scholarly journals Pathophysiological aspects of development myocardial infarction type 2 in subclinical hypothyroidism

2021 ◽  
pp. 34-41
Author(s):  
A. A. Ivannikov ◽  
A. A. Kanibolotsky ◽  
Kh. G. Alidzhanova ◽  
I. V. Bratischev
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Subclinical Hypothyroidism ◽  
Hormone Replacement ◽  
Myocardial Revascularization ◽  
Oxygen Demand ◽  
Cardiomyocyte Hypertrophy ◽  
Myocardial Oxygen Demand ◽  
Atherosclerotic Stenosis

The main purpose of the following article is to highlight one of the most pressing and poorly studied issues both for cardiology and endocrinology – treatment and prognosis for patients with severe coronary pathology and subclinical hypothyroidism (SH). Pathophysiological mechanisms of type 2 myocardial infarction (MI) development with SH as a background and hormone replacement therapy issues are considered. SH is a modifiable risk factor (RF) for cardiovascular diseases (CVD) and mortality that does not depend on traditional cardiovascular RF. SH is associated with high risk of developing coronary artery disease, MI, heart failure, and CVD mortality. SH incidence of morbidity increases with age, usually the course is oligo- or asymptomatic. SH leads to a number of pathological conditions that cause an imbalance between the myocardial oxygen demand and delivery with a possible development of type 2 MI. Clinical case of type 2 MI development in a patient with severe coronary atherosclerosis and SH is presented. The key point of type 2 MI development mechanism is insufficient oxygen (O2) supply to cardiomyocytes due to multivessel coronary artery atherosclerotic stenosis and sharp increase in O2 demand as a result of cardiomyocyte hypertrophy. Older patients with severe cardiac pathology and SH should refrain from treatment with levothyroxine or start treatment after myocardial revascularization, selecting the dose of the drug individually.

scholarly journals Characteristics of clinical signs, laboratory and instrumental examinations in various mechanisms of development of type 2 myocardial infarction

2021 ◽  
Vol 12 (3) ◽  
pp. 132-138
Author(s):  
Dmitrii V. Oblavatckii ◽  
Svetlana A. Boldueva
Keyword(s):  
Myocardial Infarction ◽  
Hypertensive Crisis ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Oxygen Demand ◽  
Microvascular Dysfunction ◽  
Myocardial Oxygen Demand ◽  
Pathogenic Variants ◽  
Severe Pathology

Aim. To identify different pathogenetic variants of myocardial infarction type 2 (MI-2). Material and methods. Reviewed 4168 cases of MI admitted in multidisciplinary hospital for 10 years. 353 patients met the criteria for MI-2 without signs of coronary atherothrombosis (CA). In the study group, the features of clinical and laboratory-instrumental manifestations were evaluated. Results. Cases of IM-2 were subdivided into 4 clinical-pathogenic variants (CPV): 1-CPV developed due an increasing in myocardial oxygen demand; 2-CPV, arising from a decrease in the supply of oxygen; 3-CPV associated with local coronary circulation disorder; 4-CPV developed due to the combined oxygen-energy imbalance. In 72 (20.4%) cases, 1-CPV was detected, caused by a hypertensive crisis and/or tachyarrhythmias; 2-CPV observed in 73 (20.68%) patients with hypotension, anemia, microvascular dysfunction, respiratory failure; 3-CPV caused by spasm and embolism of CA was detected in 47 (13.31%) cases; in 161 (45.61%) patients, IM-2 is associated with increased myocardial oxygen demand with reduced oxygen delivery. The gender and risk factors in groups are comparable. The average age of 1-CPV- and 3-CPV-patients was less and amounted to 65.7 and 56.5 versus 70.2 and 73.8 years in the 2-CPV and 4-CPV. Typical clinical and laboratory-instrumental signs of MI were common for patients with 1-CPV and 3-CPV, while 2-CPV and 4-CPV more often had chronic severe pathology, multivessel coronary disorder, and the clinical presentation and ischemic signs were less common. Conclusion. Clinical manifestations and results of examination of patients with MI-2 depend on the mechanism of its development.

