As the COVID-19 pandemic continues to unfold, the level of understanding of the etiopathogenesis, diagnosis and treatment of this disease is also growing. To date, it is becoming clear that infection caused by SARS-CoV-2 is a predisposition to a state of hypercoagulation with some thrombotic events, including acute coronary syndrome. However, despite the fact that the pandemic began 1 year ago, uncertainty about anticoagulant therapy in patients with COVID-19 continues to prevail. Given that there is currently no standardized approach to anticoagulation in patients with ACS and COVID-19, we conducted a review of the scientific literature on this problem. As a result of the study, it was found that the management tactics of patients with ACS and COVID-19 generally do not differ from the standard accepted ones. However, special attention should be paid to drug interactions between antiplatelet drugs, anticoagulants, and COVID-19 therapy. We also noted that in addition to anticoagulant and anti-inflammatory properties, heparins have a direct antiviral effect. All patients with ST-segment elevation myocardial infarction should receive standard medical therapy, which includes unfractionated heparin. In patients with non-ST-elevation myocardial infarction with an early invasive strategy, it is recommended to use heparin instead of low-molecularweight heparin as the anticoagulant of choice. At the same time, the use of low-molecular-weight heparin in patients with myocardial infarction without ST-segment elevation and COVID-19 is preferable to unfractionated heparin.

The paper presents an overview of the scientific literature containing data on the pathogenesis, diagnosis and treatment of cardiovascular consequences of a new coronavirus infection. Heart damage is observed in 7-28% of hospitalized patients with COVID-19. Myocardial damage when exposed to coronavirus infection can be realized through two pathological mechanisms: direct myocardial damage due to the interaction of SARS-CoV-2 with myocardial ACE2 receptors, as well as indirect myocardial damage, which can be caused by cytokines and other pro-inflammatory factors, microcirculation disorders, hypoxic changes cardiomyocytes. Frequent arrhythmic complications of COVID-19 are atrial fibrillation and ventricular premature beats. Despite numerous publications on heart damage in the acute phase of this disease, data on disorders remaining after recovery are insufficient, there are no clinical recommendations for the management of such patients. Based on the given clinical case, mechanisms of combination therapy of bisoprolol and amlodipine of frequent ventricular extrasystolia, which arose after COVID-19, are described.

The high prevalence of metabolic syndrome worldwide, the steady growth of morbidity in people of different age groups makes it one of the most serious problems in the clinic of internal diseases, rightfully considering it an epidemic of the 21st century. Taking into account that one of the main components of the metabolic syndrome is arterial hypertension, we studied and assessed the risk factors and effectiveness of the treatment of arterial hypertension in patients with metabolic syndrome. Purpose of the paper: To assess the risk factors and effectiveness of the treatment of arterial hypertension in patients with the metabolic syndrome. The study involved 110 patients with a verified diagnosis of Stage II arterial hypertension and metabolic syndrome. All patients in the study group were treated as inpatients at Saransk Republican Clinical Hospital № 5 during the period 2018-2020. Risk factors were assessed and the treatment of arterial hypertension in patients with metabolic syndrome was analysed. The clinical study showed that the most common risk factors for adverse prognosis in patients with metabolic syndrome and arterial hypertension are psycho-emotional stress, excess body weight, hypodynamia and hereditary burden of arterial hypertension and metabolic syndrome. Inpatient treatment of arterial hypertension in patients with the metabolic syndrome with combined hypotensive therapy was rational in 100% of cases. Inpatient treatment of patients with metabolic syndrome was effective, which was determined by a reduction in blood pressure to the level of target values. The average time of blood pressure reduction in the patients of the analyzed group was 5,86 ± 0,94 days.

In a healthy woman with a normal pregnancy, structural and functional changes in the heart are adaptive in nature, are slight and are completely normalized after childbirth. A pregnant woman with heart diseases has reduced adaptive capacity, therefore, at any stage of pregnancy, pathological changes can occur that complicate its course and lead to adverse outcomes. In addition, any pregnancy may develop new heart diseases, which can be fatal. That is why an echocardiographic assessment of structural and functional changes in the heart is necessary both during normal pregnancy and in the background of concomitant cardiovascular diseases.

