В работе обоснована возможность и целесообразность использования информационных систем в диагностике-дигитализация ЭКГ и внедрение «Смарт-ЭКГ» с оценкой эффективности ранолазина, оптимизация лечения синдрома с элевацией сегмента ST. Цель работы-внедрить дигитализацию ЭКГ и програму «Смарт-ЭКГ» с оценкой эффективности ранолазина в условиях оптимизации лечения синдрома с элевацией сегмента ST. Материал и методы. Обследовано 40 больных с острым Q-ИM (STEMI), повступивших в областной клинический кардиологический центр г. Черновцы, которым была назначена базисная терапия согласно современных рекомендаций, содержащая интервенционное вмешательство с восстановлением проходимости инфаркт-зависимой коронарной артерии, двойную антитромбоцитарную терапию, статины, β-адреноблокаторы, ингибиторы ангиотензинпревращающего фермента, антагонисты альдостерона и т.п. с добавлением ранолазина (группа І, 30 пациентов со STEMI). Контроль-группа ІІ, 10 пациентов со STEMI, которые

Purpose - comprehensive analysis of the world approach of the use of ranolazine in various clinical trials and the introduction of the program "Smart ECG" to assess the effectiveness of ranolazine.Matherial and methods. Evaluation of European guidelines, analysis of global randomized clinical trials of the ranolazine use, presentation of our own trial: we examined 40 patients with Q wave myocardial infarction (STEMI), were instituted basic therapy according to the modern recommendations which contained interventional treatment with restoration of patency of a heart attack-conditioned coronary artery, double antiplatelet therapy, statins, β-adrenergic blocker, angiotensin-converting enzyme inhibitors, aldosterone antagonists with addition of ranolazine (group I, 30 patients diagnosed STEMI), control - group II, 10 patients with STEMI, who received basic therapy without addition of ranolazine. Results. Analysis of clinical trials (CARISA, MARISA, ERICA, TERISA, MERLIN-TIMI, RIVER-PCI, RIMINI-TRIAL) proved the effectiveness of ranolazine as an antianginal and anti-ischemic drugs. The use of own program «Smart ECG» demonstrates the positive effect of ranolazine on STEMI and requires further implementation.Conclusion. In the European Society of Cardiology guidelines of the management of stable angina pectoris, ranolazine is given a class IIa (level of evidence B) recommendation as a second-line treatment to reduce angina frequency and improve exercise tolerance in subjects who cannot tolerate, have contraindications to, or whose symptoms are not adequately controlled by β- adrenergic blockers, calcium channel blockers and long-acting nitrates. In subjects with baseline low heart rate and low blood pressure, ranolazine may be considered as a first-line drug to reduce angina frequency and improve exercise tolerance - class IIa (level of evidence C) recommendation. Own study, which partially reflects the global approach according to the analyzed clinical studies, demonstrates the positive effect of ranolazine for patients with STEMI - analogue scale EQ–VAS indicates a positive effect, positive influence on the markers of electrical myocardial instability: decreasing of the probability of cases of SDNN decrease, depression of QT and maybe increase of ratio of maximum velocity for differentiated T wave.

Background. Coronary artery vasospasm (CVS) is an important mechanism of myocardial ischemia which can produce any of the manifestations of coronary artery disease from silent myocardial ischemia to acute coronary syndrome including myocardial infarction or sudden cardiac death. One of the main markers of CVS is retrosternal pain not associated with increased myocardial oxygen requirement such as that due to exercise or emotional excitement with frequent attacks in the morning and temporary ST segment elevation. Some patients have variant angina caused by the spasm of coronary arteries (СА) coupled with stable angina provoked by emotional and physical stress. Such patients have decreased exercise tolerance. Aim. To determine the feasibility and subsequence of the appointment of diagnostic procedures such as electrocardiography (ECG), bicycle ergometry (BEM), provocative tests and coronary angiography and left ventriculography (CAG & LVG) in order to visualize СА, to make the choice of patient’s management and to assign an adequate therapeutic program. Materials and methods. The patient who was admitted with complaints about progression of angina and shortness of breath received the full complex of diagnostic manipulations. The purpose was to verify the diagnosis and to prescribe an adequate treatment. Results. This clinical case shows the subsequence of the appointment of diagnostic procedures to the patient who has normal ECG, ST segment elevation on BEM and progression of angina attacks, that is, the necessity of the widespread introduction of coronary angiography. Conclusion. This article shows the necessity of appointment of CAG & LVG. CAG & LVG revealed atherosclerotic lesion of CA which caused chest paint, ST segment elevation, and this result confounded the presence of CVS as a cause of complaints in this patient. The patient underwent stenting of the affected CA which helped to eliminate the cause of pain and is compatible with adequate therapeutic tactics for patients with CA stenosis.

The aim – to determine the peculiarities of duration and treatment of a patient with myocardial infarction, complicated by pulmonary artery thrombosis and oncopathology, to show the complexity of management of such a group of patients.Matherial and methods. A clinical examination of the patient with myocardial infarction, complicated by pulmonary artery thrombosis and oncopathology was conducted.Results. Oncopatients are diagnosed acute coronary syndrome with elevation of ST segment more frequently compared to other patients. Oncothrombosis risk is connected with hypercoagulation and thrombocytopenia, cardiotoxicity of antitumor treatment, prolonged immobilization and procoagulant activity of malignant neoplasms.Сonclusion. Acute coronary syndrome and pulmonary artery thrombosis demand comprehensive approach to treatment, this group of patients has an increased risk of cardiovascular death, multidisciplinary approach and comprehensive analysis of such patients promotes early detection of pathology and timely treatment and prevention. Effective treatment for oncopatients with venous thrombosis are direct oral anticoagulants that reduce the risk of recurrent thrombosis, but should be used with caution in patients who have increased risk of major bleeding, the only recommended ones are rivaroxaban and edoxaban, also low-molecular-weight heparins, which can be prescribed to patients with risk of bleeding, cancer and inflammatory diseases of the gastrointestinal tract.

Вищий державний навчальний заклад України "Буковинський державний медичний університет", м.Чернівці Обласний клінічний кардіологічний центр, м.Чернівці 1 Обласний клінічний онкологічний центр, м.Чернівці 2