[The National Consensus statement on the management of adult patients with non-alcoholic fatty liver disease and main comorbidities].

The National Consensus was prepared with the participation of the National Medical Association for the Study of the Multimorbidity, Russian Scientific Liver Society, Russian Association of Endocrinologists, Russian Association of Gerontologists and Geriatricians, National Society for Preventive Cardiology, Professional Foundation for the Promotion of Medicine Fund PROFMEDFORUM. The aim of the multidisciplinary consensus is a detailed analysis of the course of non-alcoholic fatty liver disease (NAFLD) and the main associated conditions. The definition of NAFLD is given, its prevalence is described, methods for diagnosing its components such as steatosis, inflammation and fibrosis are described. The association of NAFLD with a number of cardio-metabolic diseases (arterial hypertension, atherosclerosis, thrombotic complications, type 2 diabetes mellitus, obesity, dyslipidemia, etc.), chronic kidney disease and the risk of developing hepatocellular cancer were analyzed. The review of non-drug methods of treatment of NAFLD and modern opportunities of pharmacotherapy are presented. The possibilities of new molecules in the treatment of NAFLD are considered: agonists of nuclear receptors, antagonists of pro-inflammatory molecules, etc. The positive properties and disadvantages of currently used drugs (vitamin E, thiazolidinediones, etc.) are described. Special attention is paid to the multi-target ursodeoxycholic acid molecule in the complex treatment of NAFLD as a multifactorial disease. Its anti-inflammatory, anti-oxidant and cytoprotective properties, the ability to reduce steatosis an independent risk factor for the development of cardiovascular pathology, reduce inflammation and hepatic fibrosis through the modulation of autophagy are considered. The ability of ursodeoxycholic acid to influence glucose and lipid homeostasis and to have an anticarcinogenic effect has been demonstrated. The Consensus statement has advanced provisions for practitioners to optimize the diagnosis and treatment of NAFLD and related common pathogenetic links of cardio-metabolic diseases.

[Association of parameters of heart rate variability with severity of bronchial obstruction and presence of pulmonary hypertension in patients with chronic obstructive pulmonary disease].

With the aim of assessing parameters of heart rate variability (HRV) and heart rhythm turbulence (HRT) in patients with chronic obstructive pulmonary disease (COPD) in dependence on severity of the course of this disease and presence of pulmonary hypertension (PH) we examined 73 patients (28 with COPD and 45 healthy subjects). Invasive measurement of central hemodynamics was conducted. Compared with the control group in patients with COPD we revealed lowering of temporal as well as frequency HRV parameters. No significant changes of HRV parameters depended on severity of COPD course. However a tendency to maximal lowering of HRV parameters was noted in the group of patients with COPD with first sec forced expiratory volume <50%. Comparison of patients with and without PH with controls revealed tendency to maximal lowering of HRV parameters in the PH group. Thus measurement of HRV can be used for supplementary assessment of severity of the disease and detection of PH.

[Allorhythmias (classification and differential diagnosis)]. / Alloritmii (klassifikatsiia i differentsial'naia diagnostika).

Allorhythmia in the broad sense is defined as a regular sequence of similar groups of ECG-complexes associated with various disorders of cardiac rhythm and conduction. The following classification of allorhythmias is suggested. A. True allorhythmias. I. Due to extrasystoles: 1) noncomplicated; 2) complicated by disorders of conduction. II. Allorrhythmias due to ectopic rhythms with capture beats: 1) paroxysmal or nonparoxysmal ectopic tachycardia; 2) escaping rhythms. III. Allorrhythmias due to impulse conduction block: 1) II degree S--A block; 2) II degree A--V-block; 2, atrial flutter and atrial tachycardia with A--V-block 3 : 2, 4 : 2, etc. B. Pseudoallorrhythmias due to regular alterations in the shape of the QRS complex: 1) transient bundle-branch block; 2) transient WPW syndrome; 3) bidirectional tachycardia. Differential diagnosis of various types of allorrhythmia is of great importance in choosing the measures and methods for antiarrhythmic therapy.

["Digitalis" arrhythmias and their treatment]. / "Digitalisnye" aritmii i ikh lechenie

The observation was conducted in 92 patients with rhythm and conductivity disorders induced by cardiac glycosides. Most of the patients had ischaemic heart disease, 60 of them having had acute myocardial infarction. All patients were prescribed cardiac glycosides (usually Strophantin and digitalis preparations) due to the appearance of cardiac insufficiency. The most frequently observed rhythm disorder consisted in ventricular extrasystole (69.5% of the cases), bigeminy, polytopic or group extrasystole being observed in many cases. Often arrhythmias consisted in atrial extrasystole, atrial fibrillation, atrial and ventricular tachycardia, atrioventricular block. "Digitalis" arrhythmias were treated with beta-adrenergic blockers: Inderal, Viskene, Eraldin, Trasicor and Aptin. These drugs proved effective in most cases with atrial arrhythmias and in some--with ventricular arrhythmias. Lidocain was more effective in cases of ventricular arrhythmias. Effective drugs of a broad spectrum are also Aimalin, Pulsenorma and Ritmodan.

