Myocardial Infarction With Nonobstructive Coronary Atherosclerosis as a Current Problem of Emergency Cardiology

Рябов, В. В.; Fedorova, Sofya S.; Вышлов, Е. В.

doi:10.29001/2073-8552-2018-33-4-10-18

Cited by 5 publications

(2 citation statements)

References 35 publications

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“…First of all, patients with TS may have atherosclerotic plaques in the coronary vessels [ 38 , 39 ]. Secondly, in some cases, AMI can proceed without obstruction of the coronary arteries as Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA) [ 44 , 73 - 75 ]. Myocardial infarction in the absence of obstructive coronary artery disease is observed in 5% to 6% of all patients with AMI [ 76 ].…”

Section: Problem Of Differential Diagnosis Of Patients With Takotsubo...mentioning

confidence: 99%

Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis

Прокудина

Kurbatov

Zavadovsky

et al. 2021

CCR

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: The purpose of the review is the analysis of clinical and experimental data on the etiology and pathogenesis of takotsubo syndrome (TS). TS is characterized by contractile dysfunction, which usually affects the apical region of the heart, lack of coronary artery obstruction, moderate increase in myocardial necrosis markers, prolonged QTc interval (in 50% of patients), sometimes elevation of ST segment (in 19% of patients), increase N-Terminal Pro-B-Type Natriuretic Peptide level, microvascular dysfunction, sometimes spasm of the epicardial coronary arteries (in 10% of patients), myocardial edema, and life-threatening ventricular arrhythmias (in 11% of patients). Stress cardiomyopathy is a rare disease, it is observed in 0.6 - 2.5% of patients with acute coronary syndrome. The occurrence of takotsubo syndrome is 9 times higher in women, who are aged 60-70 years old , than in men. The hospital mortality among patients with TS corresponds to 3.5% - 12%. In many patients with TS, but not in all, physical or emotional stress precedes the disease. Many patients with TS, but not all, have neurological or mental illnesses. The level of catecholamines is increased in patients with TS, therefore, the occurrence of TS is associated with the excessive activation of the adrenergic system. The negative inotropic effect of catecholamines is associated with the activation of β2 adrenergic receptors. An important role of the adrenergic system in the pathogenesis of TS is confirmed by studies which were performed using 125I-metaiodobenzylguanidine (125I –MIBG). TS causes edema and inflammation of the myocardium. The inflammatory response in TS is systemic. TS causes impaired coronary microcirculation and reduces coronary reserve. There is reason to believe that an increase in blood viscosity may play an important role in the pathogenesis of microcirculatory dysfunction in patients with TS. Epicardial coronary artery spasm is not obligatory for the occurrence of TS. Cortisol, endothelin-1 and microRNAs are challengers for the role of TS triggers. A decrease in estrogen levels is a factor contributing to the onset of TS. The central nervous system appears to play an important role in the pathogenesis of TS.

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Section: Problem Of Differential Diagnosis Of Patients With Takotsubo...mentioning

confidence: 99%

Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis

Прокудина

Kurbatov

Zavadovsky

et al. 2021

CCR

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“…Это сопровождается значительным уменьшением общей плотности β-адренорецепторов (β-АР) на мембране кардиомиоцитов. На фоне сниженного количества β-АР под дей ствием катехоламинов происходит возрастание по требности миокарда в кислороде и на фоне микрососудистых изменений, вазоспазма, необструктивного атеросклероза может способствовать развитию ОИМ, что характерно для пациентов с ИМБОКА [6,7].…”

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Comparative analysis of adrenergic reactivity of erythrocytes in patients with myocardial infarction depending on the severity of coronary obstruction

et al. 2020

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Цель. Сравнить показатели β-адренореактивности мембран эритроцитов (β-АРМ) у больных инфарктом миокарда (ИМ) с нестенозирующим и стенозирующим однососудистым поражением коронарных артерий. Материал и методы. В исследование включено 40 пациентов с ИМ (19 пациентов в основной группе и 21 пациент в группе контроля), из заключительного анализа было исключено 3 (15,7%) пациента с диагностированным острым миокардитом. Параметр β-АРМ был изучен при поступлении, 2-й, 4-й и 7-й день от острого ИМ, норма β-АРМ <20 отн.ед. Результаты. При изучении β-АРМ выявлено, что у весомой доли больных показатели β-АРМ в 2 раза превышают нормальные значения. Медиана β-АРМ

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Clinical profile of patients with non-ST segment elevation acute coronary syndrome: experience of a regional vascular center

Nesova,

Tsydypova,

Ryabov

2024

Cardiovasc Ther Prev

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Aim. To identify the main clinical and paraclinical characteristics of patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) of various risk groups for adverse ischemic events, as well as to describe the in-hospital outcomes of the disease.Material and methods. The retrospective analysis included 600 patients who were hospitalized at the regional vascular center from January 2019 to January 2021 with a diagnosis of NSTE-ACS.Results. Patients were stratified into very high — 208 (34,7%), high — 196 (32,7%), moderate — 108 (18%) and low — 88 (14,6%) risk groups. In the highand very high-risk groups, patients were older, characterized by a significant comorbidity index, increased bleeding risk, decreased left ventricular ejection fraction and glomerular filtration rate in comparison with patients of other groups (p<0,05). Very highrisk patients were characterized by associated clinical conditions, predominantly infectious diseases and decompensated heart failure. Unfavorable outcome of hospitalization was observed in 44 (7,3%) patients. The death probability in the very high-risk group (33; 15,9%) was higher than in the low-risk group (2; 2,3%) (Odds ratio 8,1 (95% confidence interval: 1,9-34,6); p=0,01). Regardless of the risk degree, there was a high (53,5%) likelihood of completing invasive coronary angiography as a diagnostic procedure. Most of the observed complications as a result of invasive coronary angiography were characteristic of the high(18,3%) and very high-risk groups (21,5%).Conclusion. NSTE-ACS patients at very high/high risk of adverse ischemic events represent a heterogeneous group with cardiac and noncardiac pathologies with high comorbidity and bleeding risks, decreased left ventricular ejection fraction and glomerular filtration rate, and associated clinical conditions.

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Myocardial Infarction With Nonobstructive Coronary Atherosclerosis as a Current Problem of Emergency Cardiology

Cited by 5 publications

References 35 publications

Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis

Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis

Comparative analysis of adrenergic reactivity of erythrocytes in patients with myocardial infarction depending on the severity of coronary obstruction

Clinical profile of patients with non-ST segment elevation acute coronary syndrome: experience of a regional vascular center

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