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Relevance. Creatine phosphokinase is an enzyme that is often associated with muscle and myocardial damage. However, there may be other causes of elevated levels of this enzyme, such as stroke, hypothyroidism, paraneoplastic syndrome, as well as various pharmacological effects, including taking statins and the development of statin-associated muscle symptoms, the consequences of a previous coronavirus infection - COVID-19.The aim of the work is to determine the cause of an increase in creatine phosphokinase in a patient who has suffered a coronavirus infection against the background of concomitant diseases, and to conduct a differential diagnosis of an increase in this enzyme.Results. An analysis of the patient's medical history with a significant increase in the level of creatine phosphokinase was performed and a subsequent differential diagnosis was carried out to identify the main causes of this change. The study was carried out based on the general condition of the patient, as well as the results of general and biochemical blood tests (including the level of creatine phosphokinase and lactate dehydrogenase), and instrumental studies were also carried out, such as electroneuromyography, electrocardiography, echocardiography and ultrasound.Ischemic cardiovascular disease and hypothyroidism were identified. However, the increase in creatine phosphokinase levels was not associated with statin use, since they were discontinued during observation, and the enzyme level increased over time. Other causes of increased creatine phosphokinase were also excluded, and the results indicate that the increase in the level of this enzyme is likely caused by a previous coronavirus infection with concomitant diseases.Conclusion. The present study highlights the importance of a comprehensive approach to the differential diagnosis and treatment of elevated creatine phosphokinase levels in patients with comorbid pathology, as this can be a consequence of various factors, including infections, concomitant diseases and pharmacological influences.

Relevance. Misdiagnosis of retrosternal goiter occurs in 0,2 to 45 % of patients.Case descriptions. The authors present a case of recurrent cervical goiter from cervical exposure 34 years after the first surgical intervention. The reason for the goiter recurrence was considered as an inadequate previous surgery. In the presented case report, the node extended retrosternally to a depth of 8 cm, was fused to the paratracheal tissue, was supplied with blood from the right internal thoracic artery and was intimately adjacent to the aortic arch, which complicated surgical intervention from the classical approach. An atypical course of coronary heart disease was described as a manifestation of recurrent thyrotoxicosis. The lack of effect from conservative therapy for “cardiogenic” pathology could be due to the intrathoracic location of the goiter and the occurrence of subclinical thyrotoxicosis.Surgical intervention is reasonable to perform in the extent of thyroidectomy with mandatory removal of intra-thoracic nodes with the elimination of all symptoms of thyrotoxicosis. A retrosternal goiter with a spread below the aortic arch can be removed from the cervical exposure.

Abstract. Atrial tachyarrhythmias are the most common forms of heart rhythm disorders. According to literature sources, isolated atrial flutter (AFL) is observed in 88 people per 100,000 population. Most quality-of-life assessment methods have been developed and used primarily to assess atrial fibrillation. In this context, the U22 questionnaire becomes a significant protocol aimed at quantifying paroxysmal symptoms associated with tachyarrhythmias. The aim. To evaluate changes in the quality of life in patients with typical AFL after radiofrequency ablation (RFA) and bidirectional conduction block through the cavotricuspid isthmus. Materials and methods. The study is based on the analysis of the results of the treatment of a group of 135 patients at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine in the period from 2014 to 2021. The patients had three follow-up examinations, which were subject to analysis and static processing: before RFA (n=135), after 1 month (n=122) and after 1 year (n=81). All the patients were interviewed concerning their arrhythmia-related symptoms, which were assessed according to the U22 protocol. Results. Before the procedure, the patients noted a low level of well-being (4.3±1.0 points). During the follow-up visit 1 month after RFA, the patients rated their general condition during this period at 8.9±0.7 points. The registered changes were statistically significant compared to the initial state (p

Carbamazepine is an anticonvulsant that is commonly used in neurological and psychiatric patients to treat epileptic seizures, neuropathic pain, or bipolar disorder. Carbamazepine side effects, as well as side effects of many antiepileptic drugs, include cardiotoxic effects such as atrioventricular block, bradycardia, and cardiac rhythm disorders. However, carbamazepine has also been reported to have antiarrhythmic, normotimic, and membrane-stabilizing effects. This results in its administration to treat arrhythmias in children. Based on literature, carbamazepine administration as anti-arrhythmic drug is known in cases where the basic therapy was ineffective. The medication is not registered anywhere in the world for this purpose. Thus, it can be administered only off-label. The aim of our literature review is to analyze and summarize the existing data on carbamazepine effects on cardiovascular system, to determine its safety as anti-arrhythmic drug, and to describe various factors fostering its side effects.

