Alexey Malobrodsky, a theatre manager and former general producer at Seventh Studio. (c). Kommersant Photo Agency/SIPA USA/PA Images. All rights reserved.Alexey Malobrodsky, the former director of Moscow’s Gogol Center, was hospitalised during court proceedings on 10 May after a judge refused an application for transfer under house arrest.

Malobrodsky was arrested in June 2017 as part of an embezzlement investigation into the performing arts centre, in which theatre director Kirill Serebrennikov, Yuri Itin, former director of the Seventh Studio, a project under the remit of the Gogol Center, Russian Academic Youth Theater director Sofia Apfelbaum and theatre accountant Nina Maslyaeva have also been arrested. Malobrodsky is the only accused still in pre-trial detention, the others have been released under house arrest. Seventh Studio producer Ekaterina Voronova fled the country.

I asked cardiologist Yaroslav Ashikhmin, who visited Malobrodsky on 4 May and 10 May, about the state of his health.

Yaroslav, when did you first visit Alexey Malobrodsky?

I was asked by two respected doctors — Mikhail Laskov, an oncologist and hematologist, and Andrey Volna, an orthopedist. I didn’t accept payment and came here because I was asked and because there’s such a thing as universal human values. I hoped that I’d be able to make a statement to the court, particularly regarding the direct threat to Malobrodsky’s life. There’s a 30% risk of death in the near future if nothing is done. But I wasn’t summoned. I’ve already written my conclusion, Malobrodsky’s lawyers have it. The state of his health hasn’t changed in the meantime, if a heart attack hasn’t already started developing.

When I went to visit him, they told me he has hypertension. And then I told the lawyer that I’ll write what I see in the conclusion. You can treat hypertension in pre-trial detention fine. But when I saw him, I understood that the situation is fundamentally different from what I expected.

You visited Malobrodsky in Moscow Pre-Trial Detention No.4. What are the conditions like there?

I didn’t see his cell. I was brought to a visiting room, where there was a broken fridge, wall sockets, a sink and that’s it. There was a prison officer there, it was relatively comfortable to speak to her. She was an x-ray operator.

Malobrodsky looked very ill, tired. I didn’t have much time, and so I conducted the examination differently from how I usually do it. I’m not a psychiatrist, but it was clear that this person was extremely overwhelmed and in pain.

Could you say a few words about the symptoms that you saw? Alexey has agreed to have his medical status made public.

The patient has breathing difficulties when resting. There’s pain in the chest, which I believe is connected to thrombosis of the coronary artery — that’s a myocardial infarction [commonly known as a heart attack], or what used to be called a pre-infarct state.

Moreover, I saw Malobrodsky on Friday [4 May] and there were already symptoms connected to unstable angina [a condition where a heart does not receive enough blood and oxygen]. There was already pain and difficulties breathing. The prison officers also saw this. His lips had turned blue, and there was particular problems with breathing in the lower right lung. Here we need to understand if there is a thromboembolism of the pulmonary artery or not. There was a high rate of sugar in the blood [hyperglycemia] — 11.1. This is a criteria for making a diagnosis of diabetes. As far as I understand, this diagnosis is new. Diabetes makes the flow of the coronary atherosclerosis more difficult. This can lead to a situation where the plaque, which he has on his arteries, become less stable. He had hypertension at 155/100. I had an ECG machine with me and saw the ventricular arrhythmia. The arrhythmia is quite serious.

I wrote a full medical conclusion where I stated that there is a direct threat to life. That was on Friday. I was called to see Malobrodsky again today after the court hearing. I saw him in detention, I wasn’t allowed to enter the cell. I was shocked by the behaviour of the guards, who were forcing him to walk. Both of us said that he cannot walk. His condition is serious, he should be transported via a stretcher. The guard forced him to walk. But he can’t even stand up, the signs of a weak heart were clear: his lips had turned blue and there were pronounced and significant difficulties with breathing. They accused of him putting it on…

Who accused him?

The guards. They spoke to him very roughly. They told him “not to make a circus”, to stand up and walk. He even pushed them off once, he hit a guard who had started lifting him up under the arms. But it’s impossible to fake signs like lips turning blue. I’m confident that his condition is a combination of coronary heart disease with unstable angina or a heart attack with hypertension, diabetes. It’s possible that there is a developed thromboembolism of the lung artery, plus heavy arrhythmia. On Friday, I gave him nitroglycerin, which improved the situation slightly.

28 June 2017: solidarity action in support of Russian theatre at the Brandenburg Gate, Berlin.Now we’ve called the first ambulance. They took a look at him and left. I spoke to Alexey Svet, a respected doctor, and we called another ambulance and heart resuscitation team. Someone had the phone number for the Minister of Health, so we rang Veronika Skvortsova.

There is a direct threat to life right now. The patient should be transferred to a heart clinic where an urgent coronarography can be taken. Unfortunately, it’s not always possible to confirm this diagnosis with a cardiogram. He needs an urgent test for troponin.

If Malobrodsky is taken to Moscow Hospital No.20, how critical will this be?

The patient should be observed in a centre which can perform a coronarography. I don’t know if Hospital No.20 can do that.

If we assume that he is now taken somewhere, “treated”, then they can still wish to return him to pre-trial detention. What prognosis can you make on Malobrodsky’s health?

We can’t make prognoses in this kind of situation. There needs to be a diagnosis first. Everything depends on what exactly is happening in his heart. I have a model with me, I can show you.

Alexey Malobrodsky. Source: Facebook. I believe that the actions of the paramedics, who have been making him wait for more than 90 minutes, are wrong. He needs to be taken to a ward where all the analyses can be performed.

How might the investigation have affected his health?

The court medics can make those conclusions. If you look at the factors that increase the risk of a heart attack, then emotional upheavals is one of the most serious factors that can influence the development of thrombosis.

Malobrodsky said that this all began in the middle of April, after that there was frequent pain in his chest, but he didn’t get properly treated for it. He was given a drug that slowed his heart rate and reduced blood pressure slightly. But there’s no chance of finding the right drug in a prison hospital, the one that stable patients with coronary heart disease need.

The main thing now is to make sure an heart attack doesn’t develop.