References

medsovet

Медицинский Совет

Meditsinskiy sovet = Medical Council

2079-701X2658-5790

REMEDIUM GROUP Ltd.

10.21518/2079-701X-2020-14-90-96

medsovet-5816

Research Article

КОМОРБИДНЫЙ ПАЦИЕНТ

COMORBID PATIENT

Несердечно-сосудистая коморбидность при хронических коронарных синдромах (обзор новых Европейских рекомендаций - 2019 по диагностике и лечению хронических коронарных синдромов)

Non-cardiovascular comorbidities in patients with chronic coronary syndromes (review) (2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes)

Лупанов

В. П.

Lupanov

V. P.

Лупанов Владимир Павлович – доктор медицинских наук, профессор, ведущий научный сотрудник отдела проблем атеросклероза.

121552, Москва, 3-я Черепковская ул., д. 15а

Vladimir P. Lupanov - Dr. of Sci. (Med.), Professor, Lead Researcher, Atherosclerosis Department.

15а, 3 Cherepkovskaya St., Moscow, 121552

lupanovvp@mail.ru

Национальный медицинский исследовательский центр кардиологииРоссияNational Medical Research Center of CardiologyRussian Federation

2020

15102020

0149096

2020

Лупанов В.П.

Lupanov V.P.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.med-sovet.pro/jour/article/view/5816

Тщательная оценка истории болезни пациента, включая характеристику ангинальных симптомов, оценку факторов риска и проявлений ишемической болезни сердца и других сердечно-сосудистых заболеваний, а также надлежащее физическое обследование, основные методы тестирования, имеет решающее значение для диагностики и ведения пациентов с хроническими коронарными синдромами (ХКС) и коморбидными заболеваниями. Следует учитывать также сопутствующую терапию, ее переносимость и предпочтения пациента.

Выбор терапии должен быть адаптирован, он зависит от исходной частоты сердечных сокращений, артериального давления, функции левого желудочка у каждого больного с ХКС. При этом особое внимание следует уделять больным ХКС с сопутствующими (коморбидными) заболеваниями.

У больных ХКС с активным раком решение о лечении должно основываться на дополнительных показателях, таких как ожидаемая продолжительность жизни, другие сопутствующие заболевания, наличие склонности к тромбозу, а также на взаимодействии между потенциальными препаратами для лечения ХКС и противоопухолевыми средствами.

У бессимптомных пациентов с сахарным диабетом рекомендуется периодическая регистрация ЭКГ для определения нарушений проводимости, мерцательной аритмии, безболевого инфаркта миокарда.

Заместительная гормональная терапия не рекомендуется для снижения коронарного риска у женщин в постменопаузе. Лечение ХКС у пожилых людей сложное, с более высокой возможностью осложнений при консервативной и инвазивной стратегии, таких как кровотечение, почечная недостаточность и неврологические нарушения, которые требуют особого внимания. Рекомендуется обращать внимание и на выбор дозы лекарств с почечной экскрецией, применяемых при ХКС у больных с хроническими болезнями почек для предотвращения их возможных поражений.

Сareful evaluation of patient history, including of anginal symptoms, and evaluation of risk factors and manifestation of coronary artery disease (CAD), as well as proper physical examination and basic testing, are crucial for the diagnosis and management of chronic coronary syndrome(s) (CCS) and non-cardiovascular comorbidities.

Anti-ischaemic treatment must be adapted to the individual patient based on comorbidites, co-administered therapies, expected tolerance and adherence, and patient preferences. The choice of anti-ischaemic drugs to treat chronic coronary sydromes should be adapted to the patient’s heart rate, blood pressure, and left-ventricular (LV) function.

In patients with active cancer treatment decisions should based on life be expectancy, additional comorbidities such as thrombocytopenia, increased thrombosis propensity. and potential interactions between drugs used in CCS management and antineoplastic agents.

In asymptomatic patients with diabetes mellitus, a periodic resting electrocardiogram is recommended for cardiovascular detection of conduction abnormalities, atrial fibrillation, and silent myocardial infarction.

Recommendations for chronic kidney disease (CRD): use iodinated contrast agents is minimized in patients with severe CKD and preserved urine production to prevent further deterioration.

It is recommended that particular attention is paid to side effects of drugs, intolerance, and overdosing in elderly patients with chronic coronary syndromes.

Hormone replacement therapy is not recommended for risk reduction in post- menopausal women. Тransmyocardial revascularization is not recommended in patients with debilitating angina refractory to optimal medical and revascularization strategies.

хронические коронарные синдромыкоморбидностьфакторы рискагериатрическая коморбидностькоронарная болезнь сердцадиагностикавторичная профилактикарациональная фармакотерапиябезопасность леченияпрогноз

сhironic coronary syndromes^morbiditiesraronary artery diseaserisk factorsgeriatric comorbiditydiagnosticsecondary preventionpharmacotherapysafety of treatmentprognosis

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The authors declare that there are no conflicts of interest present.