Extensive heart attack causes manifestations how to treat rehabilitation prognosis

Complications of myocardial infarction can lead to death during the first year of life after a heart attack. Quite often, a complication of myocardial infarction can kill a person in the first hours after its occurrence. However, if qualified care is provided in a timely manner, then the patient has good chances of survival.

Patients who have had an attack should be prepared at any time for complications after myocardial infarction. Experts classify complications after a heart attack depending on the time of their occurrence for several periods:

Regarding the first period, it is worth noting that it lasts for 10 days and starts from the first minute after the attack. The second period of development lasts for a month, the third period (post-infarction) lasts for six months. Specialists divide the entire complex of complications arising from the development of a heart attack into several different categories. These categories are:

With a heart attack, developing pathological disorders can be of two varieties: early and late.

Early – occur from the first minutes, late – appear in the subacute and post-infarction periods.

An early type of complications includes disturbances in the rhythm of the heart and its conduction, cardiac innervation systems, the development of cardiogenic shock, heart failure, the occurrence of ruptures of the fibro-muscular hollow organ.

Late complications that develop 2-3 weeks after the onset of a heart attack include post-infarction syndrome and chronic circulatory failure. In addition, disorders such as aneurysm and thromboembolism can be observed both at an early stage of the development of the disease, and at a late one.

The most common complications that develop when an attack occurs are disturbances in the heart rhythm and conduction of the heart innervation system.

In addition, these disorders can be the only manifestations of the development of the disease, especially with the development of repeated ones. In very rare cases, patients may develop atrial fibrillation.

The acute period of myocardial infarction is characterized by the development of cardiogenic shock and acute failure. These varieties are the earliest complications of a heart attack and are one of the most dangerous for humans in the acute period of development of an ailment.

Heart failure is a very common complication that occurs immediately after a heart attack, and the severity of developing failure depends on the extent of damage to the heart muscle. In the case of severe severe insufficiency, a person experiences cardiogenic shock. This complication is characterized by a decrease in the pumping function of the myocardium, which occurs as a result of necrotic phenomena that occur in the thickness of the muscle layer of the heart. Most often, complications of this severity develop in elderly women and patients with diabetes mellitus.

Treatment of complications arising in the acute period consists in taking medications containing nitroglycerin and ACE inhibitors.

In addition, the course of treatment includes the administration of vasopressor drugs and agents with diuretic properties.

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The use of endovascular techniques involves the use of angioplasty and intraaortic balloon counterpulsation. Sometimes, in special cases, surgical treatment is used.

Late complications are understood as pathological disorders that can manifest after a long time after the development of an attack. Most often, late complications after myocardial infarction are chronic arrhythmias and insufficiency.

Late complications of myocardial infarction may be:

  1. Postinfarction syndrome. Very often, along with the development of this pathological disorder, inflammation of the pleura and lungs occurs. There are cases when the development of pathological disorder, most often pericarditis, is associated with the subsequent progression of pleurisy and pneumonitis. This syndrome is a reaction of the immune system to the progression of cardiac tissue necrosis. In case of progression, treatment with hormone-containing drugs is used.
  2. Late pericarditis progresses in the body as an autoimmune disease and is able to develop from the first week of a heart attack. In the initial phase, the patient is shown taking aspirin, after which glucocorticoids are prescribed.
  3. The onset and progression of parietal thromboendocarditis begins after the occurrence of transmural infarction. A characteristic feature of this ailment is the appearance of thrombotic masses on the walls of blood vessels.
  4. The development of chronic insufficiency is very dangerous for human life, since with it the heart muscle loses its ability to fully pump the necessary amount of blood through the bloodstream and provide it with tissues of the human body. The progression of the disorder leads to the appearance of swelling and shortness of breath. If necessary, the attending physician prescribes beta-blockers.
  5. Postinfarction cardiosclerosis. This pathological disorder appears in the process of replacing dead heart tissue with connective tissue formations. The result of the progress of this pathological disorder is the appearance of scars on the heart body, which reduces the contractility of the heart muscle. These scars lead to malfunctions in the conductive system and heart rate. In severe form of pathological disorder, surgical intervention is used.

