Периоперационный инфаркт миокарда при хирургическом лечении повреждения позвоночника

Abstract

INTRODUCTION: In the literature, there are reported cases of myocardial infarction in young patients after strenuous physical activity, as well as without any evident connection with physical load. The most common causes of the acute coronary syndrome in young individuals are anomalies in the development of coronary arteries. The article is devoted to the description of a clinical case of acute myocardial infarction in the anterior septal region of the left ventricle in the perioperative period after surgery of spinal injury in a patient without severe somatic pathology. During the surgery, unstable hemodynamics was noted with the development of arterial hypotension, which required infusion of norepinephrine. On the basis of clinical, laboratory and instrumental examinations, in the postoperative period the diagnosis: “Q-positive myocardial infarction of the anterior septum” was made. Coronary angiography visualized the presence of an intramural passage in the middle segment of the anterior descending artery with up to 30% stenosis in systole. The resulting arterial hypotension at the operational stage, with the myocardial bridge in the anterior descending artery, was the cause of circulatory disorders in the anterior septal region with the development of myocardial infarction and a decrease in the pumping function of the heart with subsequent hemodynamic disorders. CONCLUSION: Myocardial muscle bridges are a common anomaly of coronary arteries, which is usually asymptomatic. Clinical manifestations, if present, are blurred and atypical. In certain conditions, the given anomaly may be the cause of development of the acute coronary syndrome, in young individuals as well, which shows reasonability of monitoring of ECG and of markers of myocardial infarction in the postoperative period.