Статья
Клиническая картина стрессорной кардиомиопатии (синдром такотсубо) и проблема дифференциальной диагностики с острым инфарктом миокарда
Представленные данные свидетельствуют, что синдром такотсубо (СТ) характеризуется отсутствием обструкции коронарных артерий, сократительной дисфункцией сердца, апикальным баллонированием, сердечной недостаточностью, у части пациентов – подъемом сегмента ST и удлинением интервала QTc. У каждого десятого пациента с СТ развиваются желудочковые аритмии. У большинства пациентов с СТ отмечается подъем уровня маркеров некроза (тропонин I, тропонин Т, креатинфосфокиназа-МВ (КФК-МВ)), который существенно меньше, чем у больных с острым инфарктом миокарда (ОИМ) с подъемом сегмента ST. Уровень N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP), напротив, существенно выше у больных с СТ, чем у пациентов с ОИМ. Дифференциальная диагностика СТ и ОИМ должна базироваться на комплексном подходе, заключающемся в использовании ангиографии коронарных сосудов, эхокардиографии, анализе ЭКГ, магнитно-резонансной томографии, однофотонной эмиссионной компьютерной томографии, определении уровня тропонинов, КФК-МВ, NT-proBNP.
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