5. Kutkiene S, Petrulioniene Z, Laucevicius A, et al. Is the coronary artery calcium score the fi rst-line tool for investigating patients with severe hypercholesterolemia?

During the recent years, since the start of coronary artery stent era not only coronary artery bypass graft surgery, but percutaneous transluminal angioplasty became common in patients with left main coronary artery stenosis. Mechanical complications of myocardial infarction, such as ventricular septal rupture, left ventricle free wall rupture and mitral regurgitation due to papillary muscle rupture, are straight indications for cardiac surgery. However, studies show that the age of over 70 years is a high-risk factor for cardiac surgery. In elderly patients, the duration of cardiopulmonary bypass and aortic cross-clamping time have a major impact on the surgery outcome. Therefore, strategies aimed at reducing the volume of cardiac surgery, should be more successful in elderly patients. On the other hand, elderly patients should be well prepared for surgery, and it should be performed when concomitant diseases are compensated. A case of 82-year patient admitted to the intensive care unit with acute myocardial infarction and chord papillary muscles partial rupture associated with severe mitral regurgitation, is presented. Due to the progression of pulmonary edema, mechanical ventilation was started and emergency percutaneous intervention was administered as a life-saving measure. Stents were placed in obtuse marginal branch, circumflex artery and anterior interventricular artery. Because of existing mitral regurgitation of 3-4 grade, after 2 weeks the patient was re-evaluated ex consilio. Considering relatively stable condition, mitral valve replacement with cardiopulmonary bypass was administered, which was successfully done. The successful treatment of this patient was possible because of the proper and timely staging of the patient’s management.

Patients with major coronary artery involvement are a very tough group to treat in terms of emergent revascularization possibility by percutaneous coronary intervention. Concomitant myocardial infarction and pulmonary edema makes the treatment even more complicated and requires proper anesthetic approach. A patient who had underwent a coronary artery bypass graft surgery for a late stage coronary artery disease 5 years before was admitted to the cardiac intensive care unit with myocardial infarction and acute decompensated left-sided heart failure. Considering the life-threatening angina leading to a serious complications (acute pulmonary edema) and the results of the latest coronary angiography, an urgent coronary angiography with the revision of coronary arteries condition and further possible percutaneous coronary intervention due to life-threatening emergency was offered. Mechanical ventilation was started, the patient’s condition stabilized. Left coronary artery trunk stenting, a difficult approach considering the risk for complications, was performed as the second stage intervention, saving patient’s life.

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зульФИЯ анасовна ШайХутдИнова, зам. главного врача по лечебной работе ГАУЗ «Городская клиническая больница № 7» г. Казани, тел. +7-960-048-26-37 татьЯна александровна петрова, и.о. зав. отделением эндокринологии ГАУЗ «Городская клиническая больница № 7» г. Казани, тел. +7-905-311-21-86 евгенИй нИколаевИч Иванцов, студент лечебного факультета ГБОУ ВПО «Казанский государственный медицинский университет» Минздрава России, тел. +7-958-620-44-86 Реферат. Надпочечниковая недостаточность -клинический синдром, характеризующийся недостаточной секре-цией гормонов коры надпочечника в результате нарушения функционирования одного или нескольких звеньев гипоталамо-гипофизарно-надпочечниковой системы. Такие ее проявления, как выраженная гипотония, анурия, акроцианоз, нитевидный пульс при соответствующих условиях, например изменениях электрокардиограммы и жалоб со стороны сердца, могут быть расценены как признаки шока, имеющего кардиальную природу. В статье представлен пример диагностики и лечения пациентки, поступившей с подозрением на инфаркт миокарда и кардиогенный шок. Полноценный сбор анамнеза, адекватная оценка клинического состояния больной позволили воздержаться в первые часы поступления в стационар от проведения коронароангиографии -агрессивной и дорогостоящей диагностической процедуры. Совместное ведение пациентки кардиореаниматологами, кардио-логами и эндокринологами при контроле уровней гормонов крови, проведении эндоскопических и ультразвуко-вых исследований явилось залогом правильной диагностики и успеха в лечении сложной пациентки. На фоне инфузионной терапии, терапии гормонами, вазопрессорами удалось стабилизировать состояние пациентки, постепенно повысить артериальное давление и в последующем отказаться от введения вазопрессоров. Паци-ентка была выписана из стационара на фоне значительного клинического улучшения. Ключевые слова: надпочечниковая недостаточность, шок, инфаркт миокарда. GAUZ «City Clinical Hospital № 7», Kazan, tatYana a. petrova, acting the manager of office of endocrinology of GAUZ «City Clinical Hospital № 7», Kazan, evgenY n. Ivantsov, student of medical faculty of Public Educational Institution of Higher Professional Training «Kazan state medical university », ph. +7-958-620-44-86 Abstract. Adrenal failure -a clinical syndrome characterized by insufficient secretion of hormones of the adrenal cortex as a result of malfunction of one or more parts of the hypothalamic-pituitary-adrenal system. Such signs as severe hypotension, anuria, acrocyanosis, thready pulse, changes in the electrocardiogram and complaints of the heart can be regarded as signs of shock, having a cardiac nature. The article present an example of the diagnosis and treatment of patient presenting with suspected myocardial infarction and cardiogenic shock. Diagnosis of her adrenal failure allowed to help her and save her live. The exact history taking, adequate evaluation of its clinical condition allowed in the first hours of its arrival to avoid an aggressive diagnostic procedures -coronary angiography. Tandem tr...