The aim of this article is to represent the characterization of the clinical case of chemotherapy-related atrial fibrillation (AF) development in the young woman, elaborated as a result of multiple neoadjuvant and adjuvant modes of the intake of chemotherapy (both anthracycline based and non-anthracycline ones). In this case, the noted disturbances of heart rhythm should be recognized as a manifestation of cardiotoxicity. The latter implies the degree of detrimental effect of chemotherapeutical medication on the morphophynctional parameters of the cardiovascular system. Anthracycline drugs, being highly effective chemotherapytical agents, provide well-known toxic effects on the heart and vessels. Anthracycline mediated cardiotoxicity is a well- known veracity that dates back to the 60s of the last century, but up to now this medication sustains irreplaceable components of big volume of chemotherapy modes. Moreover, it should be noted that relatively newer drugs also posses certain cardiotoxicogenic potential.

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Цель. Изучить динамику уровня натрийуретического пептида и оксида азота, а также связь этих изменений со структурным состоянием миокарда у женщин, страдающих раком молочной железы (РМЖ). Оценить эффективность кардиотропной терапии (КТТ) – комбинации валсартана и карведилола, в предотвращении выявленных изменений.Материалы и методы. В исследование включено 100 женщин, страдающих раком молочной железы, получивших хирургическое лечение, полихимиотерапию с антрациклинами, лучевую терапию.Пациентки были разделены на 3 группы: РМЖ – получившие только противоопухолевую терапию (55 человек), РМЖ + КТТ – пациентки вместе с лечением рака получали комбинацию валсартана и карведилола и не страдали артериальной гипертензией (АГ) (25 человек), РМЖ + АГ + КТТ – женщины, страдающие АГ, с противоопухолевой терапией получали комбинацию валсартана и карведилола (20 человек).Результаты. В результате исследования в группе без назначения профилактических сердечно-сосудистых лекарственных средств выявлено ухудшение систолической и диастолической функции миокарда левого желудочка, прямая корреляционная связь между уровнем натрийуретического пептида и оксида азота после окончания лечения рака молочной железы (r=0,51, р<0,05). Назначение комбинации валсартана и карведилола в качестве терапии сопровождения противоопухолевого лечения обеспечивало сохранение нормальных значенийфракции выброса левого желудочка, отсутствие нарушений процессов релаксации миокарда, приводило к снижению уровня натрийуретического пептида и оксида азота.Заключение. Комбинация валсартана и карведилола может быть использована с целью профилактики кардиотоксичности противоопухолевой терапии. Purpose. To study the dynamics of changes in the level of natriuretic peptide and nitric oxide, as well as the relationship of these changes with the structural state of the heart in women with breast cancer (ВС). To evaluate the effectiveness of the cardiotropic therapy (CT) – the combination of valsartan and carvedilol – in prevention of the identified changes.Materials and methods. 100 women with breast cancer were included in the study. The patients received surgery, anthracycline chemotherapy, and radiation therapy.The patients were randomized into 3 groups: group BC – with antitumor treatment alone (55 cases); group BC+CT – patients with antitumor treatment, who received carvedilol combined with valsartan and had no arterial hypertension (AH) (25 cases); group BC+AH+CT – patients with antitumor treatment, who received carvedilol combined with valsartan and had hypertension (20 cases).Results. The study revealed a deterioration in the systolic and diastolic function of the left ventricular myocardium, a direct correlation between the level of natriuretic peptide and nitric oxide after the end of cancer treatment in the group without prescribing preventive cardiovascular drugs. The use of the combination of valsartan and carvedilol as a therapy to accompany the antitumor treatment of breast cancer prevents the decrease of the left ventricular ejection fraction, a disorder of the relaxation processes of the myocardium, and reduces the level of natriuretic peptide and nitric oxide. Conclusion. The combination of valsartan and carvedilol may be effective to reduce the cardiotoxicity of antitumor therapy.

The aim of the study was to investigate the features of clinically suspected myocarditis complicated by the left ventricular systolic dysfunction development. 93 patients with clinically suspected myocarditis were examined. The average age was 36.63 ± 1.15 years. In 43.01 % of patients the disease was accompanied by a decrease in left ventricular systolic function. In the group of patients with left ventricular systolic dysfunction in comparison with those with preserved left ventricular ejection fraction, a significantly lower proportion of men (75 % versus 81 %, respectively, χ2 = 9.3, p < 0,01) and a higher average group age (40.7 ± 1.87 versus 33.6 ± 1.3 years, respectively, p <  0,01) were revealed. The course of the disease in patients with left ventricular systolic dysfunction was characterized by a more frequent development of rhythm disturbances (65 % versus 43.3 %, respectively, χ2  = 4.3, p  < 0,05) and a higher heart rate at admission (94.5 (75‒100) and 85 (70‒89) beats per minute, respectively, p = 0.006). The structural and functional state of the heart according to echocardiography in patients with a reduced left ventricular ejection fraction versus comparison group was characterized by larger heart chambers sizes, more pronounced violations of local left ventricular contractility, more frequent involvement of the right ventricle in the pathological process (56.3  % versus 22.2  %, respectively, χ2   =  6.4, p  < 0,05). The relationships between the left ventricular ejection fraction Весці Нацыянальнай акадэміі навук Беларусі. Серыя медыцынскіх навук. 2020. Т. 17, № 4. C. 452–460 453 and the patient’s age (r = ‒0.36), the value of the heart rate at admission (r = ‒0.32), the severity of heart failure at admission, the degree of impaired local contractility of the left ventricle, the degree of right ventricular function (TAPSE, r  =  0.58), the severity of myocardial fibrosis according to cardiovascular magnetic resonance imaging (r = ‒0.32) were revealed.