The variety of dermatological manifestations in patients with the novel coronavirus infection COVID-19, the incidence of which depends on concomitant pathology and the characteristics of drug treatment, and their characteristics are similar to those that occur with conventional viral infections is discussed. At the present time it is proposed to distinguish several groups depending on the cause and mechanism of development: angiitis of the skin; papulo-squamous rash and pink lichen; measles rash and infectious erythema; papulo-vesicular rash; toxidermia; urticarial eruptions and artifical lesions. The variety of the clinical picture of the skin manifestations of coronavirus infection requires in-depth analysis in order to interpret correctly the skin lesions and other infectious exanthema and dermatoses in patients with COVID-19.
Aim:to assess the prevalence of bendopnea and association of this symptom with clinical, laboratory and echocardiographic features, clinical outcomes during 2 years of followup in ambulatory elderly patients with chronic heart failure (CHF).Materials and methods.We conducted an open, prospective, nonrandomized study of 80 ambulatory patients aged ≥60 years admitted with heart failure II–IV NYHA class CHF. Baseline survey included physical examination, estimation of Charlson comorbidity index, echocardiography and laboratory tests. Bendopnea was considered when shortness of breath occurred within 30 sec of sitting on a chair and bending forward. Mean followup was 26.6±11.0 months.Results.Bendopnea was present in 38.8 % patients. All these patients complained of shortness of breath during physical exertion and 45.2 % of them had orthopnea. Bendopnea was associated with the male gender (odds ratio [OR] 11.8, 95 % confidence interval [CI] 4.04–34.8, p<0.001), severity of the clinical status (ШОКС [shocks] scale score) (OR 1.78, 95 % CI 1.29–2.38, p<0.001), Charlson comorbidity index (OR 1.29, 95 % CI 1.07–1.52, p=0.007), coronary heart disease (OR 26.6, 95 % CI 3.34–21.3, p=0.002), history of myocardial infarction (OR 13.9, 95 % CI 4.2–46.6, p<0.001), left ventricular (LV) aneurysm (OR 13.3, 95 % CI 2.69–65.9, p=0.002), increased indexed LV endsystolic diameter (OR 8.2, 95 % CI 1.9–34.1, p=0.004), left atrial size (OR 4.3, 95 % CI 1,4–12.5, p=0.008), indexed LV endsystolic volume (OR 1.32, 95 % CI 1.07–1.64, p=0.010), pulmonary artery systolic pressure (OR 1.26, 95 % 1.03–1.45, p=0.002), high levels of NTproBNP (OR 1.0, 95 % CI 1.0–1.002, p=0.055), creatinine (OR 1.04, 95 % CI 1.02–1.07, p=0.001), uric acid (OR 1.006, 95 % CI 1.002–1.011, p=0.004); hospitalizations (OR 7.61, 95 % 2.04–28.4, p=0.003), and patient’s mortality (OR 5.63, 95 % CI 1.94–16.4, p=0.001). Multifactorial analysis confirmed association of bendopnea with severity of clinical status (OR 1.70, 95 % CI 1.04–2.8, p=0.033), increased left atrial size (OR 5.67, 95 % CI 2.75–21.32, p=0.029) and Charlson comorbidity index (OR 1.17, 95 % CI 1.04–2.80, p=0.050). During followup 51.6 and 12.2 % of patients died among those with and without bendopnea, respectively (OR 4.22, 95 % CI 1.85–9.9, p<0.001).Conclusion. Bendopnea is associated with an adverse hemodynamic profile and prognosis, what allows to consider this symptom as a reliable marker of CHF severity.
