№ 6 (2017)

The article presents the modern concepts of the place of loop diuretics in the treatment of chronic heart failure. The theoretical and evidential base for the use of torasemide in the treatment of heart failure and its wider use is discussed.

Based on the analysis of the sample of patients (n=345, 50% men), a complex scale scale «Potassium: Plasma, erythrocytes, urine» (PPEU) was obtained and verified. The PPEU scale allows non-invasive assessment of potassium levels in blood plasma, erythrocytes and urine of patients on the basis of observed symptoms, history and questioning of patients. Testing of the scale over an independent control sample (n=175) shown the existence of reliable correlations between the experimentally determined potassium levels and the estimates obtained by the PPEU scale. The use of the proposed scale makes it possible to assess the state of potassium homeostasis of the patient even before the clinical and laboratory analyzes of the corresponding biosubstrates.

Aim. Modelling, lipid a spectrum, ischemic illness of heart. Materials and methods. The study included 210 patients with CAD with stable angina; 215 patients with CAD, who previously had myocardial infarction (MI), and 215 patients with CAD and heart failure (HF). Results. As have shown our calculations, the age of patients has the expressed value. So, at various structure of age groups parameters total cholesterol, LDL and HDL have mathematical distinctions at various groups of diseases. To evaluate lipid spectrum dependence on age and the BMI, analysis was conducted, visualized by ternary diagrams, with approximate equations. These approximate equations had grouping variables of the age of patients for each disease group and variables as total cholesterol, LDL and HDL, taking into account gender and the variables in the form. According to our calculations, the age of patients is clearly expressed. Thus, in different structure of various age groups, BMI such indicators total cholesterol, LDL and HDL, have mathematical differences in different groups of diseases. Conclusion. It is proved that dyslipidemia is essentially a biochemical manifestation of lipid metabolism disorders, which may result in significant morphological and functional disorders in the body. Our analysis revealed significant changes in the lipid spectrum, indicating a high risk of further development of atherosclerosis and its complications in the patients observed. Thus, mathematical models allow to calculate the values of total cholesterol, HDL and LDL, depending of age groups and BMI value in patients with myocardial infarction, angina, heart failure, taking gender into account.

Article considers the results of the studies of daily monitoring parameters of arterial pressure, lipid spectrum condition, contents of serum endotheline-1 level in 120 patients with arterial hypertension, hormonal status of females. Also the influence of antihypertensive irbesartan therapy at investigated indexes. Gender and age differencies of the dynamic of aterogenous lipid spectrum and endotheline-1 fractions'contents were fixed. Irbesartan therapy is accompanied by significant improvement of blood pressure daily profiles in all groups of examined patients; maximal efficacy is fixed in postmenopausal female group. Also takes place the decrease of endotheline-1 level in comparison with start indexes, statistically more valid in males and females older than 50 y.o.

Article highlites new perspectives of chronic cardiac insufficiency treatmet connected with sinoatrial node f-channels blocker ivabradine use that was fixed during the last years. The results of such large multicenter randomized trials as BEAUTIFUL, SHIFT and others are introduced. The efficacy of ivabradine use in case of chronic cardiac insufficiency with decreased systolic function is convincingly proved there. A special attention is paid to clinical situations, when ivabradine administration is rational in combination with β- adrenoblockers or without them in case of contraindications. The advantages of ivabradine prescribtion in case of combination chronic cardiac insufficiency with obstructive pulmonary disease, diabetes melitus, chronic renal pathology and other comorbid conditions are shown.

The article presents a recent insight on antiplatelet therapy in acute coronary syndrome, emphasizing clopidogrel as the most well known medication with the longest experience of usage. The data provided, from the latest European Guidelines, as some new information of translational and clinical trials published current year. A complexity and ambiguity is shown of the platelet part of hemostasis, especially, based on the data from new platelet reactivity trials. Routes are sketched of the choice of one or other medication, depended upon evidence and exact clinical situation.

Besides the fundamental role of vitamins as essential micronutrients, current clinical data point out at the importance of using the vitamine remedies for hospitalization of patients. Current work could be cosidered as systematization of available information for current point. In particular, the most important is vitamins C, D and B group use. Vitamin C donations help to reduce duration time in hospital. It is helpful to include vitamin C in protocols of tumorous diseases treatment. Joint intravenous use of hydrocortison, vitamine C and thiamine is efficient for severe sepsis and septic shock treatment. Vitamin D is effective in therapy with vitamin C and thiamine for tuberculosis patients, it helps to reduce time of hospital staying for patients in critical condition, it is important in adjuvant therapy of tumorous diseases, for decrease of sight effects of chemotherapy. Low vitamin D level is associated with higher risk of progressing of multiple sclerosis, mucoviscidosis, bronchial asthma, hyperparathyroidism in patients with chronic renal disease, preeclampsia, algeti diabetic neuropathy. Vitamins of B group are important for hyperhomocysteinemia decrease (during hemodyalisis for example), they enhance wounds healing and help to reduce cardiovascular risk.

Chronic venous insufficiency is a common vascular patbology, which demands long-lasting complex treatment including medicamentous therapy. Intake of phlebotonic medicaments lays in the basis of venous pathology treatment. Their systemic influence is aimed at improving venous and lymphatic systems' function. Taken by courses, they improve life quality of patients and slow down the progression of the disease. From geterogenous group of phlebotonics the most often used in clinical practice are horse chestnut extract-based medicaments (Eskuzan). Its use helps to influence on the main chains of chronic venous insufficiency pathogenesis; also it is profitable from pharmacoeconomical viewpoint.