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Сообщение от dmblok
Как было замечено выше - случай ургентный. На серии ЭХО нарушений сократимости в зоне бассейна ПНА - нет. В том числе и на фоне мерцания-трепетания предсердий с ЧСС - 150-160. Чем не нагрузочный тест?) Оснований подозревать перенесеный ранее передний ИМ и/или ишемию передней стенки нет никаких. Времени на проведение дополнительных исследований не так уж и много, на фоне ОЛН.
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Чем не нагрузочный тест?
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REVIEW Imaging and atrial fibrillation: the role of multimodality imaging in patient evaluation and management of atrial fibrillation Laurens F. Tops, Martin J. Schalij, and Jeroen J. Bax European Heart Journal (2010) 31 , 542–551
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1
Introduction
2 Clinical evaluation of patients with atrial fibrillation
3 Underlying heart disease
- Coronary artery disease
The presence of coronary artery disease should be assessed in patients presenting with AF. Large cohort studies have reported a high prevalence of coronary artery disease among patients with AF. 8 In 2768 patients with first detected AF, the incidence of coronary ischaemic events was 31 per 1000 person-years. 9 Furthermore, it has also been suggested that AF may be the first manifestation of cardiac ischaemia. 10 Typically, a stepwise approach starting with the evaluation of individual risk factors and exercise stress tests is applied when screening for coronary artery disease. However, non-invasive imaging modalities may have incremental value over traditional risk factors. 11 Various imaging modalities are available for the assessment of coronary artery disease in patients with AF. Conventional angiography remains the gold standard for the detection of significant coronary artery stenosis. In recent years, non-invasive assessment of coronary artery disease with multi-slice computed tomography (MSCT) has become available. This technique enables non-invasive detection of significant coronary artery stenosis with a high sensitivity and specificity. 12 It should be noted, however, that the diagnostic accuracy of MSCT may be limited in patients with AF during data acquisition. 13 In addition, MSCT still is limited by higher radiation exposure when compared with conventional angiography.
New techniques, such as the use of dose modulation during scanning, may reduce radiation exposure. In a recent study, the presence of coronary artery disease was evaluated with MSCT in 150 patients with AF and 148 patients with similar age, gender, symptomatic status, and pretest likelihood, but without a history of AF. 14 Interestingly, a higher prevalence of obstructive coronary artery disease was noted in the AF patients, compared with the non-AF patients (41% in AF patients vs. 27% in non-AF patients, P ¼ 0.01). However, more studies are needed to fully appreciate the role of MSCT in the screening for coronary artery disease in AF patients. Nuclear myocardial perfusion imaging provides information on the presence of ischaemia, a surrogate marker for coronary artery disease; the diagnostic accuracy of nuclear perfusion imaging to detect significant coronary artery stenoses is high. 15 It has been shown that nuclear imaging has similar diagnostic accuracy for the detection of coronary artery disease in asymptomatic patients with AF when compared with patients without AF. 16 Abidov et al . 17 have demonstrated the prognostic value of ischaemia detection with singlephoton emission computed tomography in 384 patients with AF and 15 664 patients without AF. The cardiac death rate was 6.3% per year in the AF patients with mildly abnormal myocardial perfusion scan, compared with 1.2% per year in the non-AF group with similar perfusion findings. This finding further underlines the importance of screening for cor- onary artery disease in AF patients.
Про эхокардиографию здесь почему-то ничего нет...? А вот другие методы, в том числе и сцинтиграфию даже есть...
А в том какое значение при ОКС ей придают, можно прочитать вот здесь [
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Да, уважаемая Анна Евгеньевна, боюсь, сцинтиграфия миокарда в отечественной кардиологии занимает совсем не то место, про которое Вы рассказывали, если даже в КАРДИОЦЕНТРЕ у Евгения Ивановича в таких ситуациях ее не делают...