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#16
09.08.2008, 12:39
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Цитата:
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#19
10.08.2008, 14:19
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Точка зрения "Храма Зевса" (Абрикосовского): "Действительно, связь между травмой и коронарной болезнью прослеживается редко. Лично я думаю, что это не травма коронарной артерии, а спазм в ответ на травму. При этом произошла "спонтанная" (в смысле нетравматического генеза) диссекция. У больного, несмотря на молодой возраст, имеется кальциноз ПНА, что позволяет предположить и наличие стенозирующий бляшки. В результате, мы имеем больного с классической картиной нестабильной стенокардии. В дальнейшем, нас уже не интересует ее генез.
Естественно, наличие травмы в анамнезе, нарушило классический алгоритм обследования больного с болями в грудной клетке." Точка зрения "еретиков": Myocardial contusion injury: redefining the diagnostic algorithm Division of Cardiology, Albert Einstein Medical CenterMyocardial contusion injury (MCI) is a complication of blunt thoracic trauma. Minimal force is required for..contusion injury.... physicians must rely on various diagnostic tests to arrive at a diagnosis of MCI... "...The most common patient complaint in MCI is precordial pain unrelieved by analgesia, which may mimic symptoms of angina or acute myocardial infarction...." Modalities used..: History and physical examination Plain radiograph Cardiac enzymes Creatinine phosphokinase myocardial band (CPK-MB) Cardiac troponin I (cTnI) Cardiac troponin T (cTnT) Echocardiography Transoesophageal echocardiography (TEE) Transthoracic echocardiography (TTE) Nuclear imaging studies Gated radionucleotide angiography (RNA) Multiple gated acquisition angiography (MUGA) Technetium pyrophosphate scanning Single photon emission computed tomography (SPECT) Certain areas of the heart are more susceptible to MCI. The right ventricle is most vulnerable because of its location beneath the sternum, and any impact can be transmitted immediately to the right ventricle. In addition, the higher pressures that exist on the left side of the heart make the mitral and aortic valves more susceptible to injury compared with the pulmonic and tricuspid valves. Pre-existing pathology in the mitral and aortic valves increases their vulnerability to MCI.1 The aortic valve can sustain rupture of the annulus, and laceration and detachment of the cusps.12 Mitral valve injury includes rupture of the chordae tendinae or papillary muscles, and laceration of the anterior or posterior leaflets.13 Blood supply to the myocardium may also be compromised. Thrombosis, vasospasm, or laceration of the coronary arteries may occur. Finally, the interventricular septum may rupture, often adjacent to the apex.12 In patients with MCI, 40–83% have abnormal ECGs.12,19 Contusions to the left ventricle may manifest as ST-T wave abnormalities, diffuse ST changes as seen in pericarditis, or as pathological Q waves... А ориентиром для диагностики был "палёный" МСКТ....
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#20
10.08.2008, 14:35
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Должен оговориться, что предложенные схемы не являются обшеместно признанными и алгоритмы различаются между кардиоторакальными центрами.
ИМХО нашего: МСКТ был бы проведен совместно с ЕХО и сцинтиграфией.
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#21
26.08.2008, 22:42
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1) [Ссылки доступны только зарегистрированным пользователям ]
[Ссылки доступны только зарегистрированным пользователям ] Clinical value, cost-effectiveness, and safety of myocardial perfusion scintigraphy: a position statement Claudio Marcassa1*, Jeroen J. Bax2, Frank Bengel3, Birger Hesse4, Claus L. Petersen5, Eliana Reyes6, and Richard Underwood6 on behalf of the European Council of Nuclear Cardiology (ECNC), the European Society of Cardiology Working Group 5 (Nuclear Cardiology and Cardiac CT), and the European Association of Nuclear Medicine Cardiovascular Committee European Heart Journal (2008) 29, 557–563
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#22
27.08.2008, 21:09
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Цитата:
PATIENTS AND METHODS: We retrospectively identified patients who had abnormal results on electron beam computed tomography (coronary artery calcium score >0) and normal to low-risk results on SPECT (defined as a summed stress score of 0-3) within a 3-month period from January 1, 1995, to October 31, 2002. Of the 504 identified patients, 285 remained after exclusion criteria were applied. Of the 285 patients, 69 (mean ± SD age, 58.2±7.6 years; 91% male) underwent at least 1 repeated myocardial perfusion SPECT imaging study within 4 years of their initial assessment as normal or at low risk without recurrence of symptoms. The value of repeated SPECT imaging was assessed by detection of a substantial change in the repeated SPECT study and by documentation of a clinical event (death, nonfatal myocardial infarction, or revascularization). Follow-up was 100% complete at a mean of 4.3±1.6 years. RESULTS: Only 4 patients (6%) had a substantial progression in their SPECT risk category; substantial changes on the SPECT scans occurred only in patients with a coronary artery calcium score greater than 100. Three patients underwent revascularization, yielding a 5-year rate for survival free of revascularization of 94% (95% confidence interval, 88%-100%). No deaths or nonfatal myocardial infarctions were reported. CONCLUSION: The principal findings of this study indicate that asymptomatic patients with initial normal or low-risk results from stress SPECT performed because of abnormal coronary artery calcium scores who remain asymptomatic are at low risk of death, myocardial infarction, or coronary revascularization. Three patients underwent revascularization by percutaneous coronary intervention despite the absence of symptoms. A substantial change in SPECT results (defined as progression from normal or low-risk summed stress score to intermediate- or high-risk summed stress score) affected 6% of patients and was not associated with any adverse hard events (nonfatal myocardial infarction or death). J. WELLS ASKEW, MD; TODD D. MILLER, MD; PHILIP A. ARAOZ, MD; JEROME F. BREEN, MD; DAVID O. HODGE, MS; AND RAYMOND J. GIBBONS, MD Abnormal Electron Beam Computed Tomography Results: The Value of Repeating Myocardial Perfusion Single-Photon Emission Computed Tomography in the Ongoing Assessment of Coronary Artery Disease Mayo Clin Proc. 2008;83(1):17-22
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#24
28.08.2008, 10:53
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Линейный вид
