avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2019-9-1-23-30avk-880Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESСЛУЧАЙ СПОНТАННОЙ ДИССЕКЦИИ КОРОНАРНОЙ АРТЕРИИ (ОБЗОР ЛИТЕРАТУРЫ И ОПИСАНИЕ СЛУЧАЯ)А САSЕ OF SPONTANEOUS CORONARY ARTERY DISSECTION (REVIEW AND CASE REPORT)ВатутинН. Т.VatutinN. T.

Донецк

Donetsk

ТарадинГ. Г.TaradinG. G.

Донецк

Donetsk

taradin@inbox.ruБортД. В.BortD. V.

Донецк

Donetsk

ДмитриевА. В.DmitrievA. V.

Донецк

Donetsk

КанишеваИ. В.KanishevaI. V.

Донецк

Donetsk

СидоренкоИ. А.SidorenkoI. A.

Донецк

Donetsk

ГОО ВПО «Донецкий национальный медицинский университет им. М. Горького»; ГУ «Институт неотложной и восстановительной хирургии им. В.К. Гусака»УкраинаState Educational Organization of Higher Professional Education «M. Gorky Donetsk National Medical University»; State Institution «V.K. Gusak Institute of Urgent and Recovery Surgery»UkraineГУ «Институт неотложной и восстановительной хирургии им. В.К. Гусака»УкраинаState Institution «V.K. Gusak Institute of Urgent and Recovery Surgery»UkraineГОО ВПО «Донецкий национальный медицинский университет им. М. Горького»УкраинаState Educational Organization of Higher Professional Education «M. Gorky Donetsk National Medical University»Ukraine201912022019912330Copyright © Ватутин Н.Т., Тарадин Г.Г., Борт Д.В., Дмитриев А.В., Канишева И.В., Сидоренко И.А., 20192019Ватутин Н.Т., Тарадин Г.Г., Борт Д.В., Дмитриев А.В., Канишева И.В., Сидоренко И.А.Vatutin N.T., Taradin G.G., Bort D.V., Dmitriev A.V., Kanisheva I.V., Sidorenko I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/880

В статье приведен обзор литературы по проблеме спонтанной диссекции коронарной артерии — надрыве её стенки, не связанном с атеросклерозом, травмой или ятрогенным воздействием и приводящим к проникновению крови между оболочками артерии. Последствием такой диссекции является обструкция коронарной артерии, вследствие формирования интрамуральной гематомы или повреждения интимы, и ишемия миокарда с развитием острого коронарного синдрома, инфаркта миокарда или внезапной кардиальной смерти. Представлены сведения по эпидемиологии, патофизиологии и этиологии заболевания. Освещена роль артериопатий, воспалительных заболеваний, беременности и женских половых гормонов, генетических причин, а также инициирующих и стрессорных факторов в развитии спонтанной диссекции коронарной артерии. Описывается клиническая картина и диагностика заболевания. Подчеркивается, что помимо клинических проявлений, традиционная электрокардиограмма и коронарная ангиография остаются стандартом диагностики диссекции. При лечении спонтанной диссекции коронарной артерии используют чрескожное коронарное вмешательство со стентированием пораженной артерии, аортокоронарное шунтирование и медикаментозные средства, причём консервативная медикаментозная терапия является предпочтительной. Особый акцент сделан на особенностях диагностических и терапевтических мероприятий у беременных и кормящих грудью пациенток. В статье также описывается клинический случай развития крупноочагового инфаркта миокарда, осложнённого кардиогенным шоком у молодой женщины без факторов риска ишемической болезни сердца в послеродовом периоде, причиной которого явилась спонтанная диссекция коронарной артерии. Диагностика заболевания сопровождалась определёнными трудностями. Ургентное чрескожное коронарное вмешательство со стентированием инфаркт-зависимой коронарной артерии позволило быстро улучшить и стабилизировать состояние пациентки.

The article presents a literature review on the problem of spontaneous dissection of the coronary artery (SCAD) — tearing of its wall, not associated with atherosclerosis, trauma or iatrogenic effects leading to blood penetration between vessel layers of the artery. The consequence of this dissection is obstruction of the coronary artery due to the formation of intramural hematoma or intima damage, and myocardial ischemia with development of acute coronary syndrome, myocardial infarction or sudden cardiac death. Information on the epidemiology, pathophysiology andetiology of the disease is presented here. It was highlighted a role of arteriopathies, inflammatory diseases, pregnancy and female sex hormones, genetic causes as well as initiating and stress factors in its development. The clinic picture and diagnosis of the disease is described. It was emphasized that in addition to clinical manifestations, the traditional electrocardiogram and coronary angiography remain the standard for diagnostics of the dissection. In the treatment of SCAD, percutaneous coronary intervention with stenting of the affected artery is used, coronary artery bypass surgery and medications with regard to preference of conservative drug therapy. A special attention is paid to the features of diagnostic and therapeutic measures in pregnant and breast-feeding patients. The article also presents a clinical case of development of large-focal myocardial infarction complicated by cardiogenic shock in a young woman without risk factors for coronary heart disease in the postpartum period caused by SCAD. Diagnosis of the disease was accompanied by certain difficulties. An urgent percutaneous coronary intervention with stenting of the infarct-related coronary artery allowed rapidlyimproving and stabilizing the patient’s condition.

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The authors declare that there are no conflicts of interest present.