The literature review presents an analysis of domestic and foreign publications, modern clinical recommendations for infective endocarditis. Based on the analysis of literature data, a change in the structure of pathogens of infective endocarditis was established, where Staphylococcus aureus occupies the leading place. Algorithms for examining patients with infective endocarditis have been analyzed. It has been shown that the role of nuclear imaging methods in the diagnosis of this pathology has increased. According to the latest recommendations for the management of patients with infective endocarditis, the diagnostic criteria for this disease have not changed significantly.

The literature review presents an analysis of domestic and foreign publications, modern clinical guidelines for infective endocarditis. Based on the analysis of literature data, the main directions of examination of patients with infective endocarditis, including complicated forms of the disease, were determined. Approaches to the treatment and prevention of infective endocarditis are analyzed. Modern aspects of surgical treatment of this pathology are considered.

The literature review is devoted to one of the most common secondary forms of arterial hypertension – renovascular hypertension of atherosclerotic genesis. The review examines the prevalence of this problem, pathogenetic mechanisms, risk factors and clinical manifestations. Special attention should be paid to the problem of combining renovascular arterial hypertension with renal dysfunction and with manifestations of heart failure, which is most typical for bilateral hemodynamically significant stenoses or significant stenosis of a single functioning kidney, and allows us to formulate an idea of atherosclerotic renovascular disease. The review contains modern ideas about the diagnosis of this disease and the tactics of managing patients with this pathology. Special attention should be paid to indications for revascularization and ways to restore blood flow through the renal arteries. The review discusses in detail the problems of patient management after interventional treatment and the prognosis of patients with atherosclerotic renovascular disease.

Cardiac age-related transthyretin amyloidosis is an underdiagnosed reason of heart failure with preserved ejection fraction, the most frequent form of heart failure. We present a clinical case of detection of transthyretin amyloidosis of the heart at stage I-II of the disease based on biomarkers, which made it possible to send the patient to a third-level hospital and achieve the maximum possible compensation for the disease. Based on this case report, we review modern algorithms allowing to suspect and make the diagnosis, from performing routine tests like ECG and echocardiography to more sophisticated instruments like 2D strain-echocardiography, radiology and endomyocardial biopsy. Also staging systems using biomarkers for cardiac transthyretin amyloidosis are discussed. We consider possible paths to early diagnosis of this disease and nuances of medical therapy.

Acute coronary syndrome (ACS) is a life-threatening condition, for the treatment of which modern methods of myocardial revascularization are used, but in the long-term follow-up period, coronary artery restenosis often occurs, which requires re-intervention. There are many factors that influence the risk of developing long-term complications. Moreover, most of them, such as age, heredity, anatomical features of damage to the coronary arteries, are non-modifiable. At the same time, there are a number of indicators that influence the likelihood of developing restenosis, which can become a potential target for therapeutic intervention. The search for predictors of lumen loss in stented arteries is an urgent problem.

Introduction. Atrial fibrillation (AF) and obstructive sleep apnea (OSA) are common in the population and share common risk factors. The prevalence of OSA in AF is established, but the incidence of AF in patients with OSA is not studied.

Purpose. To study the incidence of atrial fibrillation and atrial remodeling in patients with varying severity of obstructive sleep apnea syndrome.

Materials and methods. Retrospective analysis of 216 medical records of patients hospitalized in a therapeutic hospital in whom screening respiratory monitoring revealed OSA.

Results. Atrial fibrillation was diagnosed in 62/216 patients (28,7 %) with OSA. AF was more often observed in patients with severe OSA – in 27/76 (35,5 %) compared to those examined with a mild degree – 16/78 (20,5 %) (p=0,043). Permanent AF was more common in severe OSA compared to mild OSA (48,2 % and 10,5 %; p<0,01). The left atrial volume index (LAVI) in patients with paroxysmal AF in combination with severe OSA is greater than in patients with AF and mild and moderate OSA (58,4±11,3; 40,8±8,1 and 41,9±7,7; p<0,01). The right atrium volume index (RAVI) in patients with paroxysmal AF in combination with severe OSA is greater than in patients with AF and mild and moderate OSA (42,8±11,0; 30,2±2,2 and 32,7±8,4; p<0,05).

Conclusion. Atrial fibrillation in patients with obstructive sleep apnea syndrome is more common than in the general population, and the combination of paroxysmal atrial fibrillation with severe sleep disordered breathing characterized by more pronounced atrial remodeling than when arrhythmia is combined with mild to moderate sleep apnea.

The article describes a case of successful surgical correction of left ventricular outflow tract obstruction in a patient with hypertrophic cardiomyopathy.

Sleep-disordered breathing and nighttime bradyarrhythmias associated with this syndrome are often encountered in clinical practice. With high-grade atrioventricular blocks, such patients are usually implanted with a permanent pacemaker, but this treatment method is not indicated for patients with reversible conduction disorders. A clinical case of the successful use of CPAP therapy in a patient with second degree atrioventricular block at night associated with obstructive sleep apnea syndrome is presented. Approaches to the diagnosis and treatment of patients with bradyarrhythmias are discussed.

Introduction. Orthostatic hypotension (OH) is a common problem in elderly people, characterized by a pathological decrease in blood pressure (BP) upon moving to an upright position and leading to weakness, dizziness, and syncope.

Aim. To present a clinical case of OH in an elderly patient and discuss the features of diagnosis and treatment of OH in his patient category.

Materials and methods. A clinical case of a 76-year-old patient with a history of cancer who was diagnosed with OH is described. A comprehensive examination was performed, including a passive orthostatic test (tilt table test).

Results. During the orthostatic test, a decrease in systolic BP by 18 mmHg upon verticalization and impaired baroreflex sensitivity were revealed. Based on the discussion of the clinical case and a literature review, the features of management of elderly patients with OH were considered, including the need for an individual approach taking into account comorbidity, functional status, and the risk of adverse effects of therapy. Recommendations for non-pharmacological methods of OH correction and careful selection of medications when drug treatment is necessary are given. The importance of educating patients and their relatives about measures to prevent OH and associated complications is emphasized.

Conclusion. Timely diagnosis and correction of OH in elderly patients are essential for preventing falls, injuries, and improving quality of life. Management of patients with OH requires a comprehensive approach, taking into account individual characteristics, and should include both non-pharmacological methods and rational pharmacotherapy.

Mikhail Petrovich Ilyin is a leading clinician and therapist who devoted his life to serving the patients, raising a school of students who consider him their teacher. In addition to clinical work, he is an excellent artist, whose paintings are in collections in many countries around the world. Statements about Mikhail Petrovich by colleagues of the art staff are given.