Ишемическая болезнь сердца (ИБС) является важнейшим фактором заболеваемости и смертности населения во всем мире, а коронарная болезнь сердца(КБС) занимает лидирующие позиции в структуре временной и стойкой утраты трудоспособности населения во всех странах мира. Согласно статистическим данным Всемирной организации здравоохранения (ВОЗ) в Российской Федерации (РФ) по сравнению со странами Евросоюза и Соединенных Штатов Америки (США) имеет место значительное превышение показателей смертности от болезней системы кровообращения (БСК), в том числе ишемических болезней сердца (ИБС). Статистика сердечно-сосудистых заболеваний в мире неутешительна – более 17 миллионов смертей, что составляет треть от общего количества умерших. По статистике от сердечно-сосудистых заболеваний в России умирает один миллион человек в год. Частым проявлением КБС является стабильная стенокардия(СС). Отсутствие эффекта или недостаточная эффективность медикаментозной терапии, прогрессирующий характер стенокардии, многосо-судистые поражения КА, снижение фракции выброса левого желудочка(ЛЖ), поражение ствола левой КА служат показаниями для реваскуляризации миокарда. Медико-социальная значимость коронарной болезни сердца(КБС) огромна, смертность от нее не снижается, в том числе среди молодых и спортсменов и является частой причиной инвалидизации трудоспособного населения. На фоне успехов хирургического лечения КБС становится очевидной недостаточная разработанность методов реабилитации больных, перенесших оперативное вмешательство. Не в полной мере осуществляется индивидуальный подход к проведению кардиореабилитации(КР) с учетом особенностей состояния пациента, у значительной части больных затягиваются сроки КР, что приводит к неоправданным финансовым затратам.
One of the most dangerous diseases that threaten human life is heart disease. One way to analyze heart disease is by doing echocardiography. Echocardiographic test results can indicate whether the patient's heart is normal or not by identifying the area of the heart cavity. Therefore, many studies have emerged to analyze the heart. Therefore, I am motivated to develop a system by inputting four points of view of the heart, namely 2 parasternal views (long axis and short axis) and 2 apical views (two chambers and four chambers) with the aim of this study being able to segment the heart cavity area. This research is part of a large project that aims to analyze the condition of the heart with 4 input points of view of the heart and the project is divided into several sections. For this research, it focuses on the process of echocardiographic image segmentation to obtain images of the heart cavity with 4 input points of view of the heart using the Deep Learning method by using the Convolutional layers.
В настоящее время во всем мире смертность от сердечно-сосудистых заболеваний (ССЗ) начала снижаться, но в Узбекистан до сих пор занимают лидирующее положение в структуре смертности населения. Ежегодно только от ССЗ умирает больше людей, чем от любой другой патологии. Поэтому так важно выявить основные факторы риска в развитии данной патологии у человека. По данным ВОЗ от ССЗ в 2016 году умерло порядка 18 миллиона человек во всем мире. Это составило 31% от всех зарегистрированных случаев смерти. Ишемическая болезнь сердца, сердечный приступ и инсульт – на них приходится порядка 85% от всех смертей. Известно, что одним из факторов риска является мужской пол, это связано с тем, что мужчины до 50-55 лет чаще курят и употребляют алкоголь поэтому они чаще подвержены развитию явлений стенокардии. При этом низкую заболеваемость среди женщин связывают с гормональным фоном, а с наступлением климакса процент заболеваемости выравнивается. У мужчин риск ССЗ увеличивается после 45 лет, а у женщин — после 55 лет. Так же нельзя недооценивать значение наследственности в развитии коронарной болезни сердца, как известно: для людей, чьи родители или другие члены семьи имеют симптоматическую коронарную болезнь сердца, характерна повышенная вероятность развития заболевания. Увеличение относительного риска у лиц с отягощенной наследственностью может быть в 5 раз. Риск особенно высок, если развитие ССЗ у родителей или других членов семьи произошло до 55-летнего возраста. Наследственность способствует развитию гипертензии, сахарного диабета, ожирения и, возможно, определенных структур поведения, приводящих к развитию заболевания сердца.