Sometimes, after myocardial infarction, complications arise in the work of other body systems.

  • rupture of the interventricular septum;
  • progression of mitral regurgitation;
  • rupture of the free wall of the left ventricle;
  • thromboembolism;
  • progression of early pericarditis;
  • arrhythmia;
  • progression of pulmonary edema;
  • progression of aneurysm of the left ventricle.

Rupture of the interventricular septum occurs within 5 days after the attack. Most often, a violation can be observed in elderly patients, with the progression of hypertension and the occurrence of anterior heart attacks. Elimination of the violation is carried out using surgical intervention. During treatment, vasodilating drugs are used.

Mitral insufficiency is a pathological disorder that develops in a large number of patients with a heart attack. In severe form, this violation appears in case of rupture of the papillary muscle. Severe form of pathological violation is very dangerous for humans.

Therapeutic measures involve medical treatment and the use of coronary angioplasty techniques.

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In addition, muscle rupture is eliminated urgently with the help of surgical intervention, otherwise a fatal outcome is possible.

Rupture of the free wall of the left stomach is a pathological disorder that progresses with a transmural type of heart attack. Most often, this violation is observed in the first 5 days, is eliminated by surgical intervention.

Thromboembolism progresses during the first 10 days of the development of the disease. In the treatment of heparin using slow intravenous infusion. Further treatment is carried out with warfarin.

Pulmonary edema is a disorder that progresses in the first 10 days. The disorder is characterized by the appearance of a disorder such as cough. The progression of edema requires immediate medical attention. Doctors use intravenous diuretics and glycosides to relieve swelling.

A deficiency of blood supply to the heart muscle leads to the development of a heart attack. The disease is characterized by the death of the myocardial site, and in acute form it often ends in death. Those who did not consult a doctor on time and suffered an attack on their feet run the risk of encountering its complications.

According to statistics, 70% of patients who have had the disease have post-infarction complications. This is due to the inability of the heart to fully perform its functions. Cells that have undergone necrosis are not restored, and cardiac contractility decreases.

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Even small focal infarction in a mild form negatively affects human health. 30% of patients surviving a complicated form of the disease die in the first year after it.

The acute period is 28 days after the attack. It is at this time that the greatest number of problems appear. The main danger is that complications can occur at any stage – both the next day, and after a few years.

The development of post-infarction disorders is explained by the size of the area of ​​myocardial damage, its condition against the background of previous diseases and interaction with coronary arteries. Experts divide the complications of myocardial infarction into 5 main groups:

  • Mechanical. They arise due to structural deformations of cells and tissues and are accompanied by their rupture.
  • Electric. There is a violation of the rhythm of heart contraction and its conduction. Often manifested in large focal infarction.
  • Hemodynamic. Appear due to the inability of the heart to provide blood flow in full.
  • Embolic. They are characterized by the appearance of a large number of blood clots, which can lead to subsequent blockage of blood vessels.
  • Reactive. They arise due to violations in the functioning of the immune system, secondary organ dysfunction and the sympathetic nervous system.

Depending on the time of manifestation, violations are early and late. The first appear during the so-called acute period, the next – about two months after the attack.

There are 3 groups into which complications are divided according to the degree of threat to the body:

  • least dangerous;
  • prognostically serious;
  • life threatening.

During the rehabilitation period, a sudden death of the patient is possible. This usually occurs within a year of the attack.

Despite the therapeutic measures taken, there is a risk of a decrease in the ejection fraction of the left ventricle, as a result of which the heart cannot cope with the load and stops working.

Any pathology that occurs after a heart attack is a serious obstacle to recovery.

