Introduction. Diagnosis of infective endocarditis is a challenging task for clinicians. The issue of early infective endocarditis detection is topical, since the mortality rate of this pathological condition is high; also, along with the classic symptoms of the disease, its atypical manifestations, so-called "masks" of infective endocarditis, often occur. Objectives. The purpose of the work is to investigate one of infective endocarditis manifestations in the form of monoarthritis on the clinical case basis. Materials and methods. The medical history, the laboratory and instrumental findings, Guidelines for the management of infective endocarditis 2015; Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications, AHA 2015 (including update 2016). Results. The patient, born in 1952, complains of the right foot pain, fever with chills, general weakness. Considers herself ill for 3 weeks. In connection with the right foot pain intensification, the patient was taken to a multidisciplinary hospital by the ambulance team and hospitalized to the therapeutic department. The anamnesis vitae is notable for her undergoing a procedure for curettage of the uterine cavity for an endometrial polyp half a year before the admission. The main diagnosis: Active mitral valve endocarditis due to Streptococcus haemolyticus. Mitral valve regurgitation stage III. Chronic coronary syndrome. Heart failure with preserved ejection fraction (EF 68 %). NYHA class II. Concomitant diagnosis: Mild anemia. Reactive arthritis. Deforming osteoarthrosis of the ankle joint. The treatment included: meronem 1 g 3 times daily intravenously (IV) and linezolidine 600 mg 2 times a day per os during 4 weeks; detoxification, cardiotropic, antiplatelet and anticoagulant therapy; proton pump inhibitors, diuretics, antifungal drugs. Conclusion. Diagnosis of infective endocarditis is very challenging despite the presence of the specially developed diagnostic criteria. Given the polymorphic clinical manifestations of the disease and multiple organ damage, clinicians should be wary of the presence of infective endocarditis in patients with corresponding risk factors.
УДК 616.1 уварова к.г. Харківський національний університет імені В.Н. Каразіна рапТОВа СерцеВа СмерТь: факТОри ризику, причини, преДикТОри (ОгляД лІТераТури) анотація. Під раптовою серцевою смертю (РСС) розуміють несподівану зупинку серцевої діяльності або смерть у результаті наявних серцево-судинних захворювань. У 2012 році в Україні було зареєстровано понад 72 тис смертей від серцево-судинних захворювань. У даній статті розглядаються особливості епідеміології РСС в Україні та за кордоном, а також фактори ризику її розвитку. Приділяється належна увага основним причинам виникнення та електрокардіографічним предикторам РСС. Обговорюються питання щодо нових молекулярних біомаркерів і тих, що вже давно зарекомендували себе в якості предикторів даної нозології: маркерів серцево-судинних захворювань, запалення, гемодинамічних, міокардіальних стресових і нейрогормональних біомаркерів. Визначення розглянутих молекулярних предикторів може використовуватися для профілактики та прогнозу РСС. В огляді використовувалися закордонні літературні джерела останніх років. ключові слова: раптова серцева смерть, маркери, причини, фактори ризику. uvarova Karyna V.N. Karazin Kharkiv National University suDDen carDIac DeaTh: rIsK facTOrs, causes, preDIcTOrs (lITeraTure reVIew) summary. Sudden cardiac death (SCD) is considered as an unexpected cardiac arrest or death as a result of existing cardiovascular diseases. SCD is a fatal condition; in Europe, BCC annually takes 350-700 thousand lives. In 2012, more than 72 thousand deaths from cardiovascular diseases were registered in Ukraine. Сurrently, identification of risk factors and the implementation of risk stratification among patients with predisposing factors and diseases that potentially lead to its occurrence are extremely relevant. The problem of our understanding of the complex etiological and pathophysiological features of SCD with the subsequent application of the knowledge gained for its effective prevention in risk groups and on an individual basis is of current interest. This article considers epidemiological features of SCD in Ukraine and abroad, predisposing factors such as gender, age, ethnic aspects and other undifferentiated risk factors for SCD. Due attention is paid to the main causes of SCD, namely cardiovascular diseases and their immediate risk factors, as well as electrocardiographic predictors of SCD. Issues are discussed regarding new and already established molecular biomarkers as predictors of this nosology: markers of cardiovascular diseases (oxidized low density lipoproteins, cysteine, glutathione, heat shock proteins), inflammation (interleukin-6 and interleukin-18, C-reactive protein, lipoprotein-associated phospholipase A2, myeloperoxidase, urokinase plasminogen activator receptor, pentraxin-3, metalloproteinase), hemodynamic (natriuretic peptides), myocardial stress (cardiac troponins) and neurohormonal (renin, aldosterone, adrenomedullin, copeptin) biomarkers. The determination of the considered molecular predictors can be used for prevention and pred...
Despite significant progress in the treatment of patients with cardiac arrhythmias, atrial fibrillation (AF) remains one of the leading causes of serious cardiovascular events around the world. Currently, radiofrequency ablation (RFA) is the first-line method in the treatment of patients with AF. However, signs of sick sinus syndrome (SSS) are found in some AF patients after RFA, which requires urgent or planned pacemaker implantation. Aim. To review current therapies for AF and sick sinus syndrome (SSS) and analyze peculiarities of the SSS development after RFA for AF. Materials and methods. The analysis of the world literature data was carried out along with the analysis of our own clinical observations of patients with AF who underwent RFA. Results. As a result of the data analysis, it was proposed to identify three possible groups of causes why AF patients may develop SSS after RFA: 1) organic (associated with degenerative fibrosis of the sinus node tissue that occurs during aging, or with other underlying organic changes in the sinus node), 2) functional (associated with the remodeling of the sinus node tissue and the surrounding tissue of the atrial myocardium caused by prolonged AF persistence), 3) iatrogenic (associated with the effects of antiarrhythmic drugs on the sinus node or caused by the RFA itself). Each group of causes identified was illustrated by a clinical case with the following analysis of long-term results of RFA. Conclusions. It was proposed to develop a scale for SSS prediction in patients after RFA for AF evaluating a patient’s medical history, resting electrocardiography, 24-hour electrocardiographic monitoring, and, in some cases, coronary angiography to assess the peculiarities of the sinus node blood supply. The use of the above predictors could reduce the percentage of possible complications such as development of SSS in patients after RFA and also help to identify patients who may need a pacemaker implantation in the future.
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