в настоящее время во всем мире смертность от сердечно-сосудистых заболеваний (ССЗ) начала снижаться, но в Узбекистан до сих пор занимают лидирующее положение в структуре смертности населения. Ежегодно только от ССЗ умирает больше людей, чем от любой другой патологии. Поэтому так важно выявить основные факторы риска в развитии данной патологии у человека. По данным ВОЗ от ССЗ в 2016 году умерло
порядка 18 миллиона человек во всем мире. Это составило 31% от всех зарегистрированных случаев смерти. Ишемическая болезнь сердца, сердечный приступ и инсульт – на них приходится порядка 85% от всех смертей. Известно, что одним из факторов риска является мужской пол, это связано с тем, что мужчины до 50-55 лет чаще курят и употребляют алкоголь поэтому они чаще подвержены развитию явлений стенокардии. При этом низкую заболеваемость среди женщин связывают с гормональным фоном, а с наступлением климакса процент заболеваемости выравнивается. У мужчин риск ССЗ увеличивается после 45 лет, а у женщин — после 55 лет. Так же нельзя недооценивать значение наследственности в развитии коронарной болезни сердца, как известно: для людей, чьи родители или другие члены семьи имеют симптоматическую коронарную болезнь сердца, характерна повышенная вероятность развития заболевания. Увеличение относительного риска у лиц с отягощенной наследственностью может быть в 5 раз. Риск особенно высок, если развитие ССЗ у родителей или других членов семьи произошло до 55-летнего
возраста. Наследственность способствует развитию гипертензии, сахарного диабета, ожирения и, возможно, определенных структур поведения, приводящих к развитию заболевания сердца.
The aim of the study was to study the clinical and diagnostic significance of natriuretic peptide
(BNP) in heart failure (HF) in children with congenital heart defects.
Methods. The study included 24 children under 3 years of age with HF. All patients had HF
secondary to congenital heart disease and clinical data, echocardiographic parameters were collected. A comparative analysis of the data indicating significant changes in BNP with characteristic changes on the echocardiogram characterizing the signs of heart failure in children was carried out. Study results: analysis of NT-proBNP values and type of heart disease associated with HF. In our
cohort, median NT-proBNP was highest in patients with cyanotic heart disease (248.0 fmol/ml), followed by patients with dilated cardiomyopathy (193.3 fmol/ml). The lowest median value of NT-proBNP was recorded in patients with acyano- tic heart disease.
Conclusion. In patients with HF, BNP and echocardiography can provide diagnostic and
prognostic information. The highest BNP values were reported in patients with lower LVEF, but were not statistically significant. The combination of all these data may offer the best tools for optimizing the treatment of heart failure in children.
Purpose of the study: to study the effect of the combination of valsartan with sacubitril on myocardial remodeling in patients with coronary heart disease after revascularization. Material and research methods. The study included 320 patients with coronary artery disease who underwent coronary revascularization. On average, the concentration of creatinine was 90.08 ± 1.72 µmol / L. All patients were divided into 2 groups: patients who received valsartan (group B, 160 people), patients who received ARNI - a combination of valsartan and sacubitrile molecules (group C, 160 people). Also, all patients were divided into 2 subgroups depending on the degree of eGFR decrease by the 3rd month of observation: patients with a decrease in eGFR by the 3rd month of observation more than 20% (group 1 - 59 patients) and less than 20% (group 2 - 261 sick). In dynamics, three months later, at the end of the first and second years of follow-up after revascularization, all patients underwent an echocardiographic study (EchoCG). Research results. During the observation process, it was found that against the background of both therapy options, there was a positive dynamics of indicators characterizing myocardial remodeling. he relative dynamics of indicators between the treatment groups was comparable at all stages of observation. In the group of patients with a decrease in eGFR of more than 20% in the first 3 months against the background of standard therapy after revascularization, no significant dynamics of the geometric parameters of the heart was observed at all follow-up periods. In the group of patients who received standard therapy with the addition of sacubitrile, both in group 1 and in group 2, more favorable geometric parameters were achieved, demonstrating a decrease in the severity of pathological remodeling and the formation of CHF. Conclusion. The use of sacubitril in the treatment of patients with coronary artery disease contributes to a more pronounced positive remodeling of the heart chambers - a decrease in the size of the chambers and the LV sphericity index. The effect is more pronounced in patients with a tendency to rapidly develop CKD.