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The content of the article:
  1. Early complications
  2. Early complications can develop in the acute period of myocardial infarction, sometimes in its first minutes. These include 1-2
  3. They also include complications that appear 10 days after the manifestation of MI and later 4-5. They are divided into complications from the heart and other organs.
  4. Rehabilitation and prevention of repeated myocardial infarction
  5. Heart disease characteristics and statistics
  6. Risk Factors
  7. The consequences of a heart attack of large or small focal – early and long-term complications, rehabilitation and prognosis
  8. Cardiogenic shock
  9. Dressler’s Syndrome
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Early complications

Early complications can develop in the acute period of myocardial infarction, sometimes in its first minutes. These include 1-2

  1. 1 Acute heart failure (AHF). It occurs due to the fact that the affected part of the heart muscle stops working adequately and the contractile function of the myocardium suffers.
  2. 2 Cardiogenic shock. It develops in those cases when the contractile function decreases to a significant extent, and the heart is not able to adequately supply blood to the internal organs.
  3. 3 Violations of rhythm and conduction. The most serious of these are ventricular fibrillation and ventricular tachycardia. Irregularities may occur in the conduction system of the heart (bradycardia, blockade) 1.
  4. 4 Pericarditis. This is an inflammatory process that develops in the serous membrane of the heart. It occurs on the first or third day of the disease and can manifest itself in pain, which changes with a change in body position, an increase in body temperature 1.
  5. 5 Thromboembolic complications. At any time, a blood clot can come off and clog one of the important vessels, which increases the risk of a complication such as ischemic stroke.
  6. 6
    Due to a violation of the blood supply, acute coronary syndrome can also be complicated by gastrointestinal problems, such as erosion, acute ulcers of the gastrointestinal tract, and bleeding from the digestive tract 1.
  7. 7 Urination disorders are characteristic of men with prostate adenoma 1.

Later consequences usually arise due to the development of chronic heart failure, the cause of which is the formation of a scar on the affected area of ​​the heart muscle.

They also include complications that appear 10 days after the manifestation of MI and later 4-5. They are divided into complications from the heart and other organs.

  • Late post-infarction angina pectoris. It can be a symptom of poor blood circulation in the myocardium, increases the risk of recurrent heart attack and worsens the prognosis. In post-infarction angina pectoris, angina attacks occur or become more frequent from 24 hours to 8 weeks after the development of myocardial infarction. This indicates severe circulatory disorders in the coronary vessels 1.
  • Aneurysm of the heart – protrusion of the wall of the ventricle due to increased load on the area around the forming scar. As a rule, it develops with extensive damage to the heart muscle. Factors predisposing to the development of aneurysm of the heart also include a violation of the regime from the first days of the disease, concomitant arterial hypertension, and some others 1.
  • Arrhythmias, thromboses, pericarditis can complicate myocardial infarction both in the early and late period 1.
  • Dressler’s syndrome is an inflammatory process in the pericardium (heart membrane). It occurs 2-6 weeks after the manifestation of myocardial infarction 1.

All complications require serious treatment and lengthen the rehabilitation period.

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Rehabilitation and prevention of repeated myocardial infarction

The main task of rehabilitation is to return the patient to a quality life after a heart attack, and restore working capacity. Rehabilitation activities begin even at the stage of inpatient treatment and, as a rule, continue in a sanatorium of a cardiological profile, and then outpatient and usually last for several months 3.

Heart disease characteristics and statistics

A heart attack is a condition in which an irreversible damage to the cells of an organ occurs due to a violation of its blood supply and the resulting acute oxygen starvation. Such organs can be not only the heart, but also the brain, kidney, retina or spleen.

With myocardial infarction, sections of necrosis of various sizes appear on the heart membrane, their occurrence is associated with inferior, insufficient blood supply.

In the case of timely and qualified medical care, the patient gets the opportunity to survive, but he will not be able to return to his former life. Affected myocardial cells after a heart attack are replaced by scar tissue, which significantly limits the ability of the heart muscle to fully contract.

The patient has to reconsider his lifestyle, diet, permissible physical activity, exclude risk factors, so as not to get a relapse of the disease.