[Comparative evaluation of new drugs used in the treatment of cardiac arrhythmia].

The paper summarizes the experience gained in treating 830 patients with various cardiac rhythm disorders by employing new antirhythmic agents (propranolol, practolol, pindolol, alprenolol, oxyprenolol, benzoral, verapamil, lidocaine, imaline, sparteine, pulsonorma, disopyramide and quinidine durules). Comparative data on the efficacy of these agents are presented and indications and counterindications for their use are discussed.

[Ventricular fibrillation and asystole precursors in myocardial infarct]. / Predshestvenniki fibrilliatsii i asistolii zheludochkov u bol'nykh infarktom miokarda

Ventricular fibrillation and asystole are a frequent cause of death in myocardial infarction. The data of continuous monitoring the heart in 134 patients with acute myocardial infarction and ventricular fibrillation and asystole. The immediate precursors of ventricular fibrillation were predominantly ventricular extrasystoles. A frequent precursor of ventricular fibrillation consists in paroxysmal ventricular tachycardia. In some patients the ventricular fibrillation was preceded by the block of the bundle of His, non-paroxysmal ventricular tathycardia, escaping contractions and some other arrhythmias. A factor providing for the development of ventricular fibrillation consists in the Q-T interval lengthening on ECG. Ventricular asystole is usually preceeded by atrioventricular block, Stage II-III, and the block of the bundle of His, as well as by ventricular tachycardia and extrasystole, in some cases--by sinus bradycardia and sinoauricular block (weakness of the sinus node). The examination of the rhythm and conductivity disorders preceeding the ventricular fibrillation is of great importance in view of the possibilities of prevention of "arrhythmic death".

[Parasystolic arrhythmias]. / Parasistolicheskie aritmii.

The observation was conducted in 24 patients with parasystolic arrhythmias, 13 of them having parasystolic extrasystoles, and 11--paroxysmal and non-paroxysmal parasystolic tachycardia. Ventricular parasystole was found in 21 patients, atrial--in 3, atrioventricular--in 2; three patients had double parasystole with two ectopic centers. In the majority of patients their parasystole took a persistent, but relatively benign course, however one patient with ventricular parasystolic tachycardia persisting for many years had repeated ventricular fibrillations. For the treatment of supraventricular parasystolic arrhythmias beta-adrenergic receptors blocking agents, Isoptine, cardiac glycosides were used; in ventricular parasystole the more effective drugs are Lidocain, Novocainamid, Ajmalin.

[Syndrome of sino-atrial node asthenia]. / Sindrom slabosti sinusovogo uzla

Under observation were kept 80 patients with signs pointing to the sick sinus syndrome. Most of them suffered from ischemic heart disease, from atherosclerotic cardiosclerosis and acute myocardial infarction. Persistent sinus bradycardia with active and passive heterotopic arrhythmias were recorded in 42 patients. Sino-auricular block of the II and III degrees or asystolia of the atria with ectopic arrhythmias were observed in 37 cases. A number of patients displayed fibrillary bradyarrhythmia, extrasystole with post-extrasystolic depression of the rhythm and other disturbances. The so-called tachycardia-bradycardia syndrome characterized by the presence of tachycardiac arrhythmias occurring against the background of a marked bradycardia was registered in 25 persons. Fifteen patients demonstrated attackes of the Morgagni-Adams-Stokes syndrome, usually associated with lengthy periods of cardiac asystole. The treatment of ectopic arrhythmias in patients with the sick sinus syndrome presents considerable difficulties, but in many of them these disorders could be successfully eliminated by a careful and rigidly controlled application of antiarrhythmic agents (isoptin, ajmalin, pulsnorma, rhythmodan, beta-adrenergical blocking agents). For some patients exhibiting a tendency toward asystole electric stimulation of the heart is indicated.