It is shown the results of the investigation on the new methods of noninvasing diagnosing of Ischemic Heart disease in this paper. This method is based on analyzes of expirating air. The results of investigation showed the possibility of the surface ionizating detector in diagnosis of Ischemic Heart disease. It was revealed the statisticly importance of difference in containing the amines in expirating air of patients ill w ith Ischemic Heart disease and healthy people. The advantage of this method concludes whole harmless, expressive ness and canceling the operative intervention and possibilities of mass testing, and cheap price of observation. The difference in eliminating the amines with expirating air can be stable marker for early diagnosing of the preinfarctive state
Atherosclerosis is a chronic lesion of the arteries caused by the growth of multiple dense nodular thickenings of the walls of the artery (plaques), narrowing its lumen and contributing to the formation of a blood clot - a thrombus, which can clog the vessel. Atherosclerosis develops as a result of complex structural changes that occur in the intima (inner layer) and in the media (muscle layer) of the arteries, and it is associated with the accumulation of lipids and mucopolysaccharides in the blood vessels, the growth of connective tissue and the deposition of calcium. Cardiovascular pathology, and this is ischemic heart and brain disease, occlusive diseases of peripheral arteries, is the most common cause of morbidity, mortality and disability in the population of industrialized countries. According to the statistics of the World Health Organization, in the structure of total mortality in Russia, cardiovascular diseases account for 57%. Most of these cases are associated with diseases caused by atherosclerosis [3]. The development of atherosclerotic lesions of the vascular wall is a complex multi-stage process. It has now been established that even before endothelial damage, blood components begin to interact with the endothelial surface. In particular, low-density lipoprotein cholesterol (LDL-C) and their active component apolipoproteins are able to penetrate into the subendothelial space and, being oxidized, affect endothelial cells. In this regard, the initial stage of atherosclerosis is characterized as a response to the retention of atherogenic particles [2]. The main risk factors that play a significant role in endothelial damage are smoking, arterial hypertension and hypercholesterolemia. It has been shown that with an increase in cholesterol levels of more than 8.5 mmol/l, the risk of fatal cardiovascular complications increases by 4 times, when combined with arterial hypertension by 9 times, with smoking, the presence of hypercholesterolemia and arterial hypertension by 16 times [1]. The problem of primary and secondary prevention of ischemic stroke is not only medical, but also of great social importance, since patients who have had it become disabled in more than 80% of cases and often need outside help. Statins are considered highly effective drugs with the greatest evidence in reducing the risk of cardiovascular events in patients with coronary artery disease.
В настоящее время ишемическая болезнь сердца остается одной из существенных причиной смертности и инвалидизации в постиндустриальных странах мира.Несмотря на хирургической и медикаментозной лечении частота рецидивов стенокардии в отдаленные сроки после операции варьирует, а исследований в этом направлении проведено недостаточно.
Relevance of the problem.Despite the great successes of angiosurgery, the problem of surgical treatment of abdominal aortic aneurysms does not lose its relevance. World health statistics records a steady increase in the incidence of abdominal aortic aneurysm (ABA). According to L.J. Melton et al. (1984) and L.K. Bickerstaff et al. (1984) in the USA the number of patients with abdominal aortic aneurysm has increased 7 times in 30 years since 1951. In England and Wales, according to F.G. Fowkers et al. (1989) for the same period revealed a 20-fold increase in abdominal aortic aneurysms in men and 11-fold in women. According to the results of multicentre screening studies ABA was detected in 8% of the examined (E.S. Vourvouri, 2001), and in the age group of 64-69 years ABA was detected in 5.7% of the examined, and in the age group of 75-81 years - in 8.9% (R.A.P. Skott et al., 2001). A similar trend is observed in other countries. Accordingly, mortality from ABA is also increasing - aneurysm rupture in a number of countries is one of the ten most frequent causes of death among elderly and senile people (F.A. Lederle et al., 1990)
Currently, planned aneurysm resection has become a recognised standard of radical treatment of ABA patients and the number of these operations is steadily increasing. For example, about 40,000 ABA resections are performed annually in the USA (J.J. Grange et al., 1997). In Sweden during the period from 1987-89 to 1993-95 the number of ABA operations increased 5 times and currently 10 operations per 100,000 population are performed (A.Hallin et al., 2001), although this is 1.5 - 2 times less than the required number. However, postoperative lethality is still quite high and makes 5-7% (A.V.Pokrovskiy et al., 1992; Y.V.Belov et al., 1992; V.V.Vakhidov et al., 1992; A.W. Bradbury et al. Bradbury et al., 1997; A.Hallin et al., 2001).
E.W. Steyeberg et al. (1995) summarised the data of literature on 17238 ABA resection operations and gave an average mortality of 6.8%.
