Iznenadna dugotrajna monomorfna ventrikularna tahikardija kod prethodno zdrave odrasle osobe sa puno uzroka za to, ali koji je pravi?

  • Zoran Jović Srbin
  • Miljan Opančina Military Medical Academy, Clinic of Cardiology, Belgrade, Serbia
  • Zorica Mladenović Military Medical Academy, Clinic of Cardiology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Predrag Djurić Military Medical Academy, Clinic of Cardiology, Belgrade, Serbia
  • Ivica Djurić Military Medical Academy, Clinic of Cardiology, Belgrade, Serbia
  • Jelena Marić Kocijančić Military Medical Academy, Clinic of Cardiology, Belgrade, Serbia
  • Nemanja Djenić Military Medical Academy, Clinic of Emergency Internal Medicine, Belgrade, Serbia University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Valentina Opančina University of Kragujevac, Faculty of Medical Sciences, Department of Radiology, Kragujevac, Serbia
  • Slobodan Obradović Military Medical Academy, Clinic of Cardiology Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP230619065J
Ključne reči: miokard, bolesti;, koronarna bolest;, defibrilatori, implantabilni;, dijagnoza;, magnetska rezonanca, snimanje;, miokardni mostovi;, tahikardija, ventrikulska;, ultrasonografija

Sažetak


Uvod. Dugotrajna monomorfna ventrikulska tahikardija (VT) – DMVT je retka, nedovoljno dijagnostikovana patologija sa veoma lošom prognozom. Zajedno sa ventrikulskom fibrilacijom, DMVT je odgovorna za skoro sve iznenadne srčane smrti (ISS) nastale usled aritmije. Najčešći uzrok VT je ishemijska bolest srca, ali postoje i mnogi drugi razlozi, među kojima su aritmogena kardiomiopatija desne komore (AKDK) i fenomen miokardnog „mosta“ (bridge). Mogućnosti lečenja uključuju hibridni pristup, koji se sastoji od antiaritmijskih lekova, kateterske ablacije i implantabilnog kardioverter defibrilatora (IKD). Prikaz bolesnika. Prikazujemo slučaj 46-godišnjeg muškarca, oficira u vojsci, koji je tokom redovnih fizičkih aktivnosti kod kuće osetio bol u grudima, lupanje srca i mučninu. Zbog navedenih tegoba odmah je pregledan i dijagnostikovana mu je DMVT. Ubrzo nakon postavljanja dijagnoze bolesnik je izgubio svest i uspešno je reanimiran. Sprovedena je kompletna neinvazivna i  invazivna kardiološka dijagnostika. Utvrđeno je da je bolesnik imao stabilnu koronarnu bolest i mišićni „most“ na prednjoj descedentnoj arteriji. Nakon transtorakalne ehokardiografije i magnetne rezonance srca, posumnjano je na AKDK. Genetsko testiranje na AKDK bilo je negativno, ali prema kriterijumima konsenzusa stručnjaka Heart Rhythm Society, imali smo dovoljno dokaza za definitivnu dijagnozu. Bolesnik je hospitalizovan tokom deset dana i lečen lekovima, bez pojave VT i drugih poremećaja. Pre otpusta iz bolnice, ugradili smo mu implantibilni loop rikorder i pratili srčani ritam tokom godinu dana. Tokom trogodišnjeg praćenja svi elektrokardiografski nalazi bili su normalni. Zaključak. Iznenadna DMVT je najčešći uzrok ISS. Detaljan pregled je od neprocenjive važnosti, kao i utvrđivanje neposrednog uzroka aritmije i primena odgovarajuće terapije, koja za te bolesnike predstavlja vid lečenja koji spasava život. Terapija uključuje lekove, elektrofiziologiju ili IKD ili kombinaciju ovih pristupa u lečenju.

Biografija autora

Zoran Jović, Srbin

Klinika za kardiologiju

 

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Objavljeno
2024/02/29
Broj časopisa
Vol. 81 Br. 02 (2024): Vojnosanitetski pregled
Rubrika
Prikaz bolesnika