卷 16, 编号 2 (2025)

BACKGROUND: Identifying the association between thyroid dysfunction and the development of nonvalvular atrial fibrillation (AF) remains one of the complex and pressing issue in contemporary cardiology. To date, only a limited number of studies have examined the relationship between AF and the hypothalamic-pituitary-thyroid (HPT) axis, and the available findings are often contradictory. Few papers have explored the association between AF and HPT axis in experimental conditions.

AIM: The work aimed to evaluate the association between AF and the HPT axis in experimental models of hypothyroidism, euthyroidism, and thyrotoxicosis in rats.

METHODS: The study included 146 outbred rats. Group 1 comprised 42 rats with euthyroidism. Group 2 included 15 rats with overt thyrotoxicosis. Group 3 included 22 rats with subclinical thyrotoxicosis. Group 4 comprised 67 rats with euthyroid sick syndrome. The methods included electrocardiographic monitoring and measurement of thyroid hormone concentrations.

RESULTS: The frequency of AF paroxysms was found to depend on thyroid hormone levels: under euthyroid conditions, on thyroid-stimulating hormone (β = −0.250; p < 0.001) and thyroxine (β = 0.838; p = 0.012); in overt thyrotoxicosis, on thyroxine (β = 0.732; p = 0.00008) and triiodothyronine (β = 0.352; p = 0.043); and in subclinical thyrotoxicosis, on thyroxine (β = 2.1; p = 0.0002) and triiodothyronine (β = −0.970; p = 0.019). Threshold values of thyroid hormones were determined for euthyroid, subclinical, and overt thyrotoxic states.

CONCLUSION: A relationship between atrial fibrillation and thyroid functional status was established.

BACKGROUND: Analyzing the opinions of patients who have completed rehabilitation after acute myocardial infarction (AMI) enables assessment of various aspects of outpatient cardiac rehabilitation, identification of existing problems, and outlining of potential solutions.

AIM: The work aimed to assess the accessibility and quality of the outpatient stage of cardiac rehabilitation based on the opinions of patients who completed rehabilitation after AMI.

METHODS: A survey was conducted among 120 patients (98 men and 22 women) aged 41 to 74 years (mean age, 59.0 ± 8.7 years) who had undergone outpatient cardiac rehabilitation. A custom-designed 20-item questionnaire was used to evaluate the accessibility and quality of care.

RESULTS: A total of 117 patients (97.5%) reported a positive effect of the rehabilitation program on their well-being. Ninety-nine patients (82.5%) indicated that the goals and objectives of rehabilitation had been clearly explained by their outpatient physician. Overall, 105 patients (87.5%) evaluated the clinical component of rehabilitation positively. However, certain organizational shortcomings were identified: 26 patients (21.7%) reported difficulty reaching the clinic by phone; 29 (24.2%) mentioned waiting lists; and 45 (37.5%) noted long distances to the rehabilitation center. Unfortunately, only 58 patients (48.3%) expressed willingness to use telemedicine options (text messaging, phone calls, video consultations, mobile apps, etc.) if such services were available.

CONCLUSION: The findings may support timely and targeted adjustments to the organization of outpatient rehabilitation for patients with AMI, potentially improving their quality of life.

Chronic myeloproliferative neoplasms (MPNs) are a group of clonal hematopoietic disorders that predominantly affect older patients. These conditions are associated with increased risk of numerous complications. One of the key comorbidities in these patients is sarcopenia—a progressive loss of skeletal muscle mass, strength, and function—that significantly worsens quality of life and the prognosis of the underlying disease. The work aimed to systematize current data on the impact of sarcopenia on outcomes in patients with MPNs and to summarize recommendations for its early diagnosis and management to improve clinical outcomes. The review presents data on the epidemiology, pathogenesis, and clinical relevance of sarcopenia in patients with MPNs. Particular attention is given to the role of chronic inflammation, protein metabolism disorders, the consequences of antitumor therapy, and age-related changes in the development of muscle atrophy. The importance of early diagnosis of sarcopenia using modern tools—such as the SARC-F questionnaire, bioelectrical impedance analysis, and various physical performance tests—is emphasized. Strategies for correcting sarcopenia are presented, including physical exercise, nutritional support, and other approaches that may improve patient prognosis and quality of life. This work is of particular relevance to hematologists, geriatricians, and rehabilitation specialists involved in the care of patients with MPNs. Research into sarcopenia in the context of MPNs remains highly relevant, as timely diagnosis and management may significantly influence clinical outcomes.