Aim. To study the psychosomatic relationships and quality of life (QOL) of patients with paroxysmal supraventricular tachycardia (SVT) depending on the presence or absence of panic attacks (PA) in comparison with patients with heartbeat against the background of somatoform autonomic dysfunction.Material and methods. The study included patients with SVT and heart attacks due to sinus tachycardia in the context of somatoform autonomic disorder (SAD). All patients were interviewed to identify anxiety and depressive disorders (Hospital Anxiety and Depression Scale [HADS] and Hamilton's Depression Scale), QOL assessment (SF-36 questionnaire), and they were also consulted by a psychiatrist who established the presence or absence of PA. According to a visual analogue scale, in points from 0 to 6, we assessed the general state of our patients' health (0 points corresponded to complete health, and 6 points corresponded to a serious illness) and the effect of heartbeat on well-being (0 points - no arrhythmia, 6 points - arrhythmia «nterferes with life»).Results. The study included 96 patients: 60 with SVT (21 men, 39 women, average age was 51 [33; 61] years) and 36 with heart attacks caused by sinus tachycardia in the framework of somatoform autonomic disorder (10 men, 26 women, average age was 33 [27; 41] years). Panic disorder was diagnosed in the SVT group in 17 patients, accounting for 28.3%. Only 7 patients (41%) could clearly differentiate between SVT and PA attacks. The low sensitivity of the HADS questionnaire in patients with SVT determined the need to consult a psychiatrist for the diagnosis of panic disorders.Conclusion. PA is typical for 28.3% of patients with SVT. The combination of SVT with PA reduces the QOL of patients due to its mental components, including due to the more frequent occurrence of depressive symptoms. Patients with SAD subjectively perceive the heartbeat as a more significant factor affecting health, compared with patients with SVT. Difficulties in the differential diagnosis of PA and SVT paroxysms in real clinical practice often lead to the appointment of the same therapy without taking into account the differences in the genesis of heartbeats.

Aim.To study the association of single-nucleotide polymorphismrs3025058(5а/6а) with the development of stroke in patients of the East Siberian population with cardiovascular pathology and risk factors for its development. Materials and methods.The study involved 260 patients with stroke (age [57.0; 51.062.0]) and 272 patients of the control group (age [55.0; 51.062.0]). Among the patients who underwent stroke, 157 men and 103 women. The control group included 170 men and 102 women. The examination of the main group included: collection of complaints, anamnesis, clinical examination, computed tomography of the brain, electrocardiography, echocardioscopy, ultrasound duplex scanning of the extracranial brachiocephalic arteries, 24-hour monitoring of blood pressure and heart rate, analysis of the blood coagulation system. The patients of the main group had the following cardiovascular pathology and risk factors: arterial hypertension, paroxysmal supraventricular tachycardias, dyslipidemia, atherosclerosis of extracranial brachiocephalic arteries, disorders of the hemostasis system. The control group was examined within the framework of the international project HAPIEE. Molecular genetic research was carried out by real-time PCR. Statistical processing of the material was carried out using the Statistica for Windows 7.0, Excel and SPSS 22 application software. Results.The study established statistically significant associations between the 5a/5a genotype and the 5a allele and stroke in the general group of patients, as well as in the subgroup of men, subgroups of patients with extracranial brachiocephalic arteries atherosclerosis and dyslipidemia. In the subgroup of patients with cardiac arrhythmias, statistically significant results were obtained only for allele 5a, and in the subgroup of women with stroke, subgroups of patients with arterial hypertension and hypercoagulation, no significant associations ofrs3025058(5a/6a) polymorphism with stroke were found. Conclusion.Genotype 5a/5a and allele 5a of the single-nucleotide polymorphismrs3025058(5а/6а) increase the risk of stroke in individuals from the East Siberian population, including those in the presence of such risk factors as extracranial brachiocephalic arteries atherosclerosis and dyslipidemia.

