Relevance. Improving the quality of medical training of future doctors takes place on the basis of the introduction of innovative forms of education, namely, a competency-based approach to the educational process, which ensures the formation of students' competencies and competency levels of graduates of higher medical educational institutions. Today, the main task of higher medical education is the implementation of a competence approach in the professional training of future specialists, which consists not only in the formation of professional knowledge and skills, but also in the training of a modern, motivated, competent doctor who is deeply aware of his crucial role in society. The main components of professional competence are the ability to obtain and use knowledge with the help of clinical thinking, the combination of theoretical knowledge with the possibility of their application in everyday practice. Distance learning provided an opportunity to learn new learning opportunities, communicate and study at a distance. This sets requirements for the organization of the educational process of students, which ensures the formation of professional competencies of students, especially taking into account the student-centered direction of study.The goal of the work. To analyze the formation of professional competence among medical students based on the teaching of the elective subject "Current issues of cardiology" in the conditions of distance learning.Materials and methods. In the process of study this selective discipline, such teaching methods as explanatory-illustrative (informational-receptive), which is aimed at conveying information in various ways, especially with the use of modern technological teaching aids; reproductive, the essence of which consists in the master's reproduction of acquired knowledge in a specific methodical sequence according to etiopathogenetic ideas; problem statement - simulation of clinical history and finding its solution from the focus of knowledge of the main disciplines and pathologies of the cardiovascular system; heuristic method – an approach to learning, in which some parts of the clinical situation are determined in advance, and masters complete, objectify and solve the raised problematic questions; exploratory - the implementation of tasks that require a creative approach and increased systematic study are used.The results. In the conditions of distance learning, due to the inability of the student to study in the clinic and acquire practical skills at the bedside and in the training centers of the department, such teaching methods as the case method and simulation training made it possible to develop clinical thinking, vision of the problem and its solution using the acquired theoretical and practical knowledge .Conclusions. Improving the system of professional training of new generation medical specialists requires improvement of professional competence, a high level of professional skills, which will certainly lead to relentless adaptation to the medical environment in the future. The development of professional competence is a phenomenon characterized by many factors that affect the further development of a person as a professional, and the value sphere is the basis of a person's professional competence.

Chronic heart failure (HF) remains a potentially dangerous fatal stage of any cardiovascular disease demonstrating a steady increase in the prevalence among the general population that is accompanied by a progressive increase in the health care costs for improving the patients’ health or clinical status, increasing their quality of life, reducing the risk of death. There is wide interest in studying biomarkers in HF as they can improve the diagnosis, predict the occurrence of its decompensation, as well as help in assessing treatment effects. The objective of the study was to assess the value of determining the plasma concentration of NT-proBNP and ST2 in the patients with decompensated HF and prior acute myocardial infarction (MI) after treatment with succinic acid and arginine preparations under electrocardiographic control. Materials and methods. There were examined 120 patients with Q-QS wave and non-Q wave MI, stage II A-B decompensated chronic HF according to the classification proposed by Vasylenko V.Kh. and Strazhesko M.D., the NYHA functional class (FC) III-IV. The patients with Q-QS wave MI (60 individuals) were divided into 4 groups depending on the treatment method. The patients with non-Q wave MI (60 individuals) were divided into 4 analogous groups. Study groups were homogenous by age, gender, disease severity, duration of the post-infarction period, clinical signs of decompensation, that served as a basis for inclusion of patients in the study. Results. There was analyzed the  dynamics of changes in ECG indicators in the patients with decompensated HF and prior MI under the influence of therapy. At the beginning of controlled treatment, most patients developed signs of left ventricular hypertrophy (LVH) and reduced bioelectrical activity. Therapy applied helped reduce the incidence of sinus tachycardia cases. The studied preparations were shown to have the positive effect on the dynamics of heart rhythm disorders in the patients with decompensated HF and prior Q wave MI.  During treatment of the patients with prior non-Q wave MI, the positive dynamics in ECG findings, namely reduction in cardiac bioelectrical activity and LHV, was observed. Myocardial bioelectrical activity had a clear tendency to reduce 1 month, and especially 2 months, after treatment. When analyzing the dynamics of changes in blood levels of NT-proBNP, there was observed its significant reduction in all the groups of the patients after the end of treatment. According to the data presented in Table 1, all the treatment schemes proposed led to a significant reduction in serum levels of this peptide after treatment ended. Conclusions. Thus, we can conclude that the treatment of patients with decompensated HF secondary to prior Q-QS wave or non-Q wave MI with succinic acid and arginine preparations possessing anti-ischemic, antianginal, anti-hypoxic, angioprotective effects, allows providing adequate treatment of decompensated HF, as evidenced by the positive dynamics of changes in immunoenzymatic and electrocardiographic findings. Therefore, we plan to develop an algorithm for assessing the quality of therapy, as well as to determine the frequency and time periods of using these peptides for making therapeutic decisions.

