Da li trombolitička terapija utiče negativno ili pozitivno na infarkt miokarda sa ST-elevacijom (STEMI) nastao spontanom disekcijom koronarne arterije?

  • Zoran Jović Clinic for Cardiology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Slobodan Obradović Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; Clinic for Emergency and Internal Medicine, Military Medical Academy, Belgrade, Serbia
  • Nemanja Djenić Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Zorica Mladenović Clinic for Cardiology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Predrag Djurić Clinic for Cardiology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Marijan Spasić Clinic for Cardiology, Military Medical Academy, Belgrade, Serbia
  • Dragan Tavčiovski Clinic for Cardiology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
DOI: https://doi.org/10.2298/4701
Ključne reči: acute coronary syndrome||, ||akutni koronarni sindrom, aneurysm dissecting||, ||aneurizma, disekantna, myocardial infarction||, ||infarkt miokarda, fibrinolytic agents||, ||fibrinolitici, treatment outcome||, ||lečenje, ishod,

Sažetak


Uvod. Spontana disekcija koronarne arterije (SDKA) predstavlja veoma retku bolest sa lošom prognozom. Obično se javlja kod mladih žena bez faktora rizika od koronarne arterijske bolesti (KAB) i kod žena za vreme periporođajnog perioda. Prognoza infarkta miokarda uzrokovanog SDKA je loša, lečenje je često teško i preporuke još uvek ne postoje. Prikaz bolesnika. Prikazali smo ženu sa akutnim infarktom miokarda prednjeg zida leve komore, prouzrokovanog spontanom disekcijom medijalnog segmenta prednje descendentne arterije. Lečenje smo započeli trombolitičkom terapijom i urađena je koronarna angiografija nakon toga. Dve godine kasnije na ponovljenoj koronarnoj angiografiji nađene su normalne koronarne arterije. Takođe, analizirani su prikazi 18 bolesnika objavljeni u periodu od 1996. do 2012. godine, zajedno sa prikazom našeg bolesnika, kod kojih je disekcija koronarne arterije lečena trombolitičkom terapijom. Ustanovljeno je da je samo kod jednog bolesnika, od njih 19, opisana komplikacija nakon primene trombolitičke terapije u lečenju SDKA. Zaključak. Ponekad, kad imamo infarkt miokarda kod mladih žena bez faktora rizika od KAB, posebno kod žena u periporođajnom periodu, treba misliti na SDKA. Primer naše bolesnice, kao i osam drugih, pokazuje da se dobri klinički rezultati mogu postići trombolizom. Uprkos svemu tome, još uvek je potrebno više podataka kako bi se potvrdilo da tromboliza ne šteti u terapiji SDKA. Za sada, trombolitička terapija može biti jedna od opcija.

Biografija autora

Zoran Jović, Clinic for Cardiology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia

Klinika za kardiologiju

 

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Objavljeno
2015/07/08
Broj časopisa
Vol. 72 Br. 6 (2015)
Rubrika
Prikaz bolesnika