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Vasovagal syncope (VVS) can occur in every third of human population. Clinical symptoms of VVS areas a result of arterial hypotension with critical global cerebral hypoperfusion due to vasodilatation and bradicardia. Bradicardia is manifested as sinus node dysfunction and atrioventricular conduction disturbances due to activation of nervus vagus. Asystole can take place in some cases. Lack of efficacy of permanent pacemaker founds in patients to prevent of VVS. The results of double blind placebo controlled studies, European and American expert's opinions, probable causes of lack of efficacy of pacemakers in such category of patients and way of solution of this problem are discussed in the review. Syncope recurrences in spite of pacemaker implantation, risk of surgery complications and good life prognosis are arguments for therapeutic approach, now suitable for the most of patients with VVS. Case report (VVS with asystole but without of pacemaker implantation) with successful follow-up is analyzed in the article.

Some studies have shown that the echogenicity of atherosclerotic plaques (AP) in the carotid arteries (CA) plays an important role in evaluating the risk of cardiovascular events (CVE). The method of calculating the Gray Scale Median (GSM) is currently used to quantify the echogenicity of the CA plaque. Aim. To study GSM assessment of CA AP in patients with acute coronary syndrome (ACS) and the effect of GSM on the prognosis of CVE. Material and methods . We examined 143 patients with ACS (32-83 years old). Duplex scanning was performed on “Philips iU 22” for 1-3 days after hospitalization, the second — in 1-1,5 years. The echogenicity of the detected APs was assessed on a gray scale using a modified GSM method at the Multivox workstation. Results. We analyzed 378 CA AP in patients with ACS. The GSM analysis on the first and repeated surveys showed a significant increase in the average GSM by 2,2% (p

Aim Optimal combination therapy for chronic heart failure (CHF) currently implies the mandatory use of at least four classes of drugs: renin-angiotensin-aldosterone (RAAS) system inhibitors or angiotensin receptor blocker neprilysin inhibitors (ARNI); beta-adrenoblockers (BAB); mineralocorticoid receptor antagonists; and sodium-glucose cotransporter 2 inhibitors. Furthermore, many of these drugs are able to decrease blood pressure even to hypotension and alleviate tachycardia. This study focused on the relationship of 24-h blood pressure (BP) and heart rate (HR) with the prognosis for CHF patients with sinus rhythm and left ventricular ejection fraction (LV EF) Material and methods Effects of clinical data, echocardiographic parameters, 24-h BP, and heart rhythm (data from 24-h BP and ECG monitors) on the prognosis of 155 patients with clinically pronounced CHF, LV EF Results The one-factor analysis showed that the prognosis of CHF patients was statistically significantly influenced by the more severe functional class (FC) III CHF compared to FC II, reduced LV EF (71 bpm vs. 103 mm Hg), and the lowest death rate of 15.3 %; the group with increased HR (>69 bpm) but preserved SBP (30.3 % of all patients) where the death rate was 44.7 %, which was significantly higher than in the first group; the group with normal HR (≤69 bpm) but reduced SBP (≤103 mm Hg) (16.1 % of patients) where the death rate was 40 %, which was comparable with the second group and significantly worse than in the first group; and the group with both increased HR (>69 bpm) and reduced SBP (≤103 mm Hg) (15.5 % of patients), which resulted in the maximal risk of death (70.8 % of patients with CHF and LV EF Conclusion Low SBP (including 24-h SBP with reduced variability in day- and nighttime) in combination with high HR (including by data of Holter monitoring), low LV EF, more severe clinical course of CHF, and the absence of an adequate treatment with neurohormonal modulators (RAAS inhibitors and BAB) significantly increased the risk of death. Isolating four types of FC II-III CHF with sinus rhythm and EF

To elucidate whether there is a relationship between inflammation of the wall of aortic aneurysm and the number of vasa vasorum in it.The investigation material was aortic aneurysm wall segments obtained during surgery. Among the patients, there were 20 men and 5 women. The patients' age ranged from 33 to 69 years. The investigation used monoclonal antibodies to macrophages (CD68), T cells (CD3, CD4, and CD8) and antibodies to von Willebrand factor, endothelial NO synthase, and alpha smooth muscle actin. A morphometric study was conducted.Calculation of the number of vasa vasorum (including newly formed vessels) in the adventitia of aortic aneurysm revealed that there was a statistically significant difference between the number of vasa vasorum in patients with an active inflammatory response (Group 1) versus Group 2 patients with a moderate inflammatory process in the aneurysm wall (p≤0.05) and a statistically significant difference between Groups 1 and 3 (without inflammatory infiltrates) (p≤0.05). Endothelial vasa vasorum heterogeneity was found in case of an immune response to NO synthase. At the same time individual vasa vasorium did not contain NO synthase, this enzyme was identified in the endothelium in a number of nearby vessels.The increase in the number of vasa vasorum in the aneurysm wall in patients with abundant inflammatory infiltrates is due to the fact that some of the inflammatory cytokines of T-cells and macrophages also contribute to angiogenesis.Цель исследования - выяснить, существует ли связь между воспалением стенки аневризмы аорты и количеством vasa vasorum в ней. Материал и методы. Материалом для исследования служили сегменты стенки аневризмы аорты, полученные во время операции. Мужчин среди больных было 20 человек, женщин - 5. Возраст больных колебался от 33 до 69 лет. В работе использовали моноклональные антитела к макрофагам (CD68), Т-клеткам (CD3, CD4 и CD8), антитела к фактору Виллебранда, NO-синтазе эндотелия, α-актину гладкомышечных клеток. Проводили морфометрическое исследование. Результаты. Подсчет vasa vasorum (включая и вновь образованные сосуды) в адвентиции аневризмы аорты обнаружил статистически значимую разницу между количеством vasa vasorum у больных с активной воспалительной реакцией (1-я группа) по сравнению со 2-й группой пациентов с умеренным воспалительным процессом в стенке аневризмы (р≤0,05) и статистически значимую разницу между 1-й и 3-й группами (без воспалительных инфильтратов) (р≤0,05). При проведении иммунной реакции к NO-синтазе обнаружена гетерогенность эндотелия vasa vasorum. В то время как отдельные vasa vasorum не содержали NO-синтазу, в рядом расположенных сосудах этот фермент в эндотелии был выявлен. Выводы. Увеличение количества vasa vasorum в стенке аневризмы у больных с обильными воспалительными инфильтратами обусловлено тем, что некоторые из воспалительных цитокинов Т-клеток и макрофагов способствуют еще и ангиогенезу.