A 9-year-old African-American girl presented with sudden cardiac arrest a few hours after adenotonsillectomy. She received anaesthesia which included propofol during the procedure. Her electrocardiogram (EKG) showed type 1 Brugada pattern, and genetic testing revealed a variant of unknown significance in desmoplakin (DSP) gene. We discuss the association between propofol, Brugada EKG pattern, and malignant ventricular arrhythmias.

In patients with myocardial infarction with stable ST-segment elevation, the gold standard is to perform emergency angiography and stenting of the infarct-dependent artery. Meanwhile, the existing recommendations do not contain spe-cific treatment and diagnostic tactics for multivascular coronary pathology. The aim. To analyze the influence of different tactical approaches to the correction of multivascular atherosclerotic lesions of the coronary arteries on the processes of myocardial remodeling. Materials and methods. The study included 102 patients with multivascular coronary artery disease, who were randomly divided into 4 observation groups. The 1st group included 25 (24.5%) patients who had coronary angiography with occlusion of the infarct-dependent vessel and urgent stenting. Later, on day 2-3, the presence of hemodynamically significant stenosis of infarct-independent arteries was proved by determining fractional flow reserve and coherent to-mography with assessment of stability, size, length of atheroma and delayed stenting of these vessels. The 2nd group of observations included 26 (25.5%) patients who underwent stenting of the infarct-dependent artery, and on day 2-3 after the study of fractional flow reserve, but without optical coherence tomography, stenting of the infarct-independent vessel. The 3rd group included 25 (24.5%) patients who underwent simultaneous stenting of infarct-dependent and infarct-independent vessels after coronary angiography without additional angiographic studies (fractional flow reserve and coherent tomography). The 4th group included 26 (25.5%) patients who underwent only standard stenting of the infarct-dependent vessel and who were discharged from the department without further study of the circulation in the infarct-independent arteries and without interventions on them. All the patients received standard two-component an-tiplatelet therapy (acetylsalicylic acid 75-150 mg/day and clopidogrel 75 mg/day) and received atorvastatin 20 mg and ezetimibe 10 mg. The results obtained in patients were compared with similar results in 30 practically healthy people of the same age and sex. Markers of left ventricular myocardial remodeling activity were investigated by determining blood levels of matrix metalloproteinase-1 (MMP-1) and its tissue inhibitor 1 (TIMP-1). Results. Interventions without additional angiographic studies with complete revascularization of infarct-indepen-dent vessels (group 4) contributed to the long-term maintenance of the highest activity of MMP-1 against the background of virtually no activity of TIMP-1. Simultaneous stenting of the infarct-dependent and infarct-independent arteries only by the results of coronary angiography (group 3) contributes only to a slow decrease in the activity of metalloproteinase against the background of a slight increase in the activity of its inhibitor. Stenting of the infarct-dependent artery after coronary angiography with the study of only the fractional flow reserve without coherent tomography contributed to more active inhibition of metalloproteinase activity against the background of increase in concentrations of its inhibitor. The most active in relation to laboratory markers of myocardial remodeling was the tactic using angiographic examina-tion, determination of fractional flow reserve and coherent tomography, followed by a complete set of delayed revascu-larization. The use of delayed treatment of infarct-independent arteries using additional diagnostic techniques (study of fractional flow reserve and coherent tomography) can affect the activity of metalloproteinase 1 and its tissue inhibitor which are markers of activity of postinfarction remodeling.

Objective. Analysis of changes in viscosity and disorders of the thrombocytes-aggregation process under impact of various tactical, diagnostic and intervention approaches in patients, suffering myocardial infarction with persistent elevation of ST segment in presence of multivascular affection of coronary arteries. Materials and methods. In the investigation four tactical and treatment-diagnostic approaches were used through year of observation. Results. In patients, suffering myocardial infarction and persistent elevation of ST segment the hyperviscosity and hypercoagulation syndromes were revealed, which have manifested in first weeks by compensatory growth of thrombocytes quantity, the blood viscosity, level of fibrinogen and aggregation properties of thrombocytes. Conduction of additional more profound examination of coronary blood circulation and further application of postponed stenting of the infarction-dependent arteries have promoted lesser amplitude of fluctuations of all laboratory indices, than in other tactical and treatment approaches. Conclusion. Standard tactical and treatment-diagnostic principles in management of such category of patients do not permit to improve the state of the viscosity and coagulation-aggregation parameters principally, even while application of double antiaggregation therapy.

The purpose and the objectives of the research were the study of the course nature of postimplantational atrial fibrillation (AF) in patients of older age categories and the identification of individual links of its pathogenetic structures. We examined 387 patients aged 65-80 years with an implanted cardiac pacemaker. The object of the study included 46 (12 %) individuals (30 males and 16 females) with nonischemic postimplantational atrial fibrillation, with no signs of stenosing atherosclerosis of coronary arteries among all the patients. Postimplantational AF in the elderly is characterized by the symptoms of dizziness, nonischemic pain in the precardiac area, shortness of breath, fatigue on physical exertion, predominantly supraventricular premature contraction, diffuse changes, myocardium hypertrophy and dilatation of the cavities of the left heart, diastolic dysfunction of the left ventricle, different classes of ventricular arrhythmias, pulmonary hypertension, the presence of degenerative changes of the heart valves. In patients of older age groups with postimplantational AF a complex multifactorial set of pathological disorders is formed which is manifested by the changes in the rheological properties of blood (hyperviscosity, hyperaggegation of formed elements), the state of protein and lipid metabolism and myocardial remodeling, the presence of systemic inflammation and endothelial dysfunction of the vessels.

Annotation. Markers of vascular damage constitute highly informative substances in coronary heart disease, which allows not only assessing the state of endothelial function of the arteries, but also to predict the further course of cardiovascular pathology. The purpose of the study was to analyse changes in laboratory markers of vascular lesions under the influence of different tactical, diagnostic, and interventional approaches in patients with myocardial infarction with stable elevation of the ST segment in the presence of multivascular lesions. The study included patients who were randomly divided into 4 observation groups depending on the diagnostic and treatment tactics. The obtained results were compared with similar ones in healthy people. Studies of markers of vascular endothelial function were performed on the 1st day of infarction, on day 3-4, and a year later. Statistical data processing was performed using a package of licensed software for statistical analysis “Statistica 6.0”. An odd Student’s t test (t) was used to compare quantitative parameters between independent samples, and a χ2 criterion was used for qualitative samples at a significance level of p<0.05. It turned out that patients develop a complex dysfunction of the vascular endothelium towards a substantial predominance of the concentration of thrombogenic and vasospastic substances (endothelin-1 and thromboxane A2). In the period from 3 to 4 weeks after the infarction, a partial decrease in vasospastic and thrombogenic substances was observed against the background of an increase in nitric oxide. Meanwhile, in different groups with various diagnostic and therapeutic approaches, such changes had different intensity and dynamics. The degree of balance of endothelial dysfunction depends on the time since the development of myocardial infarction and the type of diagnostic and treatment tactics. The most significant suppression of vascular function occurred with the use of regular methods (group 4), and the maximum recovery – with the use of delayed stenting after an additional study of coronary vessels. But even with the most optimal approaches, endothelial dysfunction could not be completely corrected. It is possible that for better results it is advisable to monitor the results of treatment over a longer period of time, when on the one hand the scar tissue has finally formed, and on the other hand, the pharmacological effects of antiplatelet agents and statins will be fully involved.