Spontana disekcija koronarne arterije – neuobičajeni izazov

  • Biljana Putniković Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Ivan Ilić Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Miloš Panić Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Aleksandar Aleksić Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Radosav VIdaković Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Aleksandar N. Nešković Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
DOI: https://doi.org/10.2298/2408
Ključne reči: acute coronary syndrome||, ||akutni koronarni sindrom, dissection||, ||disekcija, coronary angiography||, ||angiografija koronarnih arterija, diagnosis||, ||dijagnoza, treatment outcome||, ||lečenje, ishod,

Sažetak


Uvod. Spontana koronarna disekcija predstavlja neuobičajen uzrok akutnog koronarnog sindroma. Uglavnom nastaje kod bolesnika koji nemaju aterosklerotsku koronarnu bolest i nosi značajan rani mortalitet. Metoda izbora za lečenje ovog ozbiljnog stanja (interventno, hirurško  ili medikamentno) još uvek nije jasno definisana. Prikaz bolesnika. U radu je prikazana bolesnica stara 41 godinu, primljena u našu bolnicu nakon neuspešne trombolitičke terapije akutnog anteriornog infarkta, iz lokalne bolnice bez sale za kateterizaciju srca. Hitan koronarni angiogram prikazao je spontanu koronarnu disekciju glavnog stabla i prednje silazne grane leve koronarne arterije. Kontrolna koronarografija nakon pet dana pokazala je proširenje disekcije u cirkumfleksnu arteriju. Zahvaljujući očuvanom koronarnom protoku (thrombolysis in myocardial infarction – TIMI II-III), odsustvu angine i simptoma srčane insuficijencije, bolesnica je medikamentno lečena dvojnom antiagregacionom terapijom, niskomolekularnim heparinom, beta blokatorom, ACE inhibitorom i statinom. Bolesnica je otpuštena nakon 12 dana lečenja. Na kontrolnim pregledima nakon šest meseci i dve godine, bolesnica je bila bez tegoba i koronarni angiogram je pokazao prisustvo disekcije uz očuvan koronarni protok krvi. Zaključak. Kod bolesnika sa spontanom koronarnom disekcijom, hitna koronarna angiografija je potrebna radi procene koronarne anatomije i zahvaćenosti disekcijom. Kod bolesnika koji nemaju anginozne smetnje ili simptome srčane insuficijencije, sa očuvanim koronarnim protokom, medikamentna terapija može biti prihvatljiv način lečenja. Dalja istraživanja su potrebna da bi se utvrdila optimalna strategija lečenja ovog retkog uzroka akutnog koronarnog sindroma.

Biografije autora

Biljana Putniković, Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Department of Cardiology, Chief
Ivan Ilić, Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Clinical Hospital Center Zemun

Cardiac catheterization Lab

Miloš Panić, Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Department of Cardiology, Coronary Care unit, Chief
Aleksandar Aleksić, Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Department of Cardiology, Cardiac catheterization laboratory, interventional cardiologist
Radosav VIdaković, Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Department of Cardiology, cardiologist
Aleksandar N. Nešković, Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Department of Cardiology, Cardiac catheterization laboratory,Chief

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Objavljeno
2015/04/22
Broj časopisa
Vol. 71 Br. 3 (2014)
Rubrika
Prikaz bolesnika