Gostria coronary syndrome with st. Gostria coronary syndrome with ST segment pidyoma (myocardial infarction)

Iak already meant earlier, gostry coronary syndrome without a second segment ST(OKSbpST) including two nosological forms IXC:

Unstable angina pectoris;

IM without pidyom segment ST.

unstable angina

Unstable angina is one of the clinical forms of IXC, which is characterized by development guest ischemia myocardium, the severity and triviality of myocardial necrosis. Unstable angina pectoris manifests itself as typical pain in the thoracic clitus, during the first hour on the EKG it means signs of myocardial ischemia in the eyes of the stiff or hourly depression of the ST segment, inversion, flattening of the abnormal pseudonomy T, Protein in blood plasma from daily development of biochemical markers in myocardial necrosis (heart troponins I or T abo MV-CPK). It is necessary to admit that the pose to attack the EKH pain can be normal.

Epidemiology

According to the data of the US National Registry, in 1999 the number of ailments that suffered from the STCS, deposited 1,932,000 people, with a total of 953,000 people who were diagnosed with a diagnosis NOT stable angina, A 530,000 units - with the diagnosis IM without a tooth Q. The National Registries of IM in the USA (NRMI I, II and III) showed that for the period 1990-1999 pp. the increase in the frequency of the ACS without the second segment is added ST from 45 to 63%.

key picture

The main ailments with unstable angina є types of angina pain in breast cancer It is located most often in the area of the heart. However, already on the first stage of the diagnostic joke There are a number of features that can be noticed, such as suspicion of "instability" of angina pectoris;

Forward, angina pectoris has come to a head. With a term of reason, angina pectoris is stressed, but it was not lower than the third FC for the classification of the Canadian heart-court partnership.

Progressive angina pectoris, so that the progress of the earlier stable angina pectoris springs as a minimum for 1 class (for the classification of the Canadian Heart-Judge Association) with the achievement of minimum III FC. Anginous pains become frequent, more trivial, and are diagnosed with more low physical costs.

Angina pectoris calm, winikla lasting 7 days, with trivial attacks up to 20-30 min, including angina pectoris calm, which was transformed from angina pectoris.

All the options for a clinical interruption of unstable angina can be found in a patient who could not tolerate IM before, as well as in a sick person with a history of IM. All the stinks are heard from the EHC's re-establishment and the news about the hospitalization. From the formal point of view, all the ailments, which may be the same in the general description of the classic picture, are guilty of being hospitalized, they have some examples of OKS without a segment ST(Unstable angina pectoris). However, there is a risk of death and development of IM, it is insane, in people who have been trying to attack angina pectoris calmly in the last 48 years, in some individuals, in those who have angina pectoris in the past 3-4 years ago.

Early postinfarction angina. Angina pectoris, for example, calm down, but it was in the closest days of the postponed IM, especially in the case of successful thrombolytic therapy in patients with IM with ST segment pidyoma. Daniy variant of angina pectoris will block the development of repeated IM and vimage of coronary angiography for nutritional revascularization of the myocardium. In Danish hour, the classical classification of unstable angina pectoris, proponated by E. Braunwald in 1989 (Table 2-10).

Table 2-10. Clinical classification of unstable angina

The prehospital stage needs to be quickened, especially in the first 2 years, at the moment the symptoms of illness appear. Organizational support for hospital support in patients with heart disease is responsible for the acceptance of CPR, early defibrillation and effective treatment of vital functions.

Nitrate - pid language nitroglycerin at 0.4 mg or isosorbid dinitrate at 1.25 mg (spray). Dotrimuvatisya care for GARDEN

75 rockiv - 