Статья
Электрокардиографические признаки поражения ствола левой коронарной артерии при остром коронарном синдроме
Инфаркт миокарда (ИМ) в результате поражения ствола левой коронарной артерии (СтЛКА) является жизнеугрожающим состоянием. Оценка электрокардиографических (ЭКГ) признаков поражения СтЛКА важна в связи с необходимостью экстренной реваскуляризации. Единого паттерна ЭКГ при поражении СтЛКА не существует. Целью настоящего обзора явился анализ данных литературы последних лет о возможностях ЭКГ-диагностики обструкции СтЛКА при остром коронарном синдроме. Отмечена вариабельность изменений ЭКГ в зависимости от степени окклюзии СтЛКА, состояния коллатерального кровотока из правой коронарной артерии, наличия сопутствующих стенозов. Элевация сегмента ST в aVR является наиболее сильным предиктором поражения СтЛКА. Описаны электрофизиологические механизмы формирования данного признака. Изложено описание ЭКГ-паттернов обструкции СтЛКА, соответствующих ЭКГ-картине ИМ с подъемом сегмента ST и ИМ без стойкого подъема ST. Приведена диагностическая значимость дополнительных ЭКГ-признаков поражения СтЛКА. Обобщены сведения о лечебно-диагностической тактике ведения пациентов с ЭКГ-признаками острого поражения СтЛКА.
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