RESULTS OF ENDOVASCULAR MYOCARDIAL REVASCULARIZATION AND QUALITY OF LIFE IN SUCH PATIENTS AGED UNDER 40

2020 ◽  
pp. 44-57
Author(s):  
F.Z. Abdullaev ◽  
F.E. Abbasov ◽  
N.M. Babaev ◽  
L.S. Shikhieva ◽  
G.A. Amrakhova
Keyword(s):  
Quality Of Life ◽  
Myocardial Infarction ◽  
Coronary Artery ◽  
Stable Angina ◽  
Myocardial Revascularization ◽  
Overweight And Obesity ◽  
Panic Attacks ◽  
Recurrent Myocardial Infarction ◽  
Stent Diameter

The aim of the paper is to correlate the results of endovascular myocardial revascularization (EMR) in patients under 40 years of age with acute coronary syndrome (ACS) / stable angina, primary EMR age ≤35/36–40 and stent diameter. Materials and Methods. The authors examined 208 patients (24–40 years of age) with coronary artery disease: 157 patients (75.5 %) aged 36–40; 51 patients (24.5 %) aged ≤35. All in all, 165 (79.3 %) patients underwent EMR; 32 patients (15.4 %) underwent coronary artery bypass grafting; 11 patients (5.3 %) refused medical intervention. EMR results and the quality of life were studied in 126 patients (76.4 %) at 10–107 months of observation (62.5±2.6 months). Results. 84 patients with ACS (50.9 %) and 81 patients with stable angina (49.1 %) underwent EMR. There were no any peri-procedural complications. The authors observed 0 % hospital and 30-day mortality. The survival rate of patients for the period up to 9 years was 99.2 %; long-term mortality was 0.8 %; the constancy of results up to 1, 2 and 3 years of follow-up was 90.5 %, 84.1 % and 81.7 %, respectively, and up to 5–9 years it was 79.4 %. An active lifestyle was verified in 74.6 % of patients; a sparing lifestyle was observed in 25.4 %; 86.5 %, of patients returned to work; transient sexual disorders were found in 28.6% of patients. 83.3 % and 27.8 % of patients kept to drug therapy and dietary regimen. 34.1 % and 23.8 % of patients kept smoking and taking power drinks; overweight and obesity were observed in 23.8 % and 19 % of patients. Recurrent myocardial infarction (MI) / angina was verified in 23 % of patients; 20.6 % of patients underwent second EMR. 23 % of patients got depressed due to recurrent myocardial infarction / angina, while 18.3 % of patients were down due to the quarantine (COVID-19); 6.3 % suffered from panic attacks, for fear of recurrent anginous pain. Conclusion. Predictors of recurrent EMR and stability of results were: 1) ACS; 2) patients’ age (≤35); 3) history of MI, ejection fraction ≤35–40 %, diabetes; 4) stent diameter (<28 mm); 5) smoking and taking power drinks. The leading predictor was the aggressiveness of atherosclerosis and diabetes in persons under 40, causing: a) early stent dysfunction; b) native and “protected” coronary vessels damage in case of intact stents patency. Keywords: ischemic heart disease, young patients, risk profile, semiotics of coronary arteries, endovascular myocardial revascularization, quality of life. Цель. Корреляция результатов эндоваскулярных реваскуляризаций миокарда (ЭВРМ) у больных моложе 40 лет с острым коронарным синдромом (ОКС) / стабильной стенокардией, возрастом при первичной ЭВРМ ≤35 лет / 36–40 лет и диаметром стентов. Материалы и методы. Обследовано 208 больных ИБС в возрасте 24–40 лет: 157 (75,5 %) чел. – в возрасте 36–40 лет, 51 (24,5 %) – ≤35 лет. ЭВРМ выполнена 165 (79,3 %) больным, коронарное шунтирование – 32 (15,4 %), 11 (5,3 %) пациентов отказались от вмешательства. Исходы ЭВРМ и качество жизни изучены у 126 (76,4 %) больных на сроках 10–107 мес. (62,5±2,6 мес.) наблюдения. Результаты. ЭВРМ выполнена 84 (50,9 %) больным ОКС и 81 (49,1 %) больному стабильной стенокардией. Перипроцедурных осложнений не выявлено. Госпитальная и 30-дневная летальность составила 0 %. Выживаемость пациентов на сроках до 9 лет – 99,2 %; отдаленная летальность – 0,8 %; сохранность результатов до 1, 2 и 3 лет наблюдения составила соответственно 90,5, 84,1 и 81,7 %, до 5–9 лет – 79,4 %. Активный образ жизни верифицирован у 74,6 % обследованных, щадящий – у 25,4 %, возврат к работе – у 86,5 %, транзиторные сексуальные нарушения – у 28,6 %. Медикаментозную терапию и диетический режим питания соблюдали 83,3 и 27,8 % пациентов. Продолжали курить и принимать энергетические напитки 34,1 и 23,8 % обследованных; избыточный вес и ожирение сохранялись у 23,8 и 19 %. Рецидив инфаркта миокарда (ИМ) / стенокардии отмечен у 23 % пациентов; повторные ЭВРМ выполнены 20,6 % больным. Депрессию из-за рецидива ИМ / стенокардии отмечали 23 % пациентов, ввиду карантина (COVID-19) – 18,3 %; 6,3 % страдали паническими атаками, боясь повторения ангинозных болей. Выводы. Предикторами повторных ЭВРМ и стабильности результатов являются: 1) ОКС; 2) возраст ≤35 лет; 3) анамнез ИМ, фракция выброса ≤35–40 %, диабет; 4) диаметр стентов <28 мм; 5) курение и прием энергетических напитков. Ведущий предиктор – агрессивность атеросклероза и диабета у лиц не старше 40 лет, обусловливающих: а) раннюю дисфункцию стентов; б) при сохранной проходимости стентов – поражение нативных и «защищенных» коронарных сосудов. Ключевые слова: ишемическая болезнь сердца, молодые больные, профиль риска, семиотика коронарных артерий, эндоваскулярная реваскуляризация миокарда, качество жизни.