The risk of thromboembolic complications associated with the use of combined oral contraceptives (COCs) and hormone replacement therapy is a concern for both physicians and patients. The work aimed to analyze existing data on the use of COCs and their associated thromboembolic risk. This review summarizes the findings of Russian and international studies conducted in women using COCs who experienced thrombotic complications. A total of 37 sources were used, including articles indexed in international citation databases such as PubMed (MEDLINE) and Scopus, as well as foundational studies and monographs indexed in the Russian Science Citation Index (RSCI). Data were selected using the following keywords: сердечно-сосудистые заболевания (cardiovascular diseases), комбинированные оральные контрацептивы (combined oral contraceptives), КОК (COCs), тромбоэмболия лёгочной артерии (pulmonary embolism), ТЭЛА (PE), and инфаркт миокарда (myocardial infarction). Materials with unidentified authorship, educational manuals, pseudoscientific online sources, and publications not relevant to the topic were excluded.

The review revealed that the use of COCs may influence the risk of developing pulmonary embolism (PE); however, thrombus formation is also affected by additional factors. Some studies suggest that third- and fourth-generation COCs may be associated with a higher risk of PE, although the absolute risk remains relatively low. It is important to emphasize that the decision to initiate COC use and the selection of a specific drug should be made by a physician based on the patient’s individual characteristics, medical history, and risk factors. Notably, discontinuation of COCs does not eliminate the risk of PE entirely, as hereditary predisposition, lifestyle, and comorbid conditions may also contribute.

INTRODUCTION: Complete atrioventricular block is a life-threatening condition that requires urgent intervention and pacemaker implantation. Determining the underlying cause of the block is essential for effective management. This article describes a rare clinical case of third-degree atrioventricular block caused by Hodgkin lymphoma.

Case Description: On January 14, 2023, an 81-year-old female was urgently admitted to a district hospital with dyspnea, generalized weakness, lower extremity edema, cough, and fever. The rhythm on electrocardiography was interpreted as atrial fibrillation, and chest radiography demonstrated pathologic findings. Pneumonia was diagnosed, and treatment with antibiotics, antiarrhythmic agents, and anticoagulants was initiated. During treatment, sinus rhythm with supraventricular extrasystoles and diffuse myocardial changes was recorded. No clinical improvement was observed. On January 31, 2023, complete atrioventricular block was documented. The patient was urgently transferred to the inpatient cardiology department, where a temporary pacemaker was implanted. Differential diagnosis of the conduction disturbance included drug-induced atrioventricular block and myocardial infarction. Echocardiography revealed masses in the right atrium, thickening of the pericardial leaflets, fluid accumulation in the cavities, and interventricular septal dyskinesia. Computed tomography planned to rule out pulmonary embolism (PE) was not performed because of technical limitations. After 29 hours of hospitalization, the patient died. Postmortem examination revealed Hodgkin lymphoma involving the mediastinum, blood vessels, and all layers of the heart. Thrombotic deposits and tumor emboli containing lymphoma cells were identified in the small branches of the pulmonary arteries. Advanced age, nonspecific symptoms, lack of suspicion for B symptoms, and the rarity of such a cause of atrioventricular block contributed to the delayed diagnosis.

CONCLUSION: Oncologic vigilance among cardiologists regarding patients with atrioventricular block remains low, which may result in diagnostic errors and, in some cases, fatal outcomes. Cardiac involvement may be the first manifestation of mediastinal lymphoma. In the present case, computed tomography might have guided physicians toward the correct diagnosis. This article aims to raise awareness among physicians about lymphomas with cardiac involvement, thereby facilitating earlier diagnosis and more effective treatment.