Multicentre studies in five major hospitals in the Netherlands found that only 74% of patients underwent ABA resection without complications; 26% had some complications, 9% of which were severe and 4.1% of which were fatal (G.J. Akkersdijk et al., 1998). Similar results were obtained in the Canadian Cooperative Study (K.W. Johnston et al., 1990). It was established that the peculiarity of complications in the majority of patients was their systemic character (L.L. Lau et al, 2001) The course of the postoperative period is most often complicated by cardiac, respiratory, renal, cerebrovascular, as well as complications associated with thrombosis and bleeding (W.E. Lloyd et al., 1996; R.D. Sayers et al., 1997; J.D. Blankenstein et al., 1998; R. Ayari et al., 1998). Ayari et al., 2001)
The undisputed leadership, without doubt, belongs to cardiac complications, the incidence of which varies from 10% to 20%. Moreover, cardiac complications account for 50-70% of total mortality. Cerebrovascular complications, although not uncommon, account for no more than 1-1.5%, but their mortality reaches 40%. Complications associated with thromboses and haemorrhages in the perioperative period reach 2-5% (M.M.Reigel et al., 1987; K.W.Johnson et al., 1990; N.Franklin et al., 1993; A.A.Milne et al., 1994).
Certainly, a large number of complications after resection of abdominal aortic aneurysms is caused by the initial severity of patients' condition, however, many unresolved tactical and technical issues of patients' preparation for the operation, stage of performance in case of combined lesions of several vascular basins play a practically significant role. Adequate management of the operation itself and the immediate postoperative period is no less important, taking into account the possibility of such dreadful complications as thrombosis and embolism, cerebral and cardiac death. Until now there is no unified complex analysis of the results of treatment of uncomplicated abdominal aortic aneurysms and, accordingly, recommendations for the prevention of possible complications.
All this determined our aim and objectives of the study.
The aim of the study is to improve the results of surgical treatment of ABA by developing an effective system for determining the main risk factors of surgical treatment and optimal surgical tactics to prevent possible complications.
Scientific novelty.For the first time a complex analysis of indications and contraindications to surgical treatment of abdominal aortic aneurysms was carried out
The most significant concomitant pathology capable to lead to formidable complications and lethality during the intervention and in the nearest postoperative period was revealed. Adequate measures of their prevention and treatment were proposed.
The algorithm of surgical treatment tactics for patients with combined pathology of coronary arteries and aortic arch branch lesions was developed
The state of haemostasis system at all stages of reconstructive surgery on abdominal aorta, starting from skin incision to wound closure, was studied for the first time.
Conclusions:
1. The proposed original classification of ABA, based on mutual dependence on the etiology of the disease, localisation, concomitant diseases, clinic and its course, allows to determine the strategy of early diagnosis, to estimate the most significant risk factors, the stage of intervention in combined lesions of adjacent and distant vascular basins and, ultimately, to determine the ways to reduce complications and mortality in patients with ABA.
2. The most informative methods of ABA diagnostics are duplex scanning and computed tomography. Non-invasive diagnostics capabilities are enough to determine the aneurysm size, its relation to the renal arteries, as well as to find out the state of visceral branches and aortic bifurcation. Abdominal aortography is indicated in patients with concomitant arterial hypertension to identify the state of the renal arteries.
3. Significant risk factors in these patients are ischaemic heart disease (44.1%), arterial hypertension (49%), haemostasis disorders (almost 100%).
4. The leading concomitant disease in the development of postoperative complications is ischaemic heart disease. Its share in abdominal aortic aneurysms is 40%. Postoperative cardiac complications reach 14.9%. Diagnostics of ischaemic heart disease should be based on the stage-by-stage detection of coronary lesions and its functional-compensatory abilities.
5. The main complications of the postoperative period after ABA resections are acute heart failure (14,9%), cerebral circulatory disorders (1,5%), acute renal failure (3,33%).
6. When significant coronary vascular channel lesions are detected in patients with ABA, it is fundamental to solve the issue of intervention staging. At 3-4 functional classes of circulatory insufficiency, appearance of new zones of hypo- or akinesia, decrease of ejection fraction below 40%, the first stage should be myocardial revascularisation surgery
7. In patients with combined lesions of brachiocephalic vessels in patients with ABA it is reasonable to assess the cerebral blood flow. In the presence of 70% or more stenosis of VCA, presence of embologenic plaque, bilateral haemodynamically significant stenosis it is necessary to perform carotid artery intervention as the first stage.
8. One of the most difficult problems of reconstructive operations in ABA is the contiguous lesion of renal and visceral branches of the abdominal aorta. The principle is their one-stage reconstruction. The types of reconstruction of these branches should be variable depending on the volume and extent of the pathological process.