Optical coherent tomography for the diagnostic of non-obstructive coronary artery myocardial infarction

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
I Leonova ◽  
S Boldueva ◽  
V Feoktistova ◽  
D Evdokimov
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Atherosclerotic Plaque ◽  
St Elevation ◽  
Spontaneous Dissection

Abstract Funding Acknowledgements Type of funding sources: None. The widespread use of coronary angiography (CAG) in patients with acute coronary syndrome led to the understanding that in some patients myocardial infarction (MI) occurs against angiographically unchanged or slightly modified coronary arteries (CA). In such cases, the so-called "type 2 IM" is diagnosed in some patients, however, to determine the true cause of MI, a modern method of investigation such as optical coherence tomography (OCT) is needed to visualize the intima of the CA and detect a minimal atherosclerotic process.  The purpose of the study was to establish the etiology of MI without obstructive coronary artery disease (MINOCA) using OCT. Materials and methods 160 conclusions of the OCT were analyzed. In 9 (6%) cases, the study was conducted in patients who underwent proven MI (mean age 43,1 ± 13,2, 8 males, 1 female) who had no hemodynamically significant CA stenosis according to CAG data. Results in 2 cases (22%) patients had ST-elevation MI, thrombotic occlusion of the CA (in one case, thrombaspiration was performed). In both patients, spontaneous dissection of the intima of the unmodified CA was detected in the OCT. The remaining 7 patients had non-ST-elevation MI, and in 2 cases, a diagnosis of type 2 MI was established: in both patients, the atherosclerotic plaque was visualized, narrowing the lumen of the CA less than 50%, in one case MI developed against a background of the hypertensive crisis, in another - against a background of spasm of CA. In the remaining 5 patients, OCT revealed subintimal atheromatous, with elements of local dissection of the intima. Thus, in 78% of patients atherosclerosis of CA of different severity (from the subintimal deposition of lipids to the development of atherosclerotic plaque, narrowing the clearance of the SC by less than 50%) was diagnosed. In the analysis of risk factors for coronary heart disease (CHD), 57% of patients with atheromatous CA had more than 2 risk factors for CHD: 3 (42%) smoked, 5 (71%) - obesity, 4 (57% ) - had arterial hypertension, 3 (42%) had dyslipidemia, 1 (14%) had type 2 diabetes. In the group of patients with spontaneous intima dissection of the CA, 1 patient (woman) did not have CHD risk factors, the 2-nd suffered from obesity and hypertension. For all patients a lifestyle correction was recommended; statins, antiplatelets were prescribed, patients with spontaneous dissection of CA had the recommendation of examination in the medical-genetic center. Conclusion Based on the results of the study, in most cases, the cause of IMBOC development was an atherosclerotic lesion of the coronary arteries, which is not always visualized with standard coronary angiography. Basically, the patients were young and middle-aged. Most patients had different risk factors for coronary heart disease.

scholarly journals Type 2 Myocardial Infarction in Acute Medical Care

2016 ◽  
Vol 01 (04) ◽  
pp. 021-024
Author(s):  
K. Sateesh ◽  
Stitha Pragna ◽  
Y Raju
Keyword(s):  
Myocardial Infarction ◽  
Medical Care ◽  
Oxygen Demand ◽  
Type Ii ◽  
Men And Women ◽  
Upper Limit ◽  
Significant Difference ◽  
The Mean ◽  
Acute Medical Care

