The main purpose of the following article is to highlight one of the most pressing and poorly studied issues both for cardiology and endocrinology – treatment and prognosis for patients with severe coronary pathology and subclinical hypothyroidism (SH). Pathophysiological mechanisms of type 2 myocardial infarction (MI) development with SH as a background and hormone replacement therapy issues are considered. SH is a modifiable risk factor (RF) for cardiovascular diseases (CVD) and mortality that does not depend on traditional cardiovascular RF. SH is associated with high risk of developing coronary artery disease, MI, heart failure, and CVD mortality. SH incidence of morbidity increases with age, usually the course is oligo- or asymptomatic. SH leads to a number of pathological conditions that cause an imbalance between the myocardial oxygen demand and delivery with a possible development of type 2 MI. Clinical case of type 2 MI development in a patient with severe coronary atherosclerosis and SH is presented. The key point of type 2 MI development mechanism is insufficient oxygen (O2) supply to cardiomyocytes due to multivessel coronary artery atherosclerotic stenosis and sharp increase in O2 demand as a result of cardiomyocyte hypertrophy. Older patients with severe cardiac pathology and SH should refrain from treatment with levothyroxine or start treatment after myocardial revascularization, selecting the dose of the drug individually.

Introduction. According to the literature data, the method of liquid ventilation for the prevention of decompression sickness (DCS) was proposed only with the condition of its initiation before compression, that excluded the physical basis of the disease - an excess of metabolically indifferent gas in the tissues. However, as the analysis shows, in most cases, the evacuation of the crew of an emergency submarine is aggravated by being in gases’ increased pressure environment. So the casualty tissues become obviously saturated with indifferent gas. Experimental confirmation of the possibility of rapid tissues’ desaturation of nitrogen during respiration by denitrogenizated and oxygenated in a normal conditions respiratory fluid (hereinafter - the method of liquid respiratory desaturation) was obtained on the biological model of DCS of Syrian hamsters. The study aim is an experimental substantiation of the possibility to use liquid respiratory desaturation as a method of preventing the development of decompression disorders. Materials and methods. Scientists have performed a study on 24 mature male Syrian hamsters weighing 165-185g, aged four months, using an experimental laboratory hyperbaric stand for temporary maintenance of small laboratory animals under high pressure of a gas or liquid medium with the possibility of switching from one medium to another in isobaric conditions.The research methodology is based on the assessment of the clinical presentation of decompression disorders and the results of ultrasound examination of gas formations in the heart, large veins and liver after the fast non-stop decompression, in the background of preliminary saturation of the animal's body with indifferent gas (nitrogen) by staying in the air under the pressure 0.6 MPa (60 MWC) for six hours. The effect on experimental groups animals deferens from the control group by the period of immersion and spontaneous breathing in the respiratory fluid (20, 30 and 40 minutes) before decompression. Results. The authors analyzed the clinical picture of acute decompression disorders. The degree of gas formation in small laboratory animals was assessed by researchers using ultrasound using a semi-quantitative method. Spontaneous breathing with the prepared liquid, lasting 30 minutes or more, made it possible to remove excess nitrogen from the body of animals of experimental groups, providing etiopathogenetic prevention of DCS before decompression. The article presents the data of morphological studies. Conclusion. Liquid respiratory desaturation is a method of preventing decompression disorders based on the removal of metabolically indifferent gases from the body during liquid respiration, in the presence of a stress gradient from tissues into the respiratory fluid. The method allows the metabolically indifferent gases' rapid desaturation from the body by liquid ventilation before/or during decompression, thereby creating conditions of ultra-fast decompression modes without the risk of decompression disorders.

Introduction. The problem of crew emergency evacuation after prolonged hyperbaric conditions is complicated by the extended decompression necessity. It is impossible to reach normal pressure conditions without risk of decompression sickness in the most cases due to large amount of dissolved indifferent gases in the tissues. Method for indifferent gases eliminating out of tissues to breathing liquid while liquid breathing is proposed. The absence of dissolved gases in the breathing liquid creates the pressure gradient that allows indifferent gases to diffuse through the alveolar-capillary barrier from the blood into the breathing liquid. The purpose of the study is to assess the possibility of liquid breathing application to prevent the development of decompression disorders after a long previous stay in conditions of excessive pressure of the gas environment. Materials and methods. Syrian hamsters, 4 months old, 120–140 g weight were used in the study. A mixture of perfluorodecalin and perfluorohexane 40:60 ratio was used as a breathing liquid. The animals were divided into four groups: control (№ 1) and three experimental by liquid breathing duration (№ 2, № 3 and № 4 was 15, 30 and 60 minutes, respectively). For isobaric transition from gas to liquid breathing the special test bed was designed. The decompression sickness simulation in laboratory animals was carried out by ultrafast decompression (within 15 seconds) after a 60-minute exposure of 0.6 MPa air gauge pressure. The research method is based on the assessment of decompression disorders clinical picture and pathomorphological studies. The duration of the decompression sickness latent period, severity, animals’ lethality, the average animals’ lethal time, rectal temperature, results of pathomorphological examinations were evaluated. Results. Decompression sickness symptoms such as twitches, convulsions and paresis were observed in the № 1 group animals. Rather less explicit symptoms of decompression sickness were found in the group № 2 in comparison of group № 1. It was assessed by clinical pictures and pathomorphological examinations. Decompression sickness symptoms were not found in none of animals of the groups № 3 and № 4. Conclusions. The technology of liquid breathing with oxygenated and denitrogenated normobaric breathing liquid while hyperbaric conditions is possible to be applied for decompression sickness prevention. The dissolved in tissues nitrogen removal degree depends on the liquid breathing duration.

A case of acute focal myocardial injury in a polymorbid female patient with intact coronary arteries according to direct coronary angiography is reported. Acute focal myocardial injury was detected by ECG-synchronized  perfusion single-photon emission computed tomogra-phy (SPECT) of the  myocardium, and confirmed by the results of postmortem examination. The article also discusses the possibility of using perfusion SPECT to diagnose acute focal changes against the background of focal inflammatory myocardial infiltration.