважна більшість лікарів вірно відповіли на запитання щодо рекомендованої частоти компресій грудної клітки − 120 (72,7%), глибини компресій грудної клітки − 147 (89,1%), співвідношення частоти компресій та частоти дихання без протекції дихальних шляхів − 123 (74,5%), початкової дози адреналіну − 138 (83,6%), недоцільності введення аміодарону у випадку асистолії − 121 (73,3%). Близько половини проанкетованих лікарів вірно відповіли на запитання щодо допустимих пауз − 84 (51%), рекомендованої частоти вентиляції легень у випадку проведення СЛР інтубованого пацієнта − 86 (52,1%), початкової дози аміодарону − 79 (47,8%), періодичності оцінки ритму та пульсу під час СЛР − 73 (44,3%). Менше третини лікарів − 38 (23%) вірно відповіли на запитання щодо рекомендованої етапності введення адреналіну у випадку фібриляції шлуночків/шлуночковій тахікардії без пульсу. Результати аналізу свідчили, що частка лікарів, які невірно відповіли на 40% та більше запитань, була вищою у групах лікарів молодше 35 років i старше 60 років (р = 0,006), та у групах лікарів зі стажем роботи за спеціальністю менше 5 років, (р = 0,001). Висновки 1. Установлено, що переважна більшість лікарів медичних закладів Вінницької області володіють достатнім рівнем знань щодо основ проведення серцево-легеневої реанімації. 2. Серед лікарів, які допустили значну кількість помилок під час анкетування (4-6), найбільша частка спостерігалася у групах старшого віку, молодше 35 років та стажем роботи за спеціальністю менше 5 років. 3. Найбільші труднощі виникають у лікарів при виборі відповіді щодо медикаментозного супроводу серцево-легеневої реанімації, тактики ведення пацієнта залежно від ритму та респіраторної підтримки. Такі дані свідчать про необхідність проведення розширених циклів серцево-легеневої реанімації для медичних працівників.

The aim – to create a regional registry of patients who have suffered an acute myocardial infarction (AMI), to determine the frequency of endpoints: death, recurrent myocardial infarction, recurrent coronary angiography (CA), coronary artery bypass grafting (CABG), acute cerebrovascular accident (ACVA), bleeding, hospitalization after MI.Materials and methods. 33 centers of Vinnytsya and Vinnytsya region were involved in the study. During the period 2017–2018, 2120 patients of middle age 75.9±7.7 years were included in the register. Among them 1361 (64.2 %) men, middle age 67.5±8.4 years and 759 (35.8 %) women, middle age 76.3±8.2 years. There were 1658 patients with Q-MI and 462 (21.8 %) patients with MI without Q-wave.Results and discussion. It was found that after discharge from the hospital 419 people (13.4 %) did not visit family doctors and cardiologists. Among them were 262 (62.5 %) men and 157 (37.5 %) women. These patients did not differ significantly in gender and age structure from those who were under medical supervision. In both groups, men predominated and there were significantly more people over the age of 60. Twelve months after AMI, 37 (1.7 %) cases of CABG were documented among patients who visited doctors, 29 patients (1.4 %) were diagnosed with ACVA, and 101 patients (4.8 %) were hospitalized for recurrent AMI and 156 people (7.4 %) underwent CA. In patients with interventional AMI treatment tactics, there were significantly fewer cases of recurrent MI (p=0.022), hospitalization (p=0.025) and death (р<0,001) within 12 months. In patients with AMI, an inverse correlation was found between age and mortality, hospitalized bleeding, and CA. The connection between the fact of performing prehospital thrombolysis and hospitalization for heart failure during the year after AMI was determined. There is a negative correlation between CA and hospitalization for heart failure, bleeding that required hospitalization, re-CA and ACVA.Conclusions. Among patients treated for acute coronary syndrome, 13.4 % do not seek outpatient medical care after discharge from the hospital. Among them are significantly more men, people over 60 years old, residents of countryside. Twelve months after AMI, 1.7 % of patients undergo CABG, 1.4 % are diagnosed with ACVA, and 1.7 % have bleeding that requires hospitalization. 25.7 % of patients are re-hospitalized during the year, 9.5 % die. Among patients who undergo emergency CA and coronary artery stenting, there are more people who have CABG and who have been diagnosed with bleeding that requires hospitalization. In this group, there is a significant reduction in cases of recurrent MI, hospitalizations and deaths during the year.

The aim of the work is to optimize local pharmacotherapy in the complex treatment of generalized periodontitis on the background of urolithiasis with the use of dental film.Material and methods. of the study was to evaluate the features of the angiographic picture among patients with acute myocardial infarction (AMI), which was complicated by acute heart failure (AHF). Materials and methods. This study is a retrospective analysis of 828 hospital charts of patients treated from STEMI in the Department of Myocardial Infarction of the Vinnytsia Regional Center of Cardiovascular Pathology. Two groups of patients were analyzed: group I (n = 699) patients with AMI without signs of high-grade acute heart failure (AHF) and group II (n = 129) patients with AMI complicated by high-grade AHF (Killip III and Killip IV).Results. Urgent coronary angiography (UCA) was performed for 456 (55.1%) patients, urgent revascularization was performed for 435 (52.5%) patients, for part of them - 403 (48.7%) patients were performed coronary artery stenting (CAS), for 18 (2, 2%) of them were performed thrombus aspiration, 2 (0.2%) of them were done angioplasty of the spacecraft without stent implantation. For 24 (2.9%) patients was carried out thrombolysis At the prehospital stage and 12 (1.4%) of them required further stenting of the spacecrafts in the coronary arteries. 21 (2.6%) patients did not require revascularization, according to the results of coronary angiography. In the general group of examined patients overwhelmed cases with a single vascular impression of CA 241 (52.8%) (p = 0.003). It was found that patients from group I had a single vascular 218 (57.2%) and double vascular - 105 (27.6%) damage of CA (p = 0.058) significantly more common, and 58 (15.2%) of investigated patients had multivascular damage of CA - which was less often among patients from group I. In the second group there was an even distribution of patients with single vascular 23 (30.7%), double vascular (28 (37.3%) and multivascular 24 (32.0%) damage of CA.