[Atrio-ventricular dissociation]. / Atrio-ventrikuliarnaia dissotsiatsiia

Cardiac rhythm disorders called atrioventricular dissociation, especially the so-called dissociation with interference have been causing controversy among the cardiologists for a long time. The latter term implies an independent activity of the atria and ventricles, that is in no way connected with an orthograde atrioventricular block, and that develops in the presence of intermittent normal conductivity of sinus impulses. This disorder is always of a secondary nature and it may be due to the disorders in the formation of the primary rhythm, or conductivity of the impulse (passive form), or acceleration of the secondary rhythm (active form). The causes of such atrioventricular dissociation may lie in sinus bradycardia, sinoauricular or incomplete atrioventricular block, compensatory pauses after extra-systoles, atrioventricular and ventricular tachycardia (paroxysmal or nonparoxysmal) with a retrograde atrioventricular block, etc. Examples of ECG patterns illustrating most of the above mechanisms are presented. Due to the existence of several mechanisms that cause atrioventricular dissociation, and due to the fact that individual authors imply different meanings by the term "interference", it seems reasonable to abandon the term "dissociation with interference". In such case it would seem more appropriate to call the state a primary rhythm or conductivity disorder indicating an incomplete atrioventricular dissociation for a proper choice of therapy.

[Prolongation of the Q-T interval of the ECG: classification and clinical significance]. / Udlinenie intervala Q-T: classification, klinicheskoe znachenie.

The extension of the Q-T interval of ECG can be accompanied by loss of consciousness and even sudden death. A unified approach is required to assess the normal duration of the Q-T interval. A table of maximum normal limits of the Q-T interval is given calculated with Bazett's formula with the coefficient K equal to 0.42. It is suggested to subdivide the extensions of the Q-T intervals according to the clinical manifestations with attacks of loss of consciousness and without them and also according to aetiology: congenital syndrome Jarvel-Lange-Nielsen and that of Romano-Ward, the acquired acute (intoxications, disorders of electrolyte balance, lesions of the central nervous system, myocardial infarction, myocarditis, medicinal reactions) and the acquired chronic (diffuse lesions of the myocardium, of the brain etc.). Personal observations of syndromes of extended Q-T intervals of different aetiology are given with attacks of ventricular tachycardia of the "torsade de pointes" type and ventricular fibrillation.

[Study of the dynamics of cardiac rhythm and the ST segment in patients with acute myocardial infarction based on the data of Holter ECG monitoring]. / Dinamika ritma serdtsa i segmenta ST u bol'nykh ostrym infarktom miokarda po dannym kholterovskogo monitoringa EKG.

Holter monitoring was performed on days 1-2, 6-9 of the disease and on days 30-60 before their discharge from hospital in 54 patients with acute gross myocardial infarction. The presence of cardiac rhythm and conduction disturbances and ischemic ST-segment depression or elevation was evaluated. The patients having frequent and prolonged (more than 3 hours during a 2-day follow-up) showed a complicated course of the disease: recurrent pain syndrome, signs of heart failure, prolonged cardiac arrhythmias, and fatal outcomes. The patients with uncomplicated acute myocardial infarction had no long-term episodes of ischemic ST-segment depression or elevation, as recorded by Holter monitoring in the first 2 days of the disease. On days 6-9 no cardiac rhythm and conduction disturbances that had been observed in them were recorded. The patients in whom the episodes of silent myocardial infarction remained on their discharge exhibited a high (35%) incidence of myocardial infarction recurrence within a year.

[Nonparoxysmal tachycardia and accelerated ectopic rhythms]. / Neparoksizmal'naia takhikardiia i uskorennye ektopicheskie ritmy.

Ectopic rhythms with impulse frequency of 60-90 per minute are referred to as "accelerated"; those with the frequency of 91-130 impulses per minute are termed "nonparoxysmal tachycardia". Forty patients (27 with nonparoxysmal tachycardia and 13 with accelerated ectopic rhythms) were under observation. Accelerated rhythms were nearly always free of clinical symptoms and did not require an anti-arrhythmia treatment. Nonparoxysmal supraventricular and ventricular tachycardia was usually accompanied by aggravation of the patient's condition. Nonparoxysmal tachycardia turned to paroxysmal one or vice versa in 7 patients. Cordarone, beta-adrenergic agents and isoptin were particularly effective in the treatment of nonparoxysmal supraventricular tachycardia, while ethmosine, cordaron and rhythmodan proved most effective against ventricular arrhythmia.

[Prevention of ventricular fibrillation in animal experiments]. / Medikamentoznaia profilaktika fibrilliatsii zheludochkov serdtsa v eksperimente.

The precursors of ventricular fibrillation and asystole developing after ligation of a branch of the coronary artery and adrenalin injection were studied in 30 albino rats. The comparative efficacy of antiarrhythmic agents (ajmalin, lidocaine, isoptin, visken) in the prevention of ventricular fibrillation induced by electric current was determined in 40 rats. Ventricular extrasystole and tachysystole as well as the block of the bundle of His branch were the most common precursors of ventricular fibrillation. In some experiments fibrillation was preceded by complete atrioventricular block, cardiac fibrillation, sinus bradycardia, nonparoxysmal ventricular tachycardia, and excaped ventricular contractions. Ventricular asystole was most frequently preceded by complete atrioventricular block and the bundle of His branch block. Among the antiarrhythmic agents studied, ajmalin proved most effective in prevention of ventricular fibrillation; it raised the fibrillation threshold in all animals. Lidocaine, which produced a prophylactic effect in 50% of experiments, was second in effectiveness. Changes in the ventricular fibrillation threshold due to the effect of these agents were statistically significant on the average. Isoptin and visken proved to be less effective.

