Тематичний Архів | Category Archives: Practice observations

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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M.Yu. Sokolov, О.S. Kryvchun. Аspiration of the intracoronary thrombi in patients with acute coronary syndromes and persistent ST elevation. Role of the floating thrombus, diagnosis and treatment

The treatment of thrombosis in STEMI patients is one of the most important tasks. Systematic approach is a key element of the reperfusion therapy success. The approach to the invasive treatment should be differentiated, first and foremost based on angiographic assessment of thrombosis.

The maximum effect thrombotic masses aspiration from the infarct-related vessel is achieved in patients with large, floating thrombi of all ages. Efficient removal of the coronary thrombi using contemporary aspiration catheters is the auxiliary procedure providing timely reperfusion therapy in patients with STEMI, reducing distal embolization and improving myocardial perfusion. Accumulation of experience with these catheters and more detailed assessment of the immediate and long-term postoperative results are necessary to make conclusion about their effectiveness and safety in clinical practice.

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Yu.V. Zinchenko, О.V. Doronin, M.R. Ikorkin. Contemporary non-drug treatment of atrial fibrillation in patients with left ventricular systolic dysfunction. Case reports.

Several cases of the successful catheter radiofrequency ablation (RFA) of atrial fibrillation in patients aged 40–54 years with severe heart failure and left ventricle systolic dysfunction due to long-term arrhythmia are presented. Procedures were performed due to low efficacy of the drug treatment. Follow-up duration was 1 to 3 years. Left ventricle systolic function restoration after RFA was observed. All patients stopped prophylactic antiarrhythmic therapy and most of them needed no medication treatment afterwards. All patients returned to fully socially active life. Sinus rhythm preservation tactics is more preferable and must take priority, especially in younger patients. RFA is one of the most wide-spread catheter procedures with proven efficacy, being enough patient-safe. It significantly improves quality of life, and today it becomes the most wide-spread of radical arrhythmia treatment. Stable sinus rhythm preservation is more constant in younger patients with less advanced myocardium structure changes and without advanced concomitant pathology.

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Yu.V. Zinchenko, O.І. Frolov. The course of arrhythmia in patients after an episode of atrial flutter 1:1.

The paper presents several clinical cases of patients with atrial flutter after an episode of atrial flutter 1:1. The causes of such conditions are analyzed, the effectiveness of the restoration and maintenance of sinus rhythm is shown, further course of the arrhythmia is studied. According to the results of clinical observation, most patients presented permanent atrial fibrillation during short-term follow-up. The management of patients with such conditions was established on the basis of case reports analysis.

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M.I. Lutai, S.V. Fedkiv, I.P. Golikova, O.O. Nemchyna, A.O. Chekalova, V.A. Slobodskiy, V.V. Tovstukha. Deposition of adipose tissue in the myocardium in normal and pathological conditions. Clinical case of lipomatose hypertrophy of right ventricle.

The article presents an overview of the problem of fat deposition in the myocardium. Morphological characteristics, clinical and noninvasive imaging techniques, such as echocardiography, multislice computed tomography and magnetic resonance imaging of the heart are presented in the article. Different forms of fat deposits as lipomatose dysplasia after myocardial infarction, arrhythmogenic right ventricular dysplasia, heart lypoma, lipomatose hypertrophy of the interatrial septum, and physiological fat deposition are described. Article is illustrated with original images of various forms of fat deposition in the heart. The clinical case of lipomatose hypertrophy of right ventricle in 55 years old patient with complaints of dyspnea on exertion is presented. During echocardiography unusual thickening and changes of the right ventricular wall structure were found. The diagnosis was confirmed by contrast cardiac MSCT. The patient had also ESC abnormalities. Further observation of patients with so-called physiological adipose tissue of myocardium is necessary in order to evaluate its clinical value and long-term prognosis.

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O.V. Melnichuk, T.V. Belyaeva, Ye.S. Rei, V.A. Slobodskyi, O.V. Tsyzh.Corrected transposition of the great arteries

Congenitally corrected transposition of the great arteries (CCTGA) is a rare congenital heart disease (CHD). In majority cases CCTGA is accompanied by other concomitant CHD. The isolated form is detected in approximately 1 % from the general amount of patients with this pathology. Diagnosis of CCTGA without other concomitant CHD appears very rarely in the clinical practice. The isolated form of CCTGA may have the protracted asymptomatic period that diminishes probability of its timely diagnosis. For patients with CCTGA low exercise tolerance is often detected even during asymptomatic period. In literature solitary clinical cases of high exercise tolerance in patients with CCTGA were described. The article dwells attention of the general cardiologists to clinical course of the disease and presents case of the first diagnosed isolated form of CCTGA in 21 years old young man with the high exercise tolerance.

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Yu.V. Zinchenko, O.V. Strafun, G.V. Kuban.Dangerous side effects of amiodarone: amiodarone-induced lung toxicity

We presented a clinical case of rarely detectable and severe side toxic effect of amiodarone, prescribed for ectopic atrial arrhythmia. Amiodarone administration for nine years caused interstitial fibrosing alveolitis, complicated by respiratory failure. Early detection of complications and steroids usage allowed to avoid further deterioration of the disease. At patient examination we have not found reasons for amiodarone prescription and long-term usage.
Therefore clinicians should pay special attention for responsible use of amiodarone, which is characterized by the highest number of extracardial side effects when comparing with other antiarrhythmic drugs. Clinicians should carefully monitor the patients in case of the need of amiodarone prescription, especially in those with multiple organ failure. It is necessary to conduct monitoring of respiratory function and X-ray examination of the lungs in patients with chronic lung diseases.

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Yu.V. Zinchenko, A.V. Doronin, O.Yu. Marchenko, S.V. LizogubDifficulties in diagnosis and treatment of ectopic atrial tachycardia.

National Scientific Center “M.D. Strazhesko Institute of Cardiology NAMS of Ukraine”, Kyiv, Ukraine
Shupyk National Medical Academy of Post-Graduate Education, Kyiv, Ukraine
The presented clinical case showed diagnostic difficulties in diagnosis of ectopic atrial tachycardia, absolute nonefficacy of administered antiarrhythmic therapy along with high result of catheter treatment method. Use of modern diagnostic methods (Holter ECG monitoring, medications tests and intraсardiac eleсtrophysiological examination) may help to precisely diagnose arrhythmia, as well as to introduce moderately invasive methods into practical arrhythmology.

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