Objective: to study the association of rs662799 with the development of acute cerebrovascular accident in patients with cardiovascular diseases and risk factors for their development. Material and methods. The material of the study was presented by 260 inpatient patients with acute cerebrovascular accident at the age of [57.0; 51.0–62.0] years as a comparison group, 272 patients aged [55.0; 51.0–62.0] years were examined, this is the control group of our study. According to gender, all patients in the main group were divided into 157 men and 103 women. There were 170 men and 102 women in the control group. All patients of the main group, along with routine methods of examination, were analyzed by the blood coagulation system, from instrumental methods of investigation-electrocardiography, echocardioscopy, ultrasound duplex scanning of extracranial brachioce phalic arteries, daily monitoring of blood pressure and heart rate, computed tomography of the brain. In patients of the main group, comorbid pathology was represented by the following cardiovascular diseases and risk factors: arterial hypertension (AG), paroxysmal supraventricular tachycardia, dyslipidemia, atherosclerosis of brachiocephalic arteries, disorders of the hemostasis system. The control group was investigated as part of the HAPIEE international project. Molecular genetic analysis was performed by real-time PCR. Statistical processing of the material was carried out using the Excel application kit and SPSS 22. The study was performed in accordance with Good Clinical Practice standards and the principles of the Helsinki Declaration. The study protocol was approved by the Ethics Committees of all participating clinical centers. Prior to inclusion in the study, written informed consent was obtained from all participants. Results. In all analyzed groups and subgroups of patients, an association was established between the rare G allele and the increased risk of PMC. The GG genotype showed significant associations with PMK in the main patient group, in the male subgroup, and in the AG subgroup. Conclusion. The AG genotype and the G allele rs662799 increase the risk of stroke in patients regardless of previous cardiovascular pathology and risk factors, including patients with arterial hypertension, supraventricular tachyarrhythmias, atherosclerosis of the brachiocephalic arteries, impaired lipid metabolism and the hemostatic system.

This article provides an overview of the European Society of Cardiology Guidelines for the management of patients with supraventricular tachycardia, developed in collaboration with the Association for European Paediatric and Congenital Cardiology and presented during the European Congress of Cardiology in Paris on August 31, 2019. The new Guidelines address the issues of diagnosis, acute and chronic treatment of all supraventricular tachycardias, with the exception of atrial fbrillation; they include chapters on supraventricular rhythm disorders in patients with congenital heart defects, tachycardia-induced cardiomyopathy, and pregnant women. Particular attention is paid to the use of radiofrequency ablation as the most modern, effective and dynamically developing technique for eradicating arrhythmias.

Aim. To study the association of single nucleotide polymorphism (SNP) rs556621 (G>T) with the development of stroke in patients of the East Siberian population with cardiovascular pathology and risk factors. Material and methods. The study involved 260 patients with stroke (157 men and 103 women) and 272 patients of the control group (170 men and 102 women). The following cardiovascular pathology and risk factors were present in the patients of the main group: arterial hypertension, paroxysmal supraventricular tachycardias, dyslipidemia, atherosclerosis of the brachiocephalic arteries, disorders of the hemostatic system. All patients underwent clinical, instrumental and molecular genetic examination. Statistical processing of the material was carried out using the set of application programs Statistica for Windows 7.0, Excel and SPSS 22. Results. As a result of the study, no statistically significant associations of genotypes and alleles of the rs1800801 polymorphism (C>T) with stroke were found in any of the analyzed groups and subgroups. Conclusion. SNP rs1800801 (C>T) does not have a significant effect on the development of stroke in people of the East Siberian population, regardless of the preceding cardiovascular pathology and risk factors.

