Тематичний Архів | Category Archives: Practice observations

Yu.H. Kyyak, M.P. Halkevych, O.Ye. Labinska, O.Yu. Barnett Acute coronary syndrome caused by myocardial bridging: electrocardiographic and angiographic evidence

Myocardial bridging is a congenital anomaly of the coronary arteries, where a band of heart muscle tunnels through the myocardium instead of resting under epicardium, due to such conditions the artery constricts as the heart squeezes the blood to pump. The case of acute coronary syndrome without ST segment elevation is presented. The patient 44 years old was admitted to coronary care unit at emergency care hospital with suspected acute myocardial infarction. During the angiography myocardial bridging was diagnosed in the anterior interventricular branch of the left coronary artery which was the cause of retrosternal pain.

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V.V. Bugayenko, N.Yu.Chubko, О.V. Tsyzh, M.P. Slobodianyk Features of diagnosis of the ischemic heart disease. False-positive and false-negative exercise tests

This article reviews scores and methodology of the assessment of the exercise test. The results of dobutamine ECG stress-tests, multispiral computer tomography determination of coronary calcium for diagnosis of the ischemic heart disease are presented. Clinical cases of false-positive and false-negative exercise tests demonstrating difficulties of exercise test results interpretation and their causes are discussed.

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K.V. Rudenko, M.L. Zhuravleva, F.М. Abdueva, I.A. Sumanova Clinical case of surgical treatment of obstructive form of hypertrophic cardiomyopathy according to the new Ferrazzi procedure

The paper describes the case of surgical treatment of hypertrophic obstructive cardiomyopathy. Extended resection of the interventricular septum, resection of three secondary (pathological) chords of the anterior leaflet of the mitral valve and mobilization of the papillary muscles of the mitral valve have been carried out using the Ferrazzi procedure. An objective improvement of echocardiography parameters and improvement of well-being with disappearance of dyspnea in moderate exercise and dizziness have been achieved after the operation.

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D.A. Mansurova, L.K. Karazhanova, A.B. Sugraliev Stent thrombosis in a patient with acute coronary syndrome without ST segment elevation with high residual platelet reactivity

Stent thrombosis is a dangerous life-threatening condition, which is more frequent during the first month after stent implantation. Currently, there are several possible schemes for preventing stent thrombosis with clopidogrel and stronger P2Y12 receptor inhibitors. The article describes the clinical case of stent thrombosis in a patient with clopidogrel resistance against the background of carrying the allelic variant of the gene CYP2C19*2, a «slow metabolizer of clopidogrel». Despite the recommended use of high doses of clopidogrel to improve the clinical outcome in patients with a homozygote CYP2C19*2 (*2/*2), this clinical case showed high doubtfulness of such tactics. In such cases, the use of more potent inhibitors of P2Y12 receptors is justified, since it allows improving clinical outcomes of mechanical revascularization.

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V.V. Bugayenko, I.P. Golikova, M.P. Slobodianyk Diagnostic tests in suspicion of the coronary artery disease in women. The role of the coronary calcium determination (clinical cases)

This study demonstrates some limitations in assessing of diagnostic tests: bicycle ergometry, treadmill test, stress echocardiography, daily ECG monitoring, as well as multispiral CT with determination of coronary calcium that makes possible to confirm or exclude coronary artery disease in women. Two clinical cases are presented. The data on stratification of cardiovascular risk are included.

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Yu.V. Zinchenko, O.І. Frolov, V.A. Krichkevych, Ye.V. Mоgilnitsky, A.Yu. Rybak, О.M. Rozhkova, R.D. Shevelyov Malignant ventricular arrhythmias in patient with cardiac angiosarcoma

Malignant tumors of the heart are very rare in clinical practice. The causes of the disease so far have not been established. Therefore, a rare clinical case of in vivo diagnosis of primary cardiac tumor (angiosarcoma, complicated by ventricular tachycardia refractory to antiarrhythmic treatment) is of a clinical interest.

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O.I. Boiko Syndrome of the tortuous coronary arteries in childhood

The aim – to explore morphological changes of coronary arteries with severe tortuosity in children. Four autopsy cases of severe coronary artery tortuosity are presented: three cases of intrauterine fetal death (two male patients and one female, at the gestation age of 28, 29 and 39 weeks) and the autopsy case of one-year-old boy. Morphological changes of the coronary arteries were examined by standard histological and histochemical methods (hematoxylin-eosin, Masson’s trichrome, Hart’s elastic stainings). Severe tortuosity of the anterior descending coronary artery was prevalent (in three cases). Detection of tortuous coronary arteries in fetuses, who died prenatally, indicates the congenital genesis of this vascular anomaly.

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S.O. Siromakha, L.M. Prokopovych, V.P. Zalevskiy, O.Z. Paratsiy, O.S. Golovenko, Ya.P. Truba, V.V. Lazoryshynets. Case of urgent treatment of atrial fibrillation in a newborn

Heart rhythm disorder is a frequent concomitant disease of cardiovascular and extra-cardiac pathology. A rare variant of heart rhythm disorder, which is not typical for newborns and young people, is atrial fibrillation. Frequency of atrial fibrillation is less than 1 %. The main purpose is analysis of clinical case in newborn with atrial fibrillation. Diagnostic and search effective methods of treatment atrial fibrillation in newborn’s is an actual problem in child cardiology. In this article described successful case of treatment life-threatening atrial fibrillation in newborn by electric cardioversion without cardiovascular pathology. Electric cardioversion in newborn’s with supraventricular tachycardia, which have hemodynamic disorders, is safe and effective therapy method.

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M.Yu. Diachenko, D.I. Onofreichuk, M.Yu. Sokolov. Syndrome of no-reflow as a result of late hospitalization for the purpose of percutaneous myocardial reperfusion

Acute coronary syndrome with ST segment elevation remains a serious problem in cardiology and often determines the level of in-hospital mortality. Later, the patient’s admission to reperfusion therapy can lead to deterioration of the immediate and long-term results of treatment. The most difficult problem with percutaneous reperfusion therapy STEMI patients is no-reflow syndrome, i.e. the absence of myocardial perfusion after restoration of the arterial blood flow. Taking into account the data of the clinical case, no-reflow syndrome can be diagnosed even when the coronary artery is open (after spontaneous opening), under the presence of visible parietal thrombi and after long period of complete obstruction of the vessel lumen. However, the full restoration of blood flow is necessary and in the later period (up to 24 hours from the onset of symptoms) in the presence of the clinic ischemia and lack of positive dynamics of ECG. As shown in the illustrated clinical cases, restoration of blood flow in the infarct-related coronary artery, even in the presence of the syndrome «no-reflow» is able to restore myocardial function during short period of observation.

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D.І. Besh. Pathohistology of the intracoronary thrombi in the patient with acute myocardial infarction

A clinical case of ST-elevation acute myocardial infarction has been presented. Apart from standard drug therapy, percutaneous coronary reperfusion with manual aspiration of thrombi was performed with further histological examination of the obtained materials. Clot formation appeared long before the development of acute myocardial infarction in this patient. It was also demonstrated an important role of inflammation at the initial step of thrombus formation in this case. But earlier coronary arteries were affected by xenobiotics.

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