Нестабильная стенокардия или нестабильные коронарные синдромы? (https://doi.org/10.51922/2616-633X.2020.4.2.944)

Н.П. Митьковская, О.В. Ласкина, Патрик Тифи

УО «Белорусский государственный медицинский университет», Университет Западного Онтарио, Лондон, Онтарио, Канада

Нестабильная стенокардия (НС) – вариант острого коронарного синдрома без подъема сегмента ST (ОКСбпST), который характеризуется отсутствием биохимических критериев повреждения миокарда, изменением клинической картины стенокардиального синдрома (увеличением функционального класса стенокардии напряжения, появлением стенокардии покоя и высокой вероятности трансформации процесса в инфаркт миокарда (ИМ)). НС и сформировавшийся ИМ без подъема сегмента ST (ИМбпST) не сопровождаются появлением патологического зубца Q, характеризуются общим сложным патогенезом, ассоциированным с прогрессирующим атеросклерозом, неокклюзирующим тромбом в области эрозии или разрыва атеросклеротической бляшки, вазоспазмом, коронарной микроциркуляторной дисфункцией или другими причинами дисбаланса между поступлением и потреблением кислорода, обуславливающими ишемию миокарда, и различаются повышением уровней маркеров некроза миокарда в крови при ИМбпST. Дифференцировать НС и ИМбпST в первые часы развития процесса, когда принимается решение о реперфузионных технологиях и медикаментозной терапии, сложно без лабораторного, а в некоторых случаях и без дополнительного обследования с визуализацией вероятной новой потери жизнеспособного миокарда, поэтому диагностика и ведение этих двух клинических состояний обычно рассматриваются в одних клинических рекомендациях. В статье рассмотрены различные механизмы развития ишемии миокарда, диагностические и лечебные инвазивные и неинвазивные технологии, улучшающие прогноз пациентов с НС.

ключевые слова: нестабильная стенокардия, острый коронарный синдром без подъема сегмента ST, оптимальная медикаментозная терапия, чрескожные коронарные вмешательства, экстракорпоральная аутогемомагнитотерапия, ультрафиолетовая модификация крови

для цитирования: Н.П. Митьковская, О.В. Ласкина, Патрик Тифи. Нестабильная стенокардия или нестабильные коронарные синдромы? Неотложная кардиология и кардиоваскулярные риски, 2020, Т. 4, № 2, С. 944–977

Unstable angina pectoris or unstable coronary syndromes?

N.P. Mitkovskaya, O.V. Laskina, Patrick Teefy

Unstable angina pectoris (UA) is a variant of acute coronary syndrome without ST segment elevation (NSTEACS), which is characterized by the absence of biochemical criteria for myocardial damage, a change in the clinical picture of angina pectoris (an increase in the functional class of angina pectoris, the appearance of resting angina and a high probability of transformation of the process into myocardial infarction (MI)). UA and the developed MI without ST segment elevation (NSTEMI) are not accompanied by the appearance of a pathological Q wave and are characterized by a general complex pathogenesis associated with progressive atherosclerosis, a non-occlusive thrombus in the area of erosion or rupture of an atherosclerotic plaque, vasospasm, coronary microcirculatory dysfunction or other causes of imbalance between oxygen intake and oxygen consumption resulting in myocardial ischemia, and are distinguished by increased levels of myocardial necrosis in the blood in case of NSTEMI. It is difficult to differentiate UA and NSTEMI in the first hours of the development of the process when a decision is made on reperfusion technologies and drug therapy without laboratory, and in some cases, additional examination with visualization of the probable new loss of viable myocardium, therefore, the diagnosis and management of these two clinical conditions are usually considered in the same clinical recommendations. The article discusses various mechanisms of the development of myocardial ischemia, diagnostic and therapeutic invasive and non-invasive technologies that improve the prognosis of patients with UA.

keywords: unstable angina pectoris, acute coronary syndrome without ST segment elevation, optimal drug therapy, percutaneous coronary interventions, extracorporeal autohemomagnetotherapy, ultraviolet blood modification

for references: N.P. Mitkovskaya, O.V. Laskina, Patrick Teefy. Unstable angina pectoris or unstable coronary syndromes?. Neotlozhnaya kardiologiya i kardiovaskulyarnye riski [Emergency cardiology and cardiovascular risks], 2020, vol. 4, no. 2, pp. 944–977

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