According to data provided to the Federation Council by the chief cardiologist of Russia, Professor I. Chazova, Russia is in second place in the prevalence of cardiopathologies and mortality from cardiovascular diseases. In addition, she provided the following data:

  • Myocardial infarction caused 39% of all premature deaths in Russia;
  • Death ends in 17% of cases of a heart attack;
  • Relapses occur in 11% of patients;
  • Every day, the emergency medical service of the Russian Federation receives more than 25000 calls related to acute coronary syndromes;

According to the Committee on Social Policy of the Council of the Federation, more than 7 million Russians suffer from symptoms of heart ischemia, which results in myocardial infarction. Besides:

  • Cardiovascular diseases diagnosed in 31 million residents of Russia;
  • Every fourth man in our country over 44 years old suffers from coronary disease, which means that he is at risk of suffering from myocardial infarction;
  • The number of post-infarction patients is approaching 2,5 million people. This figure is 2% of the total population of Russia.

The incidence of this disease directly depends on gender. In men from 45 to 50 years, pathology occurs 5 times more often than in women.

The reason for this imbalance is the presence in the female body of estrogen, a hormone that has a protective effect. These differences are leveled by the age of 60-70, when statistics show an increase in heart attacks in women up to 50%.

Even the most modern cardiology center will not be able to provide full assistance to such a patient if it is not provided in the first 1-2 hours after the onset of the attack. The main emphasis should be placed on timely diagnosis and elimination of the possible causes of this pathology.

Risk Factors

The disease develops more often in people who experience the effects of risk factors. These are lifestyle and behavior features that significantly increase the likelihood of a heart attack. These include:

  • overweight;
  • poor nutrition (excessively high content of fats and carbohydrates in the diet);
  • atherosclerosis of the coronary vessels (atherosclerotic plaque narrows the lumen of the vessel, blocks the blood flow, and also promotes the formation of blood clots);
  • male gender (female sex hormones have a protective effect on blood vessels);
  • age (after 40 years, the risk of the disease begins to increase and reaches a peak at 60 years old – at this age, the frequency of heart attack becomes the same for men and women. In older people, at 80 years old, the incidence decreases again);
  • thrombosis (blood clots can develop not only as a result of atherosclerosis, but also after abdominal operations, as well as with the use of combined oral contraceptives);
  • arterial hypertension (significantly worsens the condition of the vascular wall due to constant pressure on it, can lead to rupture and hemorrhagic heart attack);
  • bad habits – alcohol abuse and smoking;
  • hypodynamia.

In many ways, the chances of recovery depend on the exclusion of risk factors in the post-infarction period, because otherwise the damaging agent continues to act after the attack. Statistics show that 30% of people after myocardial infarction develop a recurrent heart attack within a year.

The main reason for the development of a heart attack is damage to the walls of the arteries with atherosclerotic plaques that disrupt blood circulation. This can happen with the following pathologies:

    Atherosclerosis of the coronary vessels. If the plaque reaches a large size, then it can completely block the lumen of the vessel.

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Not only the listed diseases and conditions can cause a heart attack, but there are several unfavorable factors that increase this risk several times:

  • Diabetes mellitus can become an indirect culprit of a heart attack. With an increased content of glucose in the blood, metabolic processes are disturbed, which can lead to the appearance of sclerotic plaques in the vessels.
  • At a young age, a heart attack can develop due to a hereditary predisposition.
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Given that most often a combination of several risk factors can be observed, it is not surprising that such a large number of citizens develop an extensive heart attack. The consequences, the chances of survival, rehabilitation will be considered a little later.

Symptoms of this pathology will depend on the stage of development, and they are distinguished by several:

  • Preinfarction condition.
  • The sharpest period.
  • Acute.
  • Subacute.
  • Post-infarction.

It is very important to distinguish between these periods in order to provide the necessary assistance to a person in a timely manner.

If the pre-infarction state can last a long time, sometimes up to a month, then the most acute period develops quite quickly. It is characterized by the manifestation of the following symptoms:

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The acute stage can manifest atypical symptoms:

  • Bouts of suffocation.
  • A cough appears.
  • Edema syndrome.
  • There are signs of cerebral ischemia.