9. Patients with aneurysmal lesion of abdominal aorta initially always have significant disorders of haemostasis system. In 30% of patients with occlusive diseases of aorta and its branches in the preoperative period the activity of thrombocytic-vascular link of hemostasis is increased, antithrombotic ability of vascular wall endothelium is decreased and blood rheological properties are disturbed. Activation of fibrinolysis was noted in patients with aneurysmal lesion of abdominal aorta.
10. During the operation for abdominal aortic aneurysmal lesion, after starting the blood flow the level of plasminogen increases additionally by 30%, which is a risk factor for haemorrhagic complications in the perioperative period. On the 1-3 day after the operation there is a significant decrease of blood anticoagulant potential - antithrombin-Sh by 25-27%, protein C by 23-25%. This period is the most dangerous in terms of thrombohemorrhagic complications development.
11. When using standard heparin during the operation there is a consumption of antithrombin-Sh by 30-45% and increase of platelet aggregation by 10%, which is a threatening condition for the occurrence of thrombosis of deep veins of the lower extremities with subsequent TELA. When using fraxiparin during reconstructive vascular surgeries the consumption of antithrombin-Sh and increase in platelet aggregation do not occur, prothrombin time, activated partial thromboplastin time, thrombin time are lengthened insignificantly that testifies to expediency of its use for prevention of thrombohemorrhagic complications.
12. Application of the diagnostic methods proposed by us to detect the main risk factors during the operation and in the nearest postoperative period, use of the algorithm of stage and volume of intervention allowed to reduce significantly the number of threatening complications, thus the lethality decreased 4 times, and the number of non-fatal complications - 4 times non-fatal complications - 1.5 times.
Распространенность больных СД, состоящих на диспансерном учете в Областных эндокринологических диспансерах по Республики Узбекистан на 2011 г составило 128968 больных, тогда как к 2015 году этот показатель увеличился до 169002. В 2015 году СД стал причиной смерти почти 5 млн человек в возрасте от 20 до 79 лет. Это значит, что каждые 6 секунд вследствие СД погибал 1 человек. (IDF, 2015). Сердечнососудистые заболевания - одна из ведущих причин смерти среди людей СД (до 50% и более смертей, связанных СД, в некоторых популяциях), в частности, ишемическая болезнь сердца (ИБС).
Despite advances in medical science and prevention, cardiovascular pathology remains the leading cause of morbidity and mortality in economically developed countries. Acetylsalicylic acid (ASA) is currently the most widely prescribed and most proven base drug for oral antiaggregant therapy in cardiovascular disease. Despite the widespread use of acetylsalicylic acid to prevent cardiovascular complications in patients with ischemic heart disease (IHD) ischemic events also occur in a certain proportion of patients receiving regular antithrombotic therapy, which is associated with stagnation of ASA, that is seen as a manifestation of resistance. The problem of resistance to antiplatelet drugs is fundamental in its importance, as it lays the groundwork for the individualization of preventive therapy and the formation of more effective methods of disease prevention. This article discusses the problems that arise in the antiaggregant and anti-inflammatory effect of acetylsalicylic acid in the use of ischemic heart disease.
Abstract. In ischemic heart disease (CHD), progressive disorders of the hemostasis system are corrected with shorter and longer antiplatelet therapy. However, recent studies have consistently demonstrated the development of up to 25% of all possible side effects and complications of anticoagulant and antiplatelet therapy.
Purpose of the study: to study the effect and complication of anticoagulant therapy on the state of the gastroduodenal zone in patients with ischemic heart disease.
Material and methods: 146 patients with ischemic heart disease (CHD), were examined, among them there were 12 (8.22%) patients with acute myocardial infarction (MI), 68 (46.57%) with progressive intense angina pectoris (PNS), intense angina pectoris (NS , functional class III-IV) - 66 (45.20%) people. The average age of the patients was 56.3 ± 2.4 years.
Results and its discussion: in the present study, the “ulcerative” history was assessed and whether there was a complication (bleeding, penetration or perforation). Detailing the data of the anamnesis made it possible to establish that the "ulcerative" anamnesis was detected only in 22.60% of cases. In other cases, as the duration of the course of the disease increases and, accordingly, the duration of the use of antiplatelet agents and anticoagulants, there is a directly proportional relationship to the increase in the frequency of gastropathy.