AbstractBackground: Type 2 myocardial infarction (MI) is defined as MI secondary to ischemia due to either increased oxygen demand or decreased supply. It is seen in conditions other than coronary artery disease (CAD) contributes to an imbalance between myocardial oxygen supply and/or demand. Little is known about patient characteristics and clinical outcomes.Methods: A retrospective analysis was performed in patients who were admitted in acute medical care with symptoms suggestive of myocardial ischemia and enzymatic elevation from January 2015 to December 2015. Patients with slight elevation (above the upper limit of normal) of CK-MB were included in the study and compared the clinical and laboratory profile between men and women.Results: This survey includes a total of 54 patients, Out of which complete details were available in 41 patients (M:23; F:18). The mean age was 42.61. The common causes of type-II MI were Infectious (M:9 (39.1%), F:10 (55.6%) followed by haematological disorders (M:3 (13%), F:5 (27.7%). The mean CK-MB was 28.00. The mean CPK was 122.5. There was no hypotension, renal failure at the time of admission. One patient had in-hospital mortality out of all patients, whose primary diagnosis was septicaemia with shock who had normal CPK, elevated CK-MB and elevated NT pro BNP levels. Patients with type-II MI were not referred for coronary interventions and managed conservatively.Conclusions: There is no significant difference in the risk for type 2 MI between men and women. Clinical suspicion and diagnosis of type 2 MI is crucial in acute medical care setting, as the mortality can be reduced with adequate management of underlying condition. The threshold of biomarker levels should be low (above the upper limit of normal in symptomatic ischemia) to label type 2 MI contrary to the third universal definition of MI.

scholarly journals Repetitive Myocardial Infarctions Secondary to Delirium Tremens

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
David Schwartzberg ◽  
Adam Shiroff
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Ischemia ◽  
Alcohol Withdrawal ◽  
Delirium Tremens ◽  
Oxygen Demand ◽  
Myocardial Infarctions ◽  
Myocardial Oxygen Demand ◽  
Significant Morbidity ◽  
St Segment ◽  
Patients Experience

Delirium tremens develops in a minority of patients undergoing acute alcohol withdrawal; however, that minority is vulnerable to significant morbidity and mortality. Historically, benzodiazepines are given intravenously to control withdrawal symptoms, although occasionally a more substantial medication is needed to prevent the devastating effects of delirium tremens, that is, propofol. We report a trauma patient who required propofol sedation for delirium tremens that was refractory to benzodiazepine treatment. Extubed prematurely, he suffered a non-ST segment myocardial infarction followed by an ST segment myocardial infarction requiring multiple interventions by cardiology. We hypothesize that his myocardial ischemia was secondary to an increased myocardial oxygen demand that occurred during his stress-induced catecholamine surge during the time he was undertreated for delirium tremens. This advocates for the use of propofol for refractory benzodiazepine treatment of delirium tremens and adds to the literature on the instability patients experience during withdrawal.

scholarly journals Predictors of cardiovascular events in patients with chronic heart disease after surgical myocardial revascularization (according to the data of a long-term observation)

2010 ◽  
Vol 1 (1) ◽  
pp. 75-79
Author(s):  
S. V Shalayev ◽  
L. A Arutyunyan
Keyword(s):  
Myocardial Infarction ◽  
Mechanical Ventilation ◽  
Heart Disease ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Bypass Grafting ◽  
Chronic Heart Disease

Aim. To elucidate independent predictors of fatal and nonfatal cardiovascular events in patients with chronic heart disease (CHD) after surgical myocardial revascularization during a long-term prospective observation. Subjects and methods. The study enrolled 120 patients with CHD who had undergone coronary artery bypass grafting with extracorporeal circulation. Further 2-5-year follow-ups recorded deaths from cardiac causes, including sudden deaths, as well as the incidence of nonfatal cardiovascular events (myocardial infarction, stroke). Results. The mean follow-up time was 36±5 months. During the follow-ups, there were 12 deaths: 1 and 8 deaths from pneumonia and myocardial infarction, respectively; 3 patients died suddenly. Out of the nonfatal events, myocardial infarction and stroke were recorded in 7 and 2 cases, respectively. Stepwise regression analysis showed that the independent predictors of fatal cardiac events were as follows: 1) an ejection fraction of less than 40% (relative risk 5.7 with deviations within 95% confidence interval, 1,2–10,7); 2) age of 70 years or older (4,9; 1,4–8,4); 3) diabetes mellitus (2,3; 1,1–3,7); 4) left ventricular aneurysm (2,1; 1,04–3,8); 5) mechanical ventilation for more than 24 hours (2,0; 1,2–2,9); 6) chronic obstructive pulmonary disease (1,9; 1,1–3,1). The independent predictors of all cases of both fatal and nonfatal cardiovascular events were: 1) age of 70 years or older (4,1; 1,2–8,1); 2) an ejection fraction of less than 40% (3,7; 1,1–6,5); 3) endarterectomy during coronary artery bypass grafting (2,9; 1,1–5,4); 4) mechanical ventilation for more than 100 minutes (2,2; 1,2–3,9); damage to the brachiocephalic artery area (2,1; 1,1–6,4), prior stroke (1,8; 1,1–3,8). Conclusion. The conducted study indicated the implication of both the poor traditional predictors of CHD and comorbidity, as well as the specific features of surgical intervention and anesthetic maintenance in the development of further fatal and nonfatal cardiovascular events in patients with CHD after surgical myocardial revascularization.

