Vol 26, No 9 (2019)

Polymorphic ventricular tachycardia (pirouette-type tachycardia, Torsades de Pointes, TdP), having the potential for the development of sudden cardiac death, poses a real threat to human life. The occurrence of TdP is known to be closely associated with lengthening of the QT interval. The effect of drugs is one of the most common causes of the development of acquired prolongation of the QT interval and TdP. The vast majority of the currently existing groups of pharmacological preparations have representatives that are capable of developing an extension of the QT interval and TdP. The most famous and often used of them are antiarrhythmics (IA, IC and class III), antipsychotics, antidepressants, antibiotics (macrolides and fluoroquinolones), antihistamines, antitumor and antifungal drugs, prokinetics, lipid-lowering drugs and diuretics, excluding potassium-sparing agents. Risk factors for drug-induced TdP include old age, bradycardia, the simultaneous use of >1 drug, which contributes to the development of a prolonged QTc interval or TdP, increased plasma concentrations of QT-extending drugs due to drug interactions or inadequate dose adjustment for renal/liver dysfunction, female sex, heart failure with a reduced ejection fraction, history of drug-induced TdP, hypocalcemia, hypokalemia, hypomagnesemia, increased OTc interval by >60 ms compared to the initial value, QTc interval >500 ms, rapid intravenous infusion of drugs that prolong QTc, sepsis, as well as the prolongation of the QTc interval recorded on the electrocardiogram. Assessment of the potential ability of a drug for the development of TdP, identification and correction of the risk factors that increase the likelihood of developing a drug-induced TdP, examination of the initial electrocardiogram and subsequent its monitoring, and awareness of a patient taking a drug with known risk of TdP about the possibility and characteristics of TdP manifestations, are the most important preventive measures that can prevent the arrhythmogenic effects of drugs.

A scientific review on methodology of deprescribing in elderly patients with polypragmasia is presented. Deprescribing involves the cancellation or reduction of dosages of medicines (drugs), which have become inappropriate or have lost their justification for use with the duration of treatment of elderly patients. Deprescribing is not a refusal to prescribe an effective drug, but a positive patient-oriented intervention that requires collaborative decision-making, informed patient consent and careful monitoring of effects based on the principles of high-quality drug prescription. Deprescribing is aimed at reducing the frequency of side effects associated with the use of drugs, improving functional status and preventing premature mortality. In addition, deprescribing can reduce the drug burden in the patient, and improve adherence to pharmacotherapy. The review includes evidence-based medicine data, including meta-analyzes of clinical and observational cohort studies, including for specific pharmacological classes of drugs - psychotropic agents, proton pump inhibitors, antihypertensives, statins, as well as data on deprescribing in the inpatient sector. In many cases, deprecibing can improve the condition and quality of life of patients, as well as outcomes. The methodology of deprecibing has widely accepted; guidelines and algorithms have been prepared, conferences are held.

The article focuses on evidence-based knowledge on the use of lipid-lowering drugs. The target blood lipid indicators against the background of the treatment with statins are given, the choice of rosuvastatin for the category of patients who have had an acute cardiac event, myocardial infarction, acute cerebrovascular accident and/or transient ischemic attack is justified. The fundamental positions of international and Russian clinical guidlens on the management of patients after myocardial infarction and cerebral stroke for the prevention of complications, as well as for improving the prognosis, are discussed. The non-lipid pleiotropic effects of rosuvastatin are described. It was noted that the use of rosuvastatin does not create obstacles to its combined administration with antiplatelet agents and anticoagulants, which are necessary for patients of these categories.

Migraine is a common socially significant disease, which until recently had no specific preventive therapy. The advent of monoclonal antibodies to the calcitonin-gene related peptide (CGRP) system has introduced a new era in the treatment of migraine. Since CGRP is a powerful vasodilator, cardiac safety of drugs that block this peptide has been studied especially carefully. There was no evidence of a negative effect of CGRP blockers on hemodynamic parameters and the severity of ischemia in arterial occlusion. In the study with the monitoring of 1287patients with cardiovascular diseases or their risk factors (diabetes mellitus, arterial hypertension, obesity, etc.), no negative effects of fremanizumab on the cardiovascular system, including blood pressure and electrocardiography parameters, were detected. According to a stress test, it was shown that intravenous administration of erenumab at a dose of 140 mg does not affect the exercise tolerance and the development of myocardial ischemia. Anti-CGRP monoclonal antibodies have high efficacy and safety.

Background. The article presents the results of the original study on the under-investigated issues of the effects of smoking cessation on the microcirculation parameters in patients with arterial hypertension (AH). Objective: evaluation of the microcirculation parameters in hypertensive patients who stopped smoking, depending on the duration of smoking cessation. Methods. 94 hypertensive patients with different smoking status (previously smoked, smokers, non-smokers) were examined; microcirculation in all patients was studied by the direct conjunctival videobiomicroscopy. Results. The positive effect of smoking cessation on the microcirculation parameters involved in the pathogenesis of AH (average arteriolar diameter, arteriole-to-venule ratio, and number of capillaries per 1 mm2 of conjunctival surface) was detected. It was found that the parameters changed by smoking begin to recover in the first two years of abstinence. Conclusion. The parallels between the smoking status, the degree of hypertension in the final diagnoses and the microcirculation parameters allowed the authors to recommend smoking cessation as an effective therapeutic measure.

Cerebral microangiopathy (CMA) associated with age and/or arterial hypertension is considered the most common sporadic form of damage to the small vessels of the brain. The clinical symptoms of CMA, including progressive cognitive deficit, gait disturbance, sphincter dysfunction and mental disorders, severely disrupt the social adaptation of an elderly person. The article discusses the correlates of clinical symptoms and MRI signs of CMA, as well as clinical approaches to the early diagnosis and treatment of CMA. Early diagnosis and treatment of cognitive deficiency is the best prevention of vascular dementia, which can have a tremendous impact on public health.

The article provides historical data on the world drug legislation, primarily regarding generics. The types of generics, their differences and methods of production are described. Katherine Katherine Eban’s journalistic investigation on the issue of quality of generics is also being discussed. Two branded Russian generics, Kalmirex and Flamadex, are presented; research on their pharmaceutical equivalence is considered.

Background. In our opinion, the occurrence of QRS complex fragmentation in new-onset ST-segment elevation myocardial infarction is an unfavorable prognostic sign. Description of the clinical case. This example describes the case of ST-segment elevation myocardial infarction, with stenting of the infarction-dependent artery and the development of QRS complex fragmentation according to the electrocardiogram data. Conclusion. QRS complex fragmentation in patients with new-onset ST-segment elevation myocardial infarction with may be an indicator of the complicated course of myocardial infarction.