THE POSSIBILITIES OF TREATMENT OF HEART RHYTHM DISOR-DERS IN THE CLINIC OF CARDIO SURGERY OF THE AMUR STATE MEDICAL ACADEMY (To the 60th anniversary of the invention of the irst portable pacemaker)Yu.V. Vakhnenko, E.S. Tarasyuk, A.V. Naidenov, I.E. Dorovskikh, A.N. Verevetinov, V.A. Shaburov, V.N. Nikitin, G.F. Kondratov, I.G. Beloglazova Amur State Medical Academy, Blagoveshchensk Abstract A brief historical review devoted to the 60th anniversary of the invention of the irst portable pacemaker is presented. The experience of the cardiosurgical clinic of the Amur State Medical Academy is outlined in terms of interventional treatment of coronary heart disease, congenital malformations and rhythm disturbances. Problems and prospects are discussed.

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The classifications of the World Health Organization, the European Society of Car­-diology and the American Heart Association indicate the existence of several pheno­types of myocardial non-compaction (MnC) with specific structural and func­tional abnormalities. The MnC+dilated cardiomyopathy (DCM) phenotype is considered one of the most severe variants. Disputes continue about whether to regard MnC as an independent disease or as a consequence of DCM and heart failure. In other words, MnC remains one of the most mysterious heart diseases. As an illustration of MnC+DCM phenotype, the authors offer a case of a patient with cardiovascular disease from her youth, but maintained a satisfactory state of health and performance until her old age. Symptoms of arrhythmia and heart failure with massive pericardial effusion were first described in her at the age of 66, which is uncharacteristic for this MnC phenotype. Attention is drawn to the difficulties of differential diagnosis of MnC due to the non-specificity of clinical performance, the role of echocardiography in the recognition of the disease and predictors of its unfavorable outcome. The fact that the patient, even when typical signs of MnC were detected during echocardiography, initially had coronary artery disease as the main diagnosis, indicates the relevance of publishing another case report on this rare pathology in order to improve the awareness of cardiologists and general practitioners.

Electrocardiography occupies a special place among a significant list of other methods for diagnosing the pathology of the cardiovascular system of athletes. Often its results differ significantly from those in the general population, being a consequence of the adaptation of the heart to economical functioning at rest and super-intensive work in training and competitions. This review focuses on the features of the “athlete’s electrocardiogram (ECG)”. in particular, those changes that are not a reason for removing athletes from physical activity, but in combination with known factors can lead to more serious changes up to sudden cardiac death. Fatal rhythm disorders in athletes are described, possible in Wolff-Parkinson-White syndrome, syndrome of ion channel pathology, arrhythmogenic dysplasia of the right ventricle, etc. Particular attention is paid to arrhythmia due to connective tissue dysplasia syndrome. Knowledge of these issues is necessary to choose the right tactics for an athlete with changes to the electrocardiogram and in the protocol of daily Holter monitoring of the electrocardiogram, and a doctor related to sports medicine should be aware of the features of “electrophysiological remodeling” of the athlete’s heart, normal and pathological “sports electrocardiogram”, about conditions accompanied with the development of serious rhythm disorders and algorithms for examining the cardiovascular system of the athlete.

Introduction. Myocardial damage characteristic of novel coronavirus infection is a confirmed risk factor for its severe course and high mortality. There are biomarkers of this condition correlating with an unfavorable prognosis for the patient. However, the information on the problem of myocardial damage in the available literature is not fully systematic. It concerns pathogenesis, differential diagnosis of its causes, routing of patients with acute coronary syndrome. All the above is very important for choosing the right tactics of examination and treatment of patients, who are often limited in time. Aim. To summarize the data available at the time of writing from domestic and foreign researchers on the problem of myocardial damage and its main causes (acute coronary syndrome, myocarditis, stress cardiomyopathy) in COVID-19. Materials and methods. This review summarizes the data from articles published over the past two years found in PubMed, Google Scholar and eLIBRARY. Results. The authors tried to form a generalized modern understanding of the causes and structure of cardiovascular pathology and risk factors of its destabilization in patients infected with SARS-CoV-2, the markers of increased risk of COVID-infected heart and vascular diseases, the tactics of examination and treatment of this category of patients, routing individuals with acute coronary syndrome and its differential diagnosis with non-coronary heart diseases. The questions of organization and availability of the medical care in the conditions of the pandemic and social aspects of the world cardiology problems in the current situation have been studied. Conclusion. Patients with cardiovascular disease have a more severe prognosis of the severity and outcome of COVID-19, which is explained by its pathogenesis. The group at highest risk of lethal events is composed of individuals with signs of myocardial damage, the causes of which are the above mentioned conditions. Their differential diagnosis is a difficult clinical task, which requires a systematic analysis of the dynamics of clinical syndromes and data of additional diagnostic methods from routine to the most modern (high-tech) and, of course, deep knowledge of the present problem. The correct determination of the cause of myocardial damage and the choice of the right patient’s route through the treatment network determines the effectiveness of treatment and, therefore, the prognosis of the patient’s life.