Aim. To study the association of single nucleotide polymorphism (SNP) rs2230806 (C>T) with the development of acute cerebrovascular accident (CVA) in East Siberian patients with cardiovascular pathology and risk factors.Material and methods. The study involved 260 patients with acute CVA (age [57,0; 51,0-62,0]) and 272 patients of control group (age [55,0; 51,0-62,0]). Among patients with acute CVA there were 157 men and 103 women. The control group included 170 men and 102 women. Examination of the experimental group included: acquisition of complaints, anamnesis, clinical examination, computed cerebral tomography, electrocardiography, echocardioscopy, ultrasound duplex scanning of extracranial brachiocephalic arteries, 24-hour monitoring of blood pressure and heart rate, analysis of the blood coagulation system. In patients of the experimental group, the following cardiovascular pathology and risk factors were present: arterial hypertension, paroxysmal supraventricular tachycardia, dyslipidemia, atherosclerosis of the brachiocephalic arteries, hemostatic system disorders. The control group was examined as part of the international HAPIEE project. Molecular genetic studies were performed by real-time PCR.Results. In all analyzed groups and subgroups of patients, a statistically significant relationship was found between the CC genotype and the C SNP allele rs662799 (A>G) and an increased risk of stroke.Conclusion. The CC genotype and the C SNP allele rs2230806 (C>T) increases the risk of acute cerebrovascular accident in patients regardless of previous cardiovascular pathology and risk factors, including in patients with arterial hypertension, supraventricular tachyarrhythmias, atherosclerosis of brachiocephalic arteries, and disorders of lipid metabolism and hemostatic system.

Aim. To study the association of single nucleotide polymorphism rs556621 (G> T) with development of stroke in patients of the East Siberian population with cardiovascular pathology and risk factors.Material and methods. The study involved 260 patients (157 men and 103 women) with stroke (mean age 57.0 [51.0-62.0]) and 272 patients (170 men and 102 women) of the control group (mean age 55.0 [51.0-62.0]). The examination of the main group included: collection of complaints, anamnesis, clinical examination, computed tomography of the brain, electrocardiography, echocardioscopy, ultrasound duplex scanning of extracranial brachiocephalic arteries, daily blood pressure and heart rate monitoring, analysis of the blood coagulation system. The patients of the main group have arterial hypertension, paroxysmal supraventricular tachycardias, dyslipidemia, atherosclerosis of the brachiocephalic arteries, disorders of the hemostatic system. The control group was studied in the framework of the HAPIEE international project. Molecular genetic research was performed by real-time polymerase chain reaction.Results. There were no statistically significant differences in the frequencies of genotypes and single nucleotide polymorphism rs556621 alleles (G>T) in the subgroup of patients with stroke and those in the control group. The frequency of the rare TT genotype among patients with stroke was 13.3%±4.16, among healthy individuals – 8.8±3.37% (p=0.1). Gender differences when comparing the frequencies of genotypes and alleles were also not detected (p>0.05). The frequencies of the TT genotype were approximately the same in the subgroup of patients with arterial hypertension (13.1%±4.22) and in the control group (7.4±5.25%; p>0.05). No significant differences were observed in the frequencies of the rare genotype of the studied polymorphism in the subgroup of patients with supraventricular tachycardias (20.0±14.37%), hypercoagulability (15.9±7.64%) and the control group (8.8±3.37%), p>0.05. A statistically significant relationship was found between the rare genotype TT of single nucleotide polymorphism rs556621 (G>T) and the development of stroke in patients with dyslipidemia and atherosclerotic lesions of the coronary arteries (p=0.041; odds ratio 1.86, 95% confidence interval 1.02-3.41).Conclusion. The genotype of TTs of single nucleotide polymorphism rs556621 (G> T) increases the risk of developing stroke in patients with dyslipidemia and atherosclerosis of the brachiocephalic arteries compared with carriers of the GG and GT genotypes. The obtained data are recommended to be considered when prescribing lipid-lowering and antithrombotic therapy.

The possibility to identify potentially life-threatening ventricular arrhythmias by analysis of standard electrocardiography (ECG) parameters without the use of sophisticated and expensive diagnostic techniques, such as electrophysiological heart studies, has been an important achievement of the last decades. Current differential diagnostic methods for wide QRS complex tachycardias can be categorized into 4 groups: 1) identification the ECG signs diagnostic of ventricular tachycardia, such as atrioventricular dissociation and/or sinus captures and/or fusion QRS complexes; 2) analysis of the distinct morphological features of QRS complexes during wide QRS complex tachycardias; 3) analysis of the ECG characteristics in between wide QRS complex tachycardia attacks; 4) comparison of the morphological QRS features during wide QRS complex tachycardia and during sinus rhythm periods. The list of ECG algorithms for differential diagnosis of wide QRS complex tachycardias has been growing and updated year after year; however, all of them have their limitations. Most frequently, the differential diagnosis between ventricular and aberrant supraventricular tachycardias is based on the morphological criteria of wide QRS complexes developed by H.J. Wellens et al., P. Brugada et al., M. Griffith et al., K.E. Kindwal et al., A. Vereckei et al. At the same time, there is a continuous search for new algorithms or criteria that could be easily used without decreased specificity and/or sensitivity of the diagnosis of ventricular tachycardia. The aim of this review is to comprehensively analyze the literature data and results of our own studies on the potential and limitation of standard ECG for the differential diagnosis of ventricular and various aberrant supraventricular tachycardias.