In some cases, the symptoms can be severely erased. This condition can last up to two hours. If this stage could not be avoided, it will cause quite serious extensive heart attack consequences. The chances of survival (rehabilitation is required for all such patients) will depend entirely on qualified medical care.

A week after the attack, a subacute period begins, which is characterized by the absence of pain, normalization of heart rate and blood pressure. The area of ​​necrosis on the heart muscle is gradually replaced by scar tissue.

When the post-infarction period begins, and it can last up to six months, the heart gradually adapts to new working conditions, compensatory mechanisms develop. The patient can often experience angina attacks, shortness of breath is observed and the heart rhythm is periodically disturbed.

The main reason for the development of such cardiopathology is the closure of one or several coronary arteries at once. This is due to the fact that the walls of the artery are damaged by atherosclerotic plaques that protrude into the lumen of the vessel and significantly narrow its diameter. The degree of narrowing can reach 2/3 or more of the diameter of the vessel.

The contents of an atherosclerotic plaque, consisting of fat and protein mass, can enter the lumen of the vessel. The reaction is the formation of a blood clot up to 1 cm long, which is the reason for the cessation of blood flow and spasm of the coronary artery. Occlusive obstruction occurs – complete closure of the blood flow, and, as a result, necrosis of the myocardial site.

Risk factors contributing to the occurrence of this disease in those who suffer from coronary heart disease, coronary atherosclerosis:

  • Severe or prolonged stress;
  • Hypertonic disease;
  • Severe Infectious Diseases
  • Excessive physical exertion;
  • Injury, surgery;
  • Overheating, hypothermia.

Patients with a history of diabetes, rheumatic heart disease, staphylococcal or streptococcal infection, and elevated cholesterol are at additional risk. At risk are also those who lead a sedentary lifestyle, smoke, abuse alcohol.

The consequences of a heart attack of large or small focal – early and long-term complications, rehabilitation and prognosis

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The mechanism for the development of dysfunction is as follows: due to necrosis of the myocardial site, it to one degree or another loses its ability to contract, conduct impulse. When the acute phase of the attack ends and the patient is no longer in danger of instant death, the affected area is replaced by connective tissue. This structure is the main auxiliary component of body tissues, it fills any damaged areas, while maintaining their structural integrity.

After an extensive heart attack, the following consequences from the heart are observed:

  1. Heart failure is a condition when the heart cannot adequately and fully fulfill its pumping function. It does not throw enough blood into the vessels, because of this, hemodynamics, pressure are disturbed, and starvation of cells in other organs begins. Blood can also stagnate in the veins due to the low speed of movement, and remain in the chambers of the heart itself. Acute heart failure develops during the heart attack itself, and chronic heart failure remains after the manifestation of the disease for the rest of his life. It is associated with all subsequent violations.
  2. Cardiosclerosis – the growth of connective tissue in the thickness of muscle. Since it does not possess the necessary properties, the wall of the heart loses its inherent strength. Under blood pressure, it can stretch, bulge. In the case of uneven expansion of one section of the wall, they speak of an aneurysm of the heart, and uniform and comprehensive expansion of the chambers of the heart along with the depletion of their walls is called dilatation. Both of these conditions increase the risk of heart failure with significant physical exertion or high blood pressure.
  3. Violations of the rhythm and conduction – since the pathways in the heart are disturbed, in the vast majority of cases, patients complain of arrhythmias, extrasystoles (extraordinary contractions), a feeling of cardiac arrest, tachycardia (high heart rate). Sometimes these pathologies are exacerbated by ventricular fibrillation, which is a life-threatening condition.
  4. Blood clots – A frequent consequence of an extensive heart attack is a blood clot in one of the chambers of the heart or the main vessel. This is due to the fact that the blood flow slows down, and the damaged endothelium of the vascular wall creates the conditions for intravascular coagulation. Thromboembolism is one of the most important causes of a heart attack, including repeated, therefore, in the course of drug treatment, every patient in the post-infarction period is prescribed fibrinolytics for the prevention of blood clots.
  1. Pulmonary edema – occurs due to stagnation of blood in the pulmonary circulation. The pressure in the pulmonary artery rises significantly, and the lung tissue, one of the most densely penetrated by the vessels, suffers from this in the first place. This is one of the first manifestations of heart failure, which is characterized by shortness of breath (depending on the degree of dysfunction, it can occur both during exercise and in a state of calm), a productive cough, and in the later stages, hemoptysis.
  2. Portal hypertension – has the same developmental mechanism as pulmonary, but in this case the pressure rises in the portal vein of the liver. Large volumes of blood accumulate in the blood depot of the liver, it increases and begins to compress the surrounding organs. One of the symptoms of portal hypertension is ascites, a free fluid in the abdomen that enters the intercellular space from crowded vessels.

