Saratov JOURNAL of Medical and Scientific Research

Shvartz Yu.G.

Saratov State Medical University

Clinical and echocardiographic features of heart failure in patients with obstructive sleep apnea and atrial fibrillation

Year: 2016, volume 12 Issue: №3 Pages: 349-353
Heading: Cardiology Article type:
Authors: Cherkasova S.A., Shvarts Yu.G.
Organization: Saratov State Medical University
Summary:

The combination of heart failure, obstructive sleep apnea syndrome and atrial fibrillation is a widespread case. Besides, the correlation between these pathologies has not been accurately determined yet. The aim of the research is to determine the specific features of heart failure in patients with atrial fibrillation. Material and Methods. 174 patients were involved in the research. There were people at the age of 75 and younger suffering with heart failure. 116 of them also experienced artrial fibrillation and 58 sinus rhythm. In addition, all the patients involved had hypertension. The patients underwent echocardiography and respiratory monitoring. Results. Statistical analysis showed that atrial fibrillation was a more powerful predictor of the occurrence of obstructive sleep apnea than heart failure. Furthermore, we have found significant peculiarities in relations between the features of heart failure, presence and severity of obstructive sleep apnea in the group of the patients with atrial fibrillation. Remodeling of the left heart cameras was more typical for the patients with atrial fibrillation. Conclusion. Heart failure has significant features in patients with atrial fibrillation and obstructive sleep apnea.

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Chronic oral pathology and ischemic heart disease and its complications

Year: 2013, volume 9 Issue: №3 Pages: 408-412
Heading: Stomatology Article type: Original article
Authors: Ivaschenko Y.Y., Shvarts Y.G., Parkhonyuk E.V., Eremin O.V.
Organization: Saratov State Medical University
Summary:

Objective: to establish the relationship of chronic generalized periodontitis, multiple cavities and dentofacial anomalies with various forms of coronary heart disease and its complications. Material and methods. The study included 294 patients with coronary heart disease and its complications. The patients were divided into two groups. Group I included 89 patients with acute Q-myocardial infarction, which was placed in the presence of at least 2 of the following criteria identified on the basis of a comprehensive clinical and instrumental examination: clinical, laboratory confirmation (CK-MB), electrocardiographic signs of damage or myocardial necrosis. The following statistical methods were used: multi-variate and univariate analysis of variance, non-parametric tests, crosstabulation, chi-square test, Fisher»s exact test. As a measure of variability of the normal distribution standard deviation was used. Results. It is noted that in patients with myocardial infarction more likely than in patients without coronary heart attack in history severe generalized periodontitis, dentofacial anomalies and multiple dental caries have appeared. In patients with acute myocardial infarction, severe periodontal disease has been associated with increased fibrinogen levels in the blood and an increase in the dispersion of the interval QT, which are known to be indicators of poor prognosis in acute coronary disease.

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Physician personal characteristics influencing long-term treatment of patients with cardiovascular diseases

Year: 2013, volume 9 Issue: №2 Pages: 263-269
Heading: Internal Diseases Article type: Original article
Authors: Strokova E.V., Naumova Е.A., Schwartz Y.G., Semenova O.N.
Organization: Saratov State Medical University
Summary:

The main purpose of the article is to identify the peculiarities of a doctor personality, affecting long-term therapy in patients with cardiovascular diseases. Materials and methods: To determine the type of temperament, the presence and intensity of the syndrome of emotional burnout and capacity for empathy therapists and cardiologists were asked to fill in a number of questionnaires. Each doctor had a group of patients contacting by telephone for a year after the discharge from the hospital. During the telephone contact, the patients were asked about the continuation of their therapy recommended in the hospital, the regularity of therapy, the frequency of absence, and the assessment of a physician by the patients. Results: 35 questionnaires were suitable for interpretation. Through one year after the discharge from the hospital it was able to contact with 147 patients, 18.4% (27) of patients completely stopped the treatment by recommended drugs. Positive assessment of physicians was associated with the continuation of the therapy by recommended drugs and regularity of drug taking (p=0,03). Patients assessed physicians positively more often in cases of low level of emotional state, high level of depersonalization (cynicism) and the reduction of personal accomplishment (feeling of professional inefficiency) in a doctor. Conclusion: Assessment of physicians by patients is reliably and significantly influenced by continuation of long-term therapy and regularity of drug taking.

