rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2018-14-3-361-369rpcardio-1691Research ArticleNOTES FROM PRACTICEКЛИНИЧЕСКИЙ ОПЫТEMBOLIC MYOCARDIAL INFARCTION. EXPERIENCE IN DIAGNOSIS AND MANAGEMENTЭМБОЛИЧЕСКИЙ ИНФАРКТ МИОКАРДА. ОПЫТ ВЕДЕНИЯ И ДИАГНОСТИКИШиловаА. С.ShilovaA. S.

к.м.н., врач-реаниматолог, отделение реанимации и интенсивной терапии для больных инфарктом миокарда, 119049, Москва, Ленинский просп., 8;

ассистент, кафедра факультетской терапии им. академика А.И. Нестерова, 117997, Москва, ул. Островитянова, 1

MD, PhD, Doctor of Intensive Care Unit for Patients with Myocardial Infarction, Leninsky Prospect 8, Moscow, 119049;

Assistant, Chair of Faculty Therapy named after A.I. Nesterov, Ostrovitianova ul. 1, Moscow, 117997 

a.s.shilova@gmail.comГиляроваЕ. М.GilyarovaE. M.

ординатор, кафедра профилактической и неотложной кардиологии, 

119991, Москва, ул. Трубецкая, 8 стр. 2

 

MD, Resident, Chair of Preventive and Emergency Cardiology,

Trubetskaya ul. 8-2, Moscow, 119991

АндреевД. А.AndreevD. A.

д.м.н., профессор, кафедра профилактической и неотложной кардиологии,

119991, Москва, ул. Трубецкая, 8 стр. 2

MD, PhD, Professor, Chair of Preventive and Emergency Cardiology,

Trubetskaya ul. 8-2, Moscow, 119991

ЩекочихинД. Ю.ShchekochikhinD. Yu.

к.м.н., доцент, кафедра профилактической и неотложной кардиологии,

119991, Москва, ул. Трубецкая, 8 стр. 2

MD, PhD, Associate Professor, Chair of Preventive and Emergency Cardiology, 

Trubetskaya ul. 8-2, Moscow, 119991

НовиковаН. А.NovikovaN. A.

д.м.н., профессор, кафедра профилактической и неотложной кардиологии,

119991, Москва, ул. Трубецкая, 8 стр. 2

MD, PhD, Professor, Chair of Preventive and Emergency Cardiology,

Trubetskaya ul. 8-2, Moscow, 119991

ГиляровМ. Ю.GilyarovM. Yu.

профессор, кафедра профилактической и неотложной кардиологии;

д.м.н., зам. главного врача по терапии, 119991, Москва, ул. Трубецкая, 8 стр. 2

 MD, PhD, Deputy Chief Physician for Therapeutic Care, Leninsky Prospect 8, Moscow, 119049;

Professor, Chair of Preventive and Emergency Cardiology, Trubetskaya ul. 8-2, Moscow, 119991

Городская клиническая больница №1 им. Н.И. Пирогова; Российский национальный исследовательский медицинский университет имени Н. И. ПироговаРоссияCity Clinical Hospital №1 named after N.I. Pirogov; Pirogov Russian National Research Medical UniversityRussian FederationПервый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationГородская клиническая больница №1 им. Н.И. Пирогова; Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)РоссияCity Clinical Hospital №1 named after N.I. Pirogov; I.M. Sechenov First Moscow State Medical University (Sechenov University)Russian Federation201804072018143361369Copyright © Shilova A.S., Gilyarova E.M., Andreev D.A., Shchekochikhin D.Y., Novikova N.A., Gilyarov M.Y., 20182018Шилова А.С., Гилярова Е.М., Андреев Д.А., Щекочихин Д.Ю., Новикова Н.А., Гиляров М.Ю.Shilova A.S., Gilyarova E.M., Andreev D.A., Shchekochikhin D.Y., Novikova N.A., Gilyarov M.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/1691

Acute myocardial infarction (AMI) is one of the main causes of morbidity and mortality, both in the Russian Federation and around the world. Approximately, in up to 10% of patients with clinical diagnostic features of AMI, early angiography does not reveal an occluded vessel or possibly any evidence of coronary artery disease. These patients constitute an intriguing subgroup referred to as “Myocardial Infarction with Non-Obstructive Coronary Arteries” (MINOCA). MINOCA is a collective concept that unites many different pathologies, which determines the essential heterogeneity of the etiological factors. Coronary artery embolism is recognized as an important non-atherosclerotic cause of AMI. In turn, the most common underlying disease in those with coronary embolism is the atrial fibrillation. The advantages of reperfusion strategy and cardioprotective therapy in the treatment of obstructive arteriosclerosis are well studied, widely presented in the literature and supported by a strong evidence base, while the issues of diagnosis and treatment of patients with MINOCA are currently widely discussed We present two clinical cases of embolic myocardial infarction in patients with atrial fibrillation, diagnosed in our clinic in 2017.

Острый инфаркт миокарда (ОИМ) является одной из основных причин заболеваемости и смертности как на территории Российской Федерации, так и во всем мире. Примерно у 10% пациентов с клиническими и лабораторными признаками ОИМ при коронароангиографии не выявляются признаки обструктивного атеросклероза коронарных артерий. Данные случаи рассматриваются в рамках так называемого «инфаркта миокарда без обструкции коронарных артерий» (в англоязычной литературе: myocardial infarction with non-obstructive coronary arteries или MINOCA). MINOCA – собирательное понятие, объединяющее под собой множество различных патологий, что определяет существенную гетерогенность этиологических факторов. Одной из причин повреждения миокарда в отсутствие признаков обструктивного атеросклероза является эмболия коронарных артерий из источника, расположенного вне коронарного русла. В свою очередь, у данной группы пациентов, наиболее распространенным этиологическим фактором является фибрилляция предсердий. Преимущества реперфузионной стратегии и кардиопротекторной терапии в лечении обструктивного атеросклероза хорошо изучены, широко представлены в литературе и подкреплены мощной доказательной базой, в то время как вопросы диагностики и лечения пациентов с MINOCA в настоящее время широко обсуждаются. В качестве иллюстрации мы представляем два клинических случая эмболического инфаркта миокарда на фоне фибрилляции предсердий, диагностированных в нашей клинике в 2017 г.

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