Rhythm and conduction disorders of the heart occupy one of the leading places in the structure of cardiovascular pathology in children. Supraventricular tachycardias means tachyarrhythmias, caused by abnormal myocardial excitation with the source of rhythm localization above the His bundle bifurcation — in the atria, atrioventricular junction (node), and also arrhythmias with circulation of the excitation wave between the atria and the ventricles with additional atrial compounds. The team of authors presents clinical recommendations developed on the principles of evidence-based medicine, including all stages of diagnosis and treatment of children with supraventricular tachycardias. The use of recommendations in clinical practice allows to selecte the best strategy for diagnosis and treatment of supraventricular tachycardia in a particular patient.

With the participation: All-Russian Scientific Society of Specialists in Clinical Electrophysiology, Arrhythmology and Pacing, Russian Association of Cardiovascular SurgeonsEndorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation

Supraventricular tachycardia (SVT) is one of the most common arrhythmias. The prevalence of SVT varies widely in different countries and is 2,25 per 1,000 people in the general population. SVT reduce the quality of life of patients, and in some cases can worsen the prognosis. In patients with cardiovascular disease, the risk of SVT increases. Therapy of SVT is selected depending on the stability of hemodynamic and the QRS width. Until now, the treatment of SVT remains an urgent issue of modern cardiology, since despite the high effectiveness of catheter ablation, antiarrhythmic therapy plays an important role.

Patients with dilated cardiomyopathy (DCM) often have intraventricular conduction disorders, which contribute to aggravation of heart failure, are progressive in most cases and can specify the prognosis of the disease. Paroxysmal supraventricular arrhythmias in such patients proceed with severe clinical manifestations, often accompanied by hemodynamic instability and syncope. A case report of patient (59 years old) with DCM, reduced left ventricular ejection fraction (35-37%), left bundle branch block, and paroxysmal orthodromic reciprocating tachycardia is presented. When an electrode was inserted on the right ventricular (RV) apex during the radiofrequency ablation, a third-degree atrioventricular (AV) block was recorded. This was maintained during the operation and was recurrent when trying to remove the electrode from the RV apex, and therefore there was a need for temporary and then permanent cardiac pacing therapy. Given DCM, reduced left ventricular ejection fraction, left bundle branch block, and the expected high percentage of RV pacing, a decision was made to implant a cardiac resynchronization therapy defibrillator. The literature review considers risk factors for formation of third-degree AV block during cardiac catheterization, methods of its prevention, as well as discusses the prognostic significance of catheter-induced conduction disorders, and indications for temporary and permanent cardiac pacing therapy.

Arrhythmia is often detected in cancer patient, from single ventricular premature contractions to sustained ventricular tachycardia, life threatening ventricular fibrillation and sudden cardiac death. Oncology per se, aggressive anticancer treatment, both chemotherapy and radiation and basic cardiac conditions are main causative factors for tachyarrhythmia. In this review we summarize evidence of arrhythmia and emphasize the importance of cardiac monitoring for the early diagnosis, intervention and surveillance of those patients more susceptible to develop proarrhythmia. Oncologists should be fully aware of arrhythmia and the close collaboration between cardiologists and oncologists would result in a better cardiovascular assessment, risk stratification, cardiac monitoring and treatment.

The paper describes a clinical case of a female patient with severe obstructive sleep apnea syndrome in the presence of congenital hemangioma of the face, soft palate, and tongue concurrent with paroxysmal atrial fibrillation and atrial flutter, paroxysmal supraventricular tachycardia, and sinoatrial block (maximally up to 3.9 sec). Continuous positive airway pressure therapy could reduce the number of paroxysms of atrial fibrillation and atrial flutter, supraventricular tachycardia and eliminate sinoatrial block.