РЕПЕРФУЗИОННЫЙ СИНДРОМ ПРИ ЭНДОВАСКУЛЯРНОЙ РЕВАСКУЛЯРИЗАЦИИ МИОКАРДА: КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ

Abstract

CHD retains a leading position worldwide due to high rates of mortality and disability. The best and proven strategy aimed at saving the damaged myocardium in ST-segment elevation myocardial infarction (STEMI) is rapid and effective reperfusion of the ischemic heart muscle through primary percutaneous coronary intervention (PCI) or pharmacoinvasive therapy. However, the restoration of blood flow by itself can lead to reperfusion damage to the affected myocardium. In acute coronary catastrophe caused by acute occlusion of the coronary artery, myocardial stun and hibernation develop locally. With STEMI, hibernation can be observed both near the infarction zone and in more distant areas of the myocardium. In patients with STEMI, the appearance of life-threatening arrhythmias (ventricular tachycardia and ventricular fibrillation) occurs in 4.3 % of cases and is primarily associated with reperfusion after PCI. In most cases, arrhythmias that occur during the procedure are stopped spontaneously; however, when accompanied by ventricular tachyarrhythmia, hemodynamic instability, the use of electric pulse therapy (EIT) is provided. The article presents a clinical case of a patient C., 52, whose reperfusion syndrome manifested itself by the development of life-threatening ventricular tachyarrhythmias: unstable ventricular tachycardia «torsade de points» with transformation into VF, which were stopped by EIT: defibrillation. No recurrence of ventricular tachyarrhythmia was observed in this patient. At this stage, we explain the resulting episode of unstable ventricular tachycardia with short-term myocardial stunning due to short-term ischemia and myocardial damage.