In order to assess the features of hypertension-mediated heart damage in young adults with hypertension and connective tissue dysplasia (СTD), an echocardiographic examination of 574 people aged 18 to 29 years was performed. It was revealed that young adults with hypertension and CTD have lower levels of the interventricular septum and left ventricle walls thickness, left ventricle mass and its indexes than in hypertensive patients without CTD, and these parameters do not reach the generally recognized upper limit of the norm. This leads to systematic underdiagnosis of hypertension-mediated heart damage, incorrect assessment of the stage of hypertension, and inadequate management for these patients.

In recent years, for the first time in developed economies and high-income countries, a reduction in the incidence of stroke has been achieved. The trend towards a decrease in cardiovascular morbidity in economically developed countries of the world proves the effectiveness of a preventive strategy based on the modification of the main risk factors and the use of modern drugs (antihypertensive, hypolipidemic and antithrombotic). The success of preventive medicine is associated with new medical technologies and new more effective drugs – anticoagulants and antiplatelet agents. Antithrombotic therapy for the prevention of the first or repeated stroke is the most important area of primary and secondary prevention of cardiovascular diseases. The author summarizes and analyzes new trends in antithrombotic therapy in clinical practice. The main changes in the antithrombotic strategy relate to the primary prevention of stroke, management of patients with transient ischemic attacks, and early secondary prevention.

Cardiovascular diseases, especially coronary heart disease (CHD), are the most common diseases worldwide. More than 50% of mortality occurs in this pathology. In recent decades, there is a tendency to «rejuvenate» cardiovascular diseases – primarily hypertension and СHD, which is of particular concern [6, 8]. It is generally recognized that atherosclerosis is the main etiological moment in the development of coronary heart disease. CHD includes a number of clinical diagnoses (angina pectoris, myocardial infarction, etc.) and is associated with atherosclerosis, a common degenerative disease in which lipids and the fibrous matrix are deposited in the arterial wall with the formation of an atheromatous plaque. Rupture of unstable plaques in the coronary arteries leads to the release of thrombogenic contents into the lumen of the vessel, leading to coronary artery thrombosis, occlusion and subsequent myocardial infarction, critical state with high mortality [5]. Despite the large number of known risk factors affecting the development of this disease, there is evidence, confirmed by large studies, about the presence of a genetic predisposition to this disease.

The presence of pain syndrome and an increase in functional insufficiency of the joints are the most frequent reasons for patients seeking medical help. Currently, given the growing prevalence of osteoarthritis, a more active multimodal approach to patient management is needed, taking into account their individual characteristics and needs. The main goals of osteoarthritis therapy are: pain relief; maintaining or improving joint function; preventing the build-up of functional impairment, improving health-related quality of life, and reducing/preventing structural progression of the disease. The article presents data on one of the effective and safe methods of treating osteoarthritis of the knee and hip joints – intra-articular administration of hyaluronic acid, which provides a significant reduction in pain, improvement of joint function; helps to reduce the need for NSAIDs and slow the progression of the disease. The obtained research results indicate a good and long-term symptomatic effect of the drug, a high safety profile and the possibility of its use in wide clinical practice.

