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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">cardio</journal-id><journal-title-group><journal-title xml:lang="ru">Кардиология</journal-title><trans-title-group xml:lang="en"><trans-title>Kardiologiia</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">0022-9040</issn><issn pub-type="epub">2412-5660</issn><publisher><publisher-name>Kardiomag</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.18087/cardio.2018.9.10175</article-id><article-id custom-type="elpub" pub-id-type="custom">cardio-192</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ</subject></subj-group></article-categories><title-group><article-title>Двойная блокада рецепторов альдостерона как способ устранения негативного воздействия нестероидных противовоспалительных препаратов при хронической сердечной недостаточности</article-title><trans-title-group xml:lang="en"><trans-title>Double Blockade of Aldosterone Receptors as a Method of Elimination Negative Effects of Non-Steroidal Anti-Inflammatory Drugs in Chronic Heart Failure</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Чепурненко</surname><given-names>С. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Chepurnenko</surname><given-names>Svetlana A.</given-names></name></name-alternatives><email xlink:type="simple">ch.svet2013@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Бурцева</surname><given-names>Н. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Burtseva</surname><given-names>N. V.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Шавкута</surname><given-names>Г. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Shavkuta</surname><given-names>G. V.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГБОУ ВО «Ростовский государственный медицинский университет» Минздрава России; ГБУ РО «Ростовская областная клиническая больница»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Rostov State Medical University; Rostov Regional Clinical Hospital</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ФГБОУ ВО «Ростовский государственный медицинский университет» Минздрава России</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Rostov State Medical University</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2018</year></pub-date><pub-date pub-type="epub"><day>18</day><month>11</month><year>2018</year></pub-date><volume>58</volume><issue>9</issue><fpage>96</fpage><lpage>100</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Kardiomag, 2018</copyright-statement><copyright-year>2018</copyright-year><copyright-holder xml:lang="ru">Kardiomag</copyright-holder><copyright-holder xml:lang="en">Kardiomag</copyright-holder><license xlink:href="https://cardio.elpub.ru/jour/about/submissions#copyrightNotice" xlink:type="simple"><license-p>https://cardio.elpub.ru/jour/about/submissions#copyrightNotice</license-p></license></permissions><self-uri xlink:href="https://cardio.elpub.ru/jour/article/view/192">https://cardio.elpub.ru/jour/article/view/192</self-uri><abstract><p>В статье рассматривается динамика показателей эхокардиоскопии в течение 1,5 года у пациента, перенесшего острый инфаркт миокарда. Через 2 мес после острого инфаркта миокарда фракция выброса (ФВ) была равна 42%. На фоне использования максимально возможных доз рамиприла, бисопролола и эплеренона, а также реваскуляризации методом стентирования через 8 мес ФВ увеличилась до 51%. Состояние больного резко ухудшилось после использования нестероидных противовоспалительных препаратов (НПВП) - кетопрофена и мелоксикама - в связи с обострением хронического остеохондроза. Пациент отметил усиление одышки при ходьбе, снижение толерантности к физической нагрузке, наблюдалось уменьшение ФВ до 36%. Через 4 мес приема петлевого диуретика торасемида в дозе 5 мг в добавление к имеющейся терапии показатели кардиогемодинамики вернулись к значениям до назначения НПВП. Петлевой диуретик торасемид может быть рекомендован для устранения негативных последствий использования НПВП у пациентов с хронической сердечной недостаточностью в дополнение к стандартной терапии.</p></abstract><trans-abstract xml:lang="en"><p>The article deals with the dynamics of echocardioscopy indices during 1.5 years in a patient who underwent an acute myocardial infarction (MI). Two months after the MI left ventricular (LV) end-diastolic size and LV volume were 61 mm and 190 ml, respectively; LV ejection fraction (EF) was 42%. At the background of maximal possible doses of ramipril, bisoprolol, and selective antagonist of aldosterone receptors eplerenone, and after revascularization, within eight months LV end-diastolic size decreased down to 57 mm, LV volume - to 158 ml, and LVEF increased up to 51 %. There was no change of potassium and creatinine blood serum levels. The situation changed dramatically after addition to ongoing therapy because of exacerbation of chronic osteochondrosis of ketoprofen 100, meloxicam 15 and tolperisone (Mydocalm) 450 mg / day. The patient noted an increase in dyspnea during walking, a decrease in exercise tolerance. LVEF fell to 36%, LV size increased up to values registered in 2 months after MI. There were no signs of overt fluid retention (no gain of weight, lower limbs edema, lung congestion on X-ray, hepatomegaly at ultrasound examination). In 4 months after addition to therapy of a loop diuretic torasemide (5 mg) the cardio-hemodynamic parameters almost returned to values prior to administration of anti-inflammatory drugs. Conclusion. Loop diuretic (such as torasemide) can be recommended for elimination of negative consequences of the use of nonsteroidal anti-inflammatory drugs in patients with chronic heart failure.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>постинфарктный кардиосклероз</kwd><kwd>хроническая сердечная недостаточность</kwd><kwd>нестероидные противовоспалительные препараты</kwd><kwd>торасемид</kwd><kwd>эплеренон</kwd><kwd>ischemic dilated cardiomyopathy</kwd><kwd>nonsteroidal anti-inflammatory drugs</kwd><kwd>torasemide</kwd><kwd>eplerenone</kwd><kwd>chronic heart failure</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Каратеев А. Е., Алексеева Л. И., Филатова Е. Г. и др. Обезболивающие препараты в терапевтической практике. М: ИМАПРЕСС 2013: 134 с.</mixed-citation><mixed-citation xml:lang="en">Каратеев А. Е., Алексеева Л. И., Филатова Е. Г. и др. 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