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Analysis of changes in white matter of brain and cognitive disturbances in patients with chronic heart failure and ischemic heart disease

Year: 2013, volume 9 Issue: №1 Pages: 78-82
Heading: Neurology Article type: Original article
Authors: Shvarts Y.G., Akimova N.S., Martynovich Т.V.
Organization: Saratov State Medical University
Summary:

The aim of the article is to study the relation of chronic heart failure, cognitive disturbances and changes in white matter of brain. Material et methods: Cognitive tests, echocardiography, MRI of brain and measurement of NT-proBNP in venous blood have been performed in 57 patients with l-IV functional class of chronic heart failure. Program STATISTICA 7 (methods of nonparametric correlation analysis) has been used to assess the results. Results: It has been established that during the increase of severity of CHF decrease in the thickness of medium-sized peduncles of cerebellum and the changes of coefficients of diffusion of water molecules in white matter have been marked. Conclusions: On the basis of these findings it has been determined that CHF is an independent cause of micromorphological brain damage and later the progressive atrophy of white matter. It clearly shows that the cerebral changes cause cognitive dysfunction.

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Cardiac biopotentials influence on central nervous system functioning: first steps in hypothesis verification

Year: 2012, volume 8 Issue: №4 Pages: 947-953
Heading: Internal Diseases Article type: Original article
Authors: Shvarts Yu.G., Cherkasova S.A., Kondal'skaya Yu.O.
Organization: Saratov State Medical University
Summary:

The research goal is to verify the hypothesis on influence of cardiac biopotentials on central nervous system. Materials: 20 healthy individuals aged 18-26 years old have been participated in the investigations. Two groups composed of 10 patients each have been formed. Double increase in heart biopotentials by means of artificial impulse insertion between natural cardiac contractions has been modeled. Artificial impulses have been similar to unaffected ones, produced in a normal heart work. Additional impulses have been generated using external pacemaker and have been linked up with electrodes on the chest. They have been synchronized with the heart rhythm and located in-between R waves. The duration of those impulses has been fully matched to ventricular complex. Their amplitude has been adjusted individually depending on the height of R wave. Nervous system mobility has been used as the indicator reflecting the central nervous system functioning. Degree of mobility has been defined on the basis of tapping test results. The test has been repeated at specific intervals. Groups have been exposed to two adverse testing modes. Additional impulses have been conducted to the patients of group I within an hour over a period of the first and the third 15-minute intervals and to the patients of group II over a period of the second and the fourth 15-minute intervals. In the middle and in the end of each time interval tapping test has been carried out. After preliminary analysis two other modes of stimulation have been tested. The stimulation has been performed within the 40-minute course: over a period of the first 20-minute interval and vice versa. Results: Detailed evaluation has revealed that short-time increase of nervous processes has been checked in combination with decrease in their stability. Conclusion: The data obtained have shown that there is possible influence on central nervous system functioning. The article ends with prospects of further investigation.

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Early thyroid gland dysfunction and biorhythmic activity disturbance in patients with cardiovascular pathology and atrial fibrillation

Year: 2012, volume 8 Issue: №4 Pages: 926-933
Heading: Internal Diseases Article type: Review
Authors: Baurina Yu.O., Mayskova Е.А., Shvarts Yu.G.
Organization: Saratov State Medical University
Summary:

The review deals with the problem of combined pathology of the thyroid gland and cardiovascular system, the state of thyroid homeostasis in atrial fibrillation. The main mechanisms of action of thyroid hormones on the heart and blood vessels, particularly changes in the cardiovascular system with hypo-or hyperthyroidism; the possibility of substitution therapy in subclinical disease have been presented in the article. Characteristics of daily rhythmic activity of thyroid gland in normal and various pathological conditions with persistent and paroxysmal atrial fibrillation have been considered.