Российский государственный медицинский университет. 117997 Москва, ул. Островитянова, д.1 Клиническая значимость анемического синдрома у больных хронической сердечной недостаточностью В.Н. Ларина*, Б.Я. Барт, В.Г. Ларин Российский государственный медицинский университет. 117997 Москва, ул. Островитянова, д.1 Цель. Изучить распространённость анемии и её влияние на течение хронической сердечной недостаточности (ХСН). Материал и методы. Под наблюдением находились 282 больных (86 женщин и 196 мужчин) ХСН II-IV функционального класса по NYHA в возрасте от 39 до 85 лет (медиана 67 [62-73] лет). Анемию определяли по критериям ВОЗ при уровне гемоглобина крови <13 г/дл у мужчин и <12 г/дл у женщин. Результаты. Анемия была выявлена у 18,8% больных ХСН и у всех была лёгкой степени тяжести (уровень гемоглобина более 9 г/дл). Частота анемии у больных с сохранённой и сниженной фракцией выброса левого желудочка (ФВЛЖ) значимо не различалась, 19,1% и 18,5%, соответственно. При нарушенной функции почек анемия выявлялась у 35,8% больных ХСН. Больные с анемией и без неё были сопоставимы по полу, тяжести ХСН, частоте сердечных сокращений и ФВЛЖ. Однако больные с анемией были старше, имели более длительное течение ХСН (р=0,014), более низкие индекс массы тела (p=0,041), клиренс креатинина (0,026), систолическое (p=0,039) и диастолическое артериальное давление (p=0,006) и чаще страдали сахарным диабетом (p=0,004, χ2=8,01) чем больные без анемии. Причиной развития анемии у 35,8% больных был дефицит железа, у 9,4%-дефицит витамина В12, у 15,1%-дефицит фолиевой кислоты. У 39,7% больных причина анемии не была установлена. Заключение. Выявлена тесная связь анемического синдрома при ХСН с возрастом, уровнем клиренса креатинина, сахарным диабетом и частотой госпитализаций вследствие сердечной декомпенсации. Ключевые слова: анемия, хроническая сердечная недостаточность, функция почек, дефицит железа, дефицит витамина В12, дефицит фолиевой кислоты РФК 2010;6(3):311-317 Clinical significance of anemic syndrome in patients with chronic heart failure
Aim. To identify risk factors of decompensation of chronic heart failure (CHF) and related hospitalization in elderly outpatients. Material and methods. The total of 248 patients aged 60-85 years with CHF NYHA class II-IV were enrolled into the study. The first group consisted of 87 (35.1%) patients who required hospitalization due to CHF decompensation during the follow-up, the second group -of 161 patients without need for hospital admission. All the patients had undergone clinical and laboratory examination, estimation of CHF severity by the Scale of clinical state, assessment of quality of life and 6-minute walk test (6MWT), echocardiography. Results. Patients were matched for age, gender, disability occurrence, education level, body mass index, quality of life, hemodynamic parameters, incidence rates of anemia, diabetes mellitus and atrial fibrillation. CHF was more severe in patients who had required hospitalization (p<0.001), they were more often diagnosed with left ventricular aneurysm (p=0.001), chronic kidney disease (p=0.001), left ventricular ejection fraction (LVEF)<35% (p<0.001), history of stroke (p<0.001), III-IV degree mitral regurgitation (p=0.007), hyperuricemia (p<0.001), lower exercise tolerance (p=0.007) compared with patients without hospitalization. Higher functional class of CHF (OR=0.29; 95% CI 0.13-0.69; p=0.003), LVEF<35% (OR 0.37; 95% CI 0.18-0.76; p=0.007), chronic kidney disease (OR=0.29; 95% CI 0.13-0.68; p=0.004) and hyperuricemia (OR=0.23; 95%CI 0.10-0.50; p<0.001) were shown to be independent risk factors of CHF decompensation that required hospital admission in elderly patients. Conclusuion. High FC of CHF, low LVEF, hyperuricemia and renal dysfunction play a key role in CHF decompensation and related hospitalization in elderly patients. Key words: chronic heart failure, hospitalization, elderly patients. Цель. Выявить факторы, повышающие риск декомпенсации хронической сердечной недостаточности (ХСН) и связанных с ней госпитализаций у пожилых больных, наблюдаю-щихся в поликлинических условиях. Материал и методы. В исследование были включены 248 больных в возрасте от 60 до 85 лет с ХСН II-IV функционального класса (ФК) по NYHA. Первую группу составили 87 (35,1%) больных, которым в процессе наблюдения потребовалась госпитализация в связи с декомпенсацией ХСН, вторую группу составил 161 больной, не нуждавшийся в ней. Всем больным проводили клинико-лабораторное обследование, оценивали тяжесть ХСН по шкале оценки клинических состояний, качество жизни, осуществляли тест с 6-минутной ходьбой, эхокардиографию. Результаты. Больные двух групп были сопоставимы по возрасту, полу, наличию инвалидности, уровню образования, индексу массы тела, качеству жизни, гемодинамическим по-казателям, частоте встречаемости анемии, сахарного диабета и фибрилляции предсердий. Течение ХСН было более тяжёлое у больных, которым потребовалась госпитализация (р<0,001), у них чаще выявлялись аневризма левого желудочка (ЛЖ) (р=0,001), хроническая болезнь почек (ХБП) (р=0,001), фракция выброса левого желудочка (Ф...