The prognosis for extensive heart attack largely depends on whether complications arose or not.

Each of the complications has its own period of vulnerability, during which the risk of its development is highest. During the disease, acute, acute, subacute periods and the stage of scarring are distinguished. Cardiogenic shock occurs in the acute period, reperfusion syndrome in the acute, and post-infarction syndrome, also known as Dressler’s syndrome, is likely in the subacute and during scarring.

Cardiogenic shock

This condition is accompanied by acute chest pain and occurs in the first hours after a heart attack. Cardiogenic shock occurs when the pumping function of the heart drops sharply, and due to the stressful situation and the release of biologically active substances from the affected tissues, the peripheral vessels are reduced. At this point, peripheral resistance grows, cells begin to starve, and sensitive shock organs are damaged.

Reperfusion syndrome is a more distant complication, but no less dangerous. It occurs when, after a heart attack, drugs are dissolved in a large volume that dissolve dense blood clots, i.e., fibrinolytics. Tissue in conditions of prolonged ischemia has accumulated a large amount of toxic substances. When fresh blood abruptly flows into it, these metabolites enter the bloodstream, and the lesion area expands even more. Therefore, fibrinolytic drugs should be strictly dosed.

Dressler’s Syndrome

Dressler’s syndrome, or post-infarction syndrome occurs later than other complications. Why is it dangerous? This is an autoimmune reaction of the body to damaged tissue, which develops a few weeks after a heart attack. The immune system recognizes dead tissue of the heart muscle as foreign, producing antibodies on them.

The main goal of therapy is to prevent the development of complications. With the implementation of pathogenetic treatment, the chances of surviving with the consequences of an extensive heart attack increase. This is evidenced by medical sources and reviews of patients who have had an illness.

What are the consequences of an extensive myocardial infarction, will it lead to death, how high are the chances of surviving during the resuscitation period and after, what should be the rehabilitation? We will answer all questions in order.

According to medical statistics, about 40% of people who have suffered an attack die within the first year after an attack of the disease, 19% do not cross the five-year survival threshold, having suffered a relapse or complications of the disease. Severe consequences can be:

  • pericarditis, leading to proliferation of connective tissue (“armored heart”);
  • endocarditis, leading to the appearance of blood clots and thromboembolic syndrome;
  • heart failure;
  • arrhythmia;
  • pulmonary edema ;
  • cardiogenic shock;
  • myocardial rupture;
  • ventricular aneurysm;
  • cessation of cardiac activity.

In the case of scar formation on the myocardium, the prognosis of survival can be considered favorable if the patient follows the recommendations of the doctor and conducting maintenance therapy.

Even with such a prognosis, recurrent heart attack can occur, which often leads to irreversible consequences. Relapse is possible within 6-8 weeks after the first attack, during the appearance of scar tissue.

The prognosis and consequences of myocardial infarction depend on many factors: the depth, localization and area of ​​damage to the heart muscle, the age of the patient, general condition, the presence of concomitant diseases, the speed of medical care, the method of treatment, etc. The quality and duration of rehabilitation, including psychological 3, also affects the patient’s future life and ability to work.

Complications of MI are divided into early and late.

Treatment – drug and non-drug: diet, lifestyle correction

Physical rehabilitation (physiotherapy exercises) or cardiorehabilitation

Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.