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Clinical and laboratory peculiarities of acute myocardial infarction after chronic tonsillitis

Year: 2012, volume 8 Issue: №2 Pages: 238-242
Heading: Internal Diseases Article type: Original article
Authors: Dzhukaeva Kh.R., Shvarts Y.G.
Organization: Saratov State Medical University
Summary:

Aim: The definition of the relationship of clinical and laboratory features of acute myocardial infarction depending on the suffering of chronic tonsillitis. Materials and methods. The study included 54 patients with acute myocardial infarction suffering for 1-2 days. The collection of the anamnesis, assessment of clinical factors, inspection of the palatine tonsils, clinical and biochemical blood tests have been done. Markers of myocardial necrosis, an electrocardiogram with calculation of a dispersion of interval QT, echocardiogram have been taken into account. Results. 45 of 54 patients reported the symptoms of chronic tonsillitis in their lifetime. At 17 patients the previous diagnosis of chronic tonsillitis has been made, in 6 of them bilateral tonsillectomy was held. All of the patients were divided into 2 groups: 1 with proven chronic tonsillitis (17 patients) and 2 — the others (37 patients). At patients with chronic tonsillitis substantially more developed acute heart failure at sick this group glucose of the blood at receipt was higher than in 2 groups (p=0,004), given distinction was independent of presence of diabetes. According to the echocardiography 1 group of patients determined course-diastolic dimensions of the right ventricle increase in comparison with 2 groups (p=0,01). Conclusion. In patients with chronic tonsillitis more severe course of acute myocardial infarction has been determined, which became evident in the relatively high values of blood glucose on admission. The frequent development of congestive heart failure, and increase of the course-diastolic dimensions of the right ventricle have been also revealed.

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Anemic syndrome in patients with ischemic heart disease and chronic heart failure (review)

Year: 2011, volume 7 Issue: №4 Pages: 831-837
Heading: Internal Diseases Article type: Review
Authors: Kaluta Т.Yu., Suvorova S.A., Shvarts Y.G.
Organization: Saratov State Medical University
Summary:

Anemic syndrome of different severity often accompanies ischemic heart disease (IHD) and chronic heart failure (CHF). Anemia has association with unfavorable prognosis in patients with all forms of CVD — acute and chronic. In this article the authors summarize a literature review of English articles dedicated to the problem of anemia and ischemic heart disease (IHD) and the results of original research on the relationship between anemic syndrome and prognosis in the hospitalized patients with IHD and chronic heart failure (CHF). Anemia is frequently observed in patients with CHF, and evidence suggests that anemia might be associated with an increased mortality in both systolic and diastolic chronic heart failure (CHF), morbidity and rate of hospitalization in CHF patients. Moreover, CHF itself could be involved in the pathogenesis of anemia. Early studies suggested a pathogenic role of inflammation mediators. The normalization of hemoglobin concentration by EPO and iron supply in patients with CHF and chronic renal insufficiency results in improved exercise capacity by increasing oxygen delivery and improving cardiac function. However, there is limited information concerning the association of hemoglobin concentration and new onset of clinically recognized coronary artery disease, and lack of information about the effect of anemia treatment on prognosis of acute forms of IHD

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Professor Pavel Nikolaevich Nikolaev (to the 130-th anniversary)

Year: 2011, volume 7 Issue: №2 Pages: 542-546
Heading: Scientific schools Article type: Review
Authors: Chernenkov Y.V., Shvarts Y.G., Erugina M.V., Zavialov A.I.
Organization: Saratov State Medical University
Summary:

The article presents biography of professor P. N. Nikolaev. It reflects his scientific and practical contribution to the development of the most significant directions in Russian medicine including professional training of Health Service specialists

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Anemic syndrome in hospitalized patients with ischemic heart disease: inflammation marker or factor of pathogenesis?

Year: 2010, volume 6 Issue: №3 Pages: 596-600
Heading: Internal Diseases Article type: Original article
Authors: Suvorova S.A., Parkhonyuk Е.М., Shvarts Yu.G.
Organization: Ulyanovsk Central City Clinical Hospital, Saratov State Medical University
Summary:

The article presents the research results on the correlation between anemic syndrome and main risk factors in hospitalized patients with different forms of cardiovascular pathologies. This category of patients is characterized by more severe arterial hypertension and low level of total cholesterol in blood. It has been revealed that anemia in patients with CVD (cardiovascular diseases) is not only associated with unfavorable prognosis, but also becomes a marker of peculiarities in mechanism of disease development indicating the severity of inflammatory component

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