The article provides a summary of the 2021 European Society of Cardiology (ESC) Guidelines for the diagnosis and treatment of acute and chronic heart failure (CHF). The most significant changes for general practitioners, internists and primary care cardiologists, from our point of view, regards etiology, terminology, as well as algorithms for diagnosing and treating CHF in accordance with phenotypes, new indications to a number of drugs, in particular sodium-glucose cotransporter type 2 inhibitors (dapagliflozin and empagliflozin) with assignment of class I recommended therapy and vericiguat. The article discusses the diagnostic criteria for different heart failure phenotypes, the potential of treating patients with heart failure mildly reduced and preserved ejection fraction.
The purpose of the present review is to bring into focus the issues regarding terminological and registration aspects of multimorbidity we come across in the modern literature. Key questions regarding the definitions for the most widely used terms «comorbidity», «polymorbidity» and «multimorbidity» are discussed. We also considered the aspects of their origin and distinctive features between the concepts. The interaction between illnesses can exacerbate one another, modify the clinical picture and course of illnesses, the nature and severity of complications, lead to a progressive worsening of the prognosis and quality of life in patients. It has been proposed that the terms of “comorbidity» (in case of presence of the pathogenesis interrelation) or “polimorbidity» (in case of absence of the pathogenesis interrelation) are the most appropriate diagnostic and treatment patterns for practice and epidemiological study. «Multimorbidity» seems to be a more appropriate term for clinical practice usage, because it involves not only diagnosis but also interaction between diagnosises, symptoms/syndromes, the mobility or self-care problems et al. The algorithm of the managing patients with multimorbidity is presented.
Atrial fibrillation (AF) is a complex pathology that requires an integrated approach in both diagnosis and treatment, including optimal prevention of thrombosis, control of clinical symptoms, and identification and treatment of cardiovascular risk factors and comorbidities. The article analyzes some of the new positions of the recommendations of the European Society of Cardiology on atrial fibrillation, presented in 2020. Effective diagnostic and therapeutic approaches are discussed in the management of patients with AF in conditions of multimorbidity. The basic principles of the CC to ABC concept, introduced with the aim of improving a structured approach to the treatment of patients with AF, and the 4S-AF regimen necessary for decision on the use of oral anticoagulants, choosing a method of control of the rhythm and / or its frequency, choosing between ablation, cardioversion and antiarrhythmic drugs, as well as to determine the mode of treatment of major cardiovascular diseases. To improve the prognosis and achieve the best results in these patients, the most important is to reduce the risk of stroke, control cardiovascular risks and comorbidities, and ensure high adherence to the therapy within the framework of the concept of comprehensive patient protection. Rivaroxaban is considered by the authors of the article as one of the drugs that provides comprehensive anticoagulant protection of patients with AF. The efficacy profile of rivaroxaban in the prevention of acute cerebrovascular accident and high safety rates were confirmed in a population of multimorbid AF patients of different ages and the highest risk of stroke and / or bleeding.
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