The article discusses the validity and the effectiveness of the use of symptomatic slow-acting drugs for osteoarthritis (SYSADOA) in the treatment of patients with clinically pronounced stages of knee osteoarthritis (II-III degrees according to the Kellgren–Lawrence classification), developed at different ages under different comorbid circumstances. The aim of the study was to evaluate the effect of the use of Alflutop as part of complex therapy in relation to the functional status of the affected joint at the 4th week of the follow-up. In the first case, it was anamnestically established that the patient had an immediate allergic reaction to repeated intra-articular administration of hyaluronic acid derivatives two years earlier, and GCS (glucocorticosteroids) could not be used due to the risk of recurrence of osteomyelitis. In the second case, an elderly man with severe somatic pathology (type 1 diabetes, bronchial asthma) was diagnosed with a clinically pronounced stage of gonarthritis (grade III according to Kellgren–Lawrence), the use of SYSADOA was preceded by 3 two-week courses of conservative therapy using hyaluronic acid derivatives in combination with intra-articular corticosteroids, while significant results could not be achieved. Finally, in the third case, a man with a history of idiopathic purulent gonarthritis was contraindicated to the injectable forms of GCS, and for socio-economic reasons it was not possible to use hyaluronates. Considering these circumstances, the combination of NSAIDs + SYSADOA was used in all the above mentioned cases (at the start – intra-articular, then intramuscularly). As a result of studying the clinical effectiveness of the proposed therapy regimen in patients with the presence of an arthritic component of the disease, positive results of the drug therapy were established: by the end of the course of therapy, the amplitude of movements and the severity of the pain syndrome showed more significant positive changes vs laboratory parameters. Given the impossibility of using derivatives of HA, as well as GCS, the use of a SYSADOA in our comorbid cases is the only possible component of an effective complex conservative therapy for knee osteoarthritis.

The aim of the work was to analyze the mechanisms and effectiveness of dorsopathy in two ways of dredging exposure to essential oils: the known and proposed, rules-oriented biopuncture. Materials and methods. 90 patients under the age of 65 with aggravation of lumbar dorsopathy were monitored, which included tests of «Multi-Personality Study» and «Self-Education-Activity-Mood» during the survey. Electro-physiological techniques were represented by the thermography, reovaso- and dopplerography of the arteries of the lower extremities. All patients, divided into three groups, received a basic therapeutic effect. In addition, the first two groups used a mixture of essential oils: in the 1st group by massage, in the 2nd – stimulating the points of reflexotherapy. In the 3rd, the control group, used a perfume substance that does not have a therapeutic effect. The correction consisted of 10 procedures alternating through the day. The results of the study and the conclusion. The dynamics of the main indicators confirmed the reliably high performance of both oil use options – in the form of improvements in 60% and 63,3% of observations against 49,9% in the 3rd group. The verification of this was a positive change in the indicators of thermo- and reograms. On the other hand, the first two groups showed differences in the pace of achieving sustained analgesia, with the advantage of the 2nd group. These data were consistent with the tendency to normalize the mental background in these patients, confirmed by psychological testing. In general, the results of the study reflect the prospects for widespread use of essential oils in accordance with biopuncture rules, in favor of which evidence of the psycho-regulating effect of technology, indirectly affecting the level of pain threshold. Here, as a significant mechanism, in addition to the actual reflex, it is possible to assume the direct effect of low dosages of oils on the olfactory system.

The results of numerous studies conducted over the past decades have shown that the greatest importance in determining the risk of disease and death at the individual level is the accumulation of visceral adipose tissue, associated with the development of metabolic disorders and local influence when it accumulates in the internal organs. Bioimpedance analysis is a simple and widely available clinical method for determining the excess content of visceral adipose tissue, thereby allowing you to identify patients with obesity and a high risk of developing cardiovascular complications, even in the first meeting with a doctor. The results of the determination of visceral adipose tissue by bioimpedance analysis are comparable with the data obtained by CT and MRI. According to our observations conducted on 154 patients with various cardiovascular diseases, the content of visceral adipose tissue , which is 14% or more according to bioimpedance analysis, was combined with disorders characteristic of the metabolic syndrome. At the same time, the increase in BMI from the 1st to the 3rd degree did not reflect the severity of metabolic disorders. There were no significant differences in the content of visceral adipose tissue and blood levels of triglycerides, glucose, and HDL-C in patients with different degrees of obesity. To date, it is obvious that obesity, determined by BMI, is very heterogeneous and its negative role in the development of diseases is revealed only when observing very large groups of the population. Research data on the importance of visceral adipose tissue and its association with risk factors for cardiovascular disease suggest the need for a new classification of obesity. We present a draft for discussing the new classification of obesity in our article.