FEATURES OF CLINICAL COURSE OF ACUTE CORONARY SYNDROME CAUSED BY THE CORONARY SLOW FLOW PHENOMENON (REVIEW OF LITERATURE AND DESCRIPTION OF THE CLINICAL CASE)
DOI:
https://doi.org/10.11603/2415-8798.2019.2.10024Keywords:
coronary slow flow phenomenon, coronary syndrome Y, acute coronary syndrome, coronary angiography, levocarnitine, arginineAbstract
The coronary slow flow phenomenon (CSFP) – is a microvascular injury, which consists in delayed coronary blood flow (movement of contrast agents) in coronary arteries without their significant stenosis. The main causes of CSFP are structural and functional disorders in the system of coronary microcirculation due to endothelial dysfunction, diffuse calcification or non-obstructive atherosclerosis, hibernation of the hypoxic myocardium. The lack of clear criteria for diagnosis and adequate treatment programs justify expediency of accumulation of clinical material and research of mechanisms of its development.
The aim of the study – to analyze the clinical case of the development of acute coronary syndrome in a patient with angiographically diagnosed coronary slow flow phenomenon, to investigate the features of the clinical course of coronary syndrome Y and optimize its treatment and prevent the development of complications.
Results and Discussion. The introduction of diagnostic coronary angiography makes it possible to conduct a differential diagnosis of microcirculatory disturbances of coronary blood flow, as well as to assess the adequacy of the proposed treatment. The given clinical case is characterized by the typical clinical symptomatology of acute coronary syndrome in the absence of an angiographic atherosclerotic changes in coronary arteries, patient – woman 66 years old. The proposed treatment with Nebivolol, Rosuvastatin and the combined metabolic drug – Levocarnitine and Arginine gave a rapid clinical effect, which was manifested by the disappearance of symptoms of ischemia and the absence of chest pain.
Conclusions. Thus, microcirculatory disturbances, in particular the coronary slow flow phenomenon, play a significant role in the pathogenesis of acute coronary syndrome, which should be taken into account in the diagnostic algorithm for the management of such patients. The main differential diagnostic criterion in such cases is coronary angiography, and in the complex treatment it is necessarily to include beta-blockers, statins and metabolically active agents – Levocarnitine and Arginine, which have endothelial normalizing and energy-myocardiocyte protective properties.
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