[Late arrhythmias in myocardial infarct]. / Pozdnie aritmii pri infarkte miokarda.

The authors had 75 patients with myocardial infarction under observation. After the 15th day of the disease various disorders of cardiac rhythm and conductivity were revealed in 85% of patients during cardiomonitor surveillance. The most frequent occurrences were ventricular extrasystole (72.5%), sinus bradycardia (40%) and atrial extrasystole (37.5%). Primary ventricular fibrillation was noted in 4 (5.3%) patients two of whom were resuscitated. In 50 patients with myocardial infarction of more than one month duration disorders of cardiac rhythm during physical load were studied (dosed walking under telectrocardiographic control and/or on a treadmill). During dosed waling 28% of patients developed arrhythmia or it was intensified (sinus tachycardia was not taken into account). During a load on a treadmill such changes were encountered in 30% of patients. A favourable effect of treatment with cordarone was produced in most patients with ventricular extrasystole some of whom were resistant to lidocain treatment. A good effect was produced in some patients by means of the pulsnorma or rythmodan. Beta-adrenergic blocking agents as well as cordaron and isoptin were effective in atrial extrasystole and sinus tachycardia. Hyperbaric oxygenation was used in 14 patients with disorders of rhythm. Disappearance of arrhythmia or considerable improvement was registered in 11 patients after treatment consisting of 10-12 procedures.

[Detection of heart rhythm disorders by ECG autotransmission via telephone]. / Vyiavlenie narushenii ritma serdtsa metodom autotransliatsii EKG po telefonu.

The method of patient's own telephone transmission of his or her ECG was used for the diagnosis of arrhythmias in 70 patients with a history of heart rhythm disorders. Various arrhythmias were diagnosed, using this method, in 91.4% of the patients. Repeated conventional ECG recordings detected arrhythmias in 54.3% of the patients only over the entire hospital stay time. A comparison of ECG telephone autotransmission and intermittent ECG tape-recording by the Cardiocassette device showed identical rhythm disorders in 91.3% of the cases, while bicycle ergometry proved less informative for the diagnosis of arrhythmias as compared to ECG telephone transmission. The latter method may be useful in monitoring patients with heart rhythm disorders, particularly at the outpatient stage of treatment. It allows antiarrhythmic therapy to be administered as soon as arrhythmia is detected which is an advantage over ECG tape-recording.

[Anti-arrhythmic effectiveness of ethmozine, cordaron and rhythmodan in treating ischemic heart disease]. / Antiaritmicheskaia éffektivnost' étmozina, kordakona i ritmodana pri lechenii bol'nykh ishemicheskoi bolezn'iu serdtsa.

The authors observed 127 patients with different disorders of the cardiac rhythm treated with ethmozine, cordarone and rhythmodan. To assess the efficacy of the therapy circadian ECG was recorded on a magnetic tape with a portable cardiomonitor, exercise tests (bicycle ergometry, treadmill and walking under ECG control) were conducted. Good effect was seen after a course of treatment in patients with ventricular and atrial extrasystolae, paroxysms of supraventricular, ventricular tachycardia and auricular fibrillation. Cordarone was found effective in the Wolff-Parkinson - White syndrome and paroxysms of supraventricular tachycardia.

[The use of Cordanum in combination with Corinfar-Retard for the treatment of ectopic arrhythmias in the sick sinus syndrome in patients with ischemic heart disease]. / Primenenie kordanuma v sochetanii s korinfarom-retard dlia lecheniia éktopicheskikh aritmii pri sindrome slabosti sinusovogo uzla u bol'nykh ishemicheskoi bolezn'iu serdtsa.

38 patients with ischemic heart disease (IHD) and sick sinus syndrome (SSS) received combined therapy with nifedipine (Corinfar-Retard) and talinolol (Cordanum). The former drug had a positive chronotropic effect on the heart, the latter's chronotropic effect was slightly negative. All the patients had sinus bradycardia and ectopic arrhythmia which needed therapeutic correction: supraventricular and ventricular extrasystoles, fibrillation paroxysms or/and atrial flutter, paroxysmal supraventricular tachycardia, ventricular tachycardia. Cordanum was given in a dose 50 mg twice a day, Corinfar-Retard 20 mg twice a day for 16 days. 30 patients responded to the treatment. In addition to good subjective response, episodes of extrasystoles, paroxysms, flutter and fibrillation occurred much less frequently. Side effects resulted in the treatment discontinuation in 3 patients.