scholarly journals Left Internal Thoracic Artery Graft to Left Anterior Descending Coronary Artery after Blunt-Chest-Trauma Myocardial Infarction: 14-Year Outcome

2017 ◽  
Vol 44 (3) ◽  
pp. 214-218
Author(s):  
Paulo Roberto B. Evora ◽  
Minna Moreira D. Romano ◽  
Gabriela B. Tannus de Souza ◽  
Danilo T. Wada ◽  
André Schmidt ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Blunt Chest Trauma ◽  
Chest Trauma ◽  
Internal Thoracic Artery ◽  
Myocardial Revascularization ◽  
Left Internal Thoracic Artery ◽  
Artery Graft ◽  
History Of

In 2005, we reported an acute myocardial infarction secondary to a left anterior descending coronary artery injury sustained in a motorcycle accident. The treatment was late myocardial revascularization with in situ left internal thoracic artery-to-left anterior descending coronary artery anastomosis. There is little information available about the natural history of acute myocardial infarction after blunt chest trauma, especially when treated in this manner. This present communication reports the 14-year outcome in our patient.

scholarly journals Multi-Vessel Coronary Artery Disease: Choice of Myocardial Revascularization Strategy

2020 ◽  
Vol 27 (4) ◽  
pp. E202041
Author(s):  
Nestor Seredyuk ◽  
Andrii Matlakh ◽  
Yaroslava Vandzhura ◽  
Mykyta Bielinskyi ◽  
Oleksii Skakun ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Myocardial Revascularization ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
The Right

Multi-vessel coronary artery disease is quite a common state, which is often diagnosed by coronary angiography in patients with both stable coronary artery disease and acute coronary syndromes. Major difficulties in percutaneous coronary intervention include stent thrombosis and the need for antiplatelet therapy (aspirin and a P2Y12 inhibitor). Stent thrombosis leads to the recurrence of myocardial infarction and may occur within the first few hours after percutaneous coronary intervention. The use of dual antiplatelet therapy, especially that combined with low-molecular-weight heparin in the first days after myocardial infarction, poses a risk of bleeding, which often occurs in real clinical practice. Among P2Y12  inhibitors, ticagrelor causes bleeding somewhat more frequently than clopidogrel. A case of multi-vessel coronary artery disease is described in this paper. Coronary angiography revealed right-dominant circulation; occlusion of the proximal and medial segments of the right coronary artery, thrombolysis in myocardial infarction flow grade 0; stenosis of the left main coronary artery (50-60%), thrombolysis in myocardial infarction flow grade 2; diffuse stenosis of the medial and distal segments of the left anterior descending artery, thrombolysis in myocardial infarction flow grade 1; stenosis of the proximal segment of the left circumflex artery (> 75%), thrombolysis in myocardial infarction flow grade 1. The patient underwent percutaneous coronary intervention; the stents were implanted in the infarct-dependent right coronary artery. The clinical course was complicated by early stent thrombosis with subsequent thrombus extraction; a day later melena developed. Bleeding was stopped, the intensity of antithrombotic therapy was reduced: the combination of aspirin and ticagrelor was replaced by the combination of aspirin and clopidogrel. Six weeks after stenting of the infarct-dependent coronary artery, complete myocardial revascularization (hybrid intervention) was performed: coronary artery bypass grafting [the left internal mammary artery → the left anterior descending artery], coronary autogenous bypass grafting [the aorta → the right coronary artery and the aorta → the left circumflex artery]. The role of fractional flow reserve or instantaneous wave-free ratio-controlled complete myocardial revascularization techniques is discussed. The following algorithm for myocardial revascularization was used: percutaneous coronary intervention for the right coronary artery + coronary artery bypass grafting-3: the left internal mammary artery → the left anterior descending artery, the aorta → the left circumflex artery, the aorta → the right coronary artery.

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