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Мета роботи-встановити ефективність відновного лікування хворих з декомпенсованою серцевою недостатністю (СН) у ранньому та пізньому постінфарктному періоді, застосовуючи бурштинову кислоту та препарати аргініну, оцінити їх вплив на толерантність до фізичних навантажень. Матеріал і методи. Обстежено 120 хворих з діагнозом Q-QS та не-Q інфаркт міокарда, (ІМ) в яких зафіксована декомпенсована хронічна серцева недостатність (ХСН) II А-Б стадії за класифікацією В. Х. Василенка та М. Д. Стражеска, III-IV ФК (за NYHA). Хворі з діагнозом Q-QS ІМ (60 пацієнтів) були сформовані у чотири групи залежно від отриманих методів лікування. Аналогічно сформовані у чотири групи пацієнти з діагнозом не-Q ІМ (60 пацієнтів). Усім пацієнтам виконано тест шестихвилинної ходьби (ТШХ) за стандартною методикою в ранковий час, у лікарняному коридорі, довжиною 30-50 м. Перед початком ходи зафіксовано частоту серцевих скорочень (ЧСС), артеріальний тиск (АТ) (систолічний та діастолічний) та виконано електрокардіографію (ЕКГ) у 12 стандартних відведеннях. Критерії припинення тесту: біль у грудній клітці, тяжка задишка, судоми кінцівок, запаморочення, шаткість ходьби, потовиділення, різка блідість, спожитий O 2 (SpO 2) менше 86%. Результати. Оцінюючи появу клінічних ознак під час виконання фізичних навантажень у хворих, що перенесли Q-ІМ, констатовано, що такі ознаки, як ангінальний больовий синдром, порушення ритму та запаморочення у групі хворих стандартного лікування не лише зменшувались, а навпаки, мали схильність до зростання. У той же час, застосування бурштинової кислоти, препаратів аргініну та їх поєднання сприяло суттєвому зменшенню клінічних ознак неадекватності дозованих навантажень. Так, наприклад, ангінальний больовий синдром, який на початку лікування супроводжував фізичні навантаження в 60%, 73,3%, 66,7% хворих вказаних груп, через два місяці лікування залишався лише у третини осіб, відповідно 20%, 26,7%, 13,3%. Аналогічні закономірності мала динаміка випадків запаморочення та поява ціанозу/блідості. Аналізуючи динаміку клінічних ознак при виконанні фізичних навантажень у пацієнтів, що перенесли не-Q ІМ, встановлено незначне зменшення таких ознак, як ангінальний больовий синдром, задишка, порушення ритму, запаморочення у групі осіб, які отримували стандартне лікування. При цьому, застосування бурштинової кислоти, препаратів аргініну, а особливо їх поєднання, значно зменшило клінічні ознаки неадекватної відповіді на фізичні навантаження. Також, пройдена дистанція у пацієнтів, що перенесли Q ІМ, ускладнений декомпенсованою СН протягом першого та, особливо, другого місяця лікування, супроводжувалось вірогідно (р<0,05) меншим значенням ЧСС, систолічним артеріальним тиском (САТ) та діастолічним артеріальним тиском (ДАТ) як у стані спокою, так і після виконання навантаження. Пацієнти останньої групи, які до лікування проходили (174,87±1,92) м, через два місяці лікування виконували (369,00±4,71) м (р<0,05). ЧСС у таких хворих на початку терапії зростала з (88,27±2,5) уд/хв до (105,4±3,22) уд/хв

Chronic heart failure (HF) remains a potentially dangerous fatal stage of any cardiovascular disease demonstrating a steady increase in the prevalence among the general population that is accompanied by a progressive increase in the health care costs for improving the patients’ health or clinical status, increasing their quality of life, reducing the risk of death. There is wide interest in studying biomarkers in HF as they can improve the diagnosis, predict the occurrence of its decompensation, as well as help in assessing treatment effects. The objective of the study was to assess the value of determining the plasma concentration of NT-proBNP and ST2 in the patients with decompensated HF and prior acute myocardial infarction (MI) after treatment with succinic acid and arginine preparations under electrocardiographic control. Materials and methods. There were examined 120 patients with Q-QS wave and non-Q wave MI, stage II A-B decompensated chronic HF according to the classification proposed by Vasylenko V.Kh. and Strazhesko M.D., the NYHA functional class (FC) III-IV. The patients with Q-QS wave MI (60 individuals) were divided into 4 groups depending on the treatment method. The patients with non-Q wave MI (60 individuals) were divided into 4 analogous groups. Study groups were homogenous by age, gender, disease severity, duration of the post-infarction period, clinical signs of decompensation, that served as a basis for inclusion of patients in the study. Results. There was analyzed the  dynamics of changes in ECG indicators in the patients with decompensated HF and prior MI under the influence of therapy. At the beginning of controlled treatment, most patients developed signs of left ventricular hypertrophy (LVH) and reduced bioelectrical activity. Therapy applied helped reduce the incidence of sinus tachycardia cases. The studied preparations were shown to have the positive effect on the dynamics of heart rhythm disorders in the patients with decompensated HF and prior Q wave MI.  During treatment of the patients with prior non-Q wave MI, the positive dynamics in ECG findings, namely reduction in cardiac bioelectrical activity and LHV, was observed. Myocardial bioelectrical activity had a clear tendency to reduce 1 month, and especially 2 months, after treatment. When analyzing the dynamics of changes in blood levels of NT-proBNP, there was observed its significant reduction in all the groups of the patients after the end of treatment. According to the data presented in Table 1, all the treatment schemes proposed led to a significant reduction in serum levels of this peptide after treatment ended. Conclusions. Thus, we can conclude that the treatment of patients with decompensated HF secondary to prior Q-QS wave or non-Q wave MI with succinic acid and arginine preparations possessing anti-ischemic, antianginal, anti-hypoxic, angioprotective effects, allows providing adequate treatment of decompensated HF, as evidenced by the positive dynamics of changes in immunoenzymatic and electrocardiographic findings. Therefore, we plan to develop an algorithm for assessing the quality of therapy, as well as to determine the frequency and time periods of using these peptides for making therapeutic decisions.