Purpose of the study: to study the effect of the combination of valsartan and sacubitril on the indices of central hemodynamics in patients with coronary heart disease (CHD) within 2 years after revascularization. Material and research methods. The study included 320 patients with coronary artery disease who underwent coronary revascularization. All patients were divided into 2 groups: patients who received valsartan (group B, 160 people), patients who received ARNI - a combination of valsartan and sacubitrile molecules (group C, 160 people). At baseline and in dynamics after three months, at the end of the first and second years of follow-up after revascularization in patients with coronary artery disease systolic the blood pressure (SBP, mm Hg), diastolic blood pressure (DBP, mm Hg), heart rate in minute, the concentration of brain natriuretic peptide (BNP) in the blood were determined. Also, during echocardiography, the stroke volume of the heart, indexed to the body surface area (SI, ml / m2), the minute index (MI, ml / m2), the mean pressure in the pulmonary artery (PA, mm Hg) were determined. Research results. In the group of patients taking valsartan (group B), the relative dynamics of BNP concentration was -10.69 ± 0.55% by the 3rd month of observation, -21.24 ± 1.03% by the end of the 1st year, and -34, 39 ± 1.64% by the end of the 2nd year of observation. The inclusion of sacubitril in the therapy scheme contributed to a greater positive effect in reducing the BNP concentration: the relative dynamics of the BNP concentration was -10.30 ± 0.52% by the 3rd month of observation, - 21.91 ± 1.00% by the end of the first year of observation, and -39.28 ± 1.67% (p <0.05 significant difference with group B). By the end of the 1st and 2nd years of observation, the use of a combination of valsartan and sacubitril contributed to a more pronounced decrease in blood pressure (p <0.01), a more pronounced dynamics of MI (p <0.05) and a decrease in pressure in РA (significantly lower baseline indicators, p <0.05 and indicator in group B, p <0.01). Conclusion. The present study revealed a positive effect of revascularization and subsequent therapy of coronary artery disease with the inclusion of sacubitrile on the BNP concentration, blood pressure and mean pressure of pulmonary artery.
Сердечно-сосудистые заболевания (ССЗ) и психоэмоциональные расстройства - обычное явление. Пациенты с ССЗ, а именно с хронической коронарной болезнью сердца чаще страдают психоэмоциональными расстройствами, чем население в целом. У людей с психоэмоциональными расстройствами больше шансов в конечном итоге разовьется сердечнососудистые заболевания, а также у них более высокий уровень смертности, чем у населения с изолированным психоэмоциональным расстройством. Пациенты с сердечно-сосудистыми заболеваниями, которые также находятся в психоэмоциональном расстройстве, имеют худший исход, чем пациенты, не страдающие психоэмоциональными расстройствами. Существует ступенчатая взаимосвязь: чем тяжелее психоэмоциональное расстройство, тем выше последующий риск смерти и других сердечно-сосудистых событий [4].
Вполне возможно, что психоэмоциональные расстройства является лишь маркером более тяжелых сердечно-сосудистых заболеваний, которые пока невозможно выявить с помощью имеющихся в настоящее время исследований.Однако, учитывая повышенную распространенность психоэмоциональных расстройств у пациентов с сердечно-сосудистыми заболеваниями, вероятна причинно-следственная связь с сердечнососудистыми заболеваниями, вызывающими более выраженными психоэмоциональными расстройствами, или с депрессией, вызывающими более частые сердечно-сосудистые заболевания, и худшим прогнозом для сердечно-сосудистых заболеваний. Было описано много возможных патогенетических механизмов, которые правдоподобны и вполне могут быть важны [2,3].
Однако, независимо от наличия причинно-следственной связи, психоэмоциональные расстройства является основным фактором качества жизни и сама по себе требует профилактики, выявления и лечения. Психоэмоциональные расстройства после острого сердечного приступа обычно является расстройством адаптации, которое может улучшиться спонтанно при комплексном кардиологическом лечении. Дополнительные стратегии ведения пациентов с сердечными психоэмоциональными расстройствами включают программы кардиологической реабилитации и физических упражнений, общую поддержку, когнитивно-поведенческую терапию, прием антидепрессантов, комбинированные подходы и, возможно, программы лечения заболеваний.
Наличие нескольких факторов риска может свидетельствовать о более важном общем риске, чем значительное увеличение от нормальных значений одного фактора риска. Современные тенденции стратификации риска у пациентов с ишемической болезнью сердца поляризованы между использованием простых данных и комплексных показателей, традиционных данных и новых факторов риска, общевалидных показателей и персонализированных показателей, в зависимости от характеристик пациента, типа ИБС, степени воздействия на предложенную терапию. Вся известная информация и методики могут быть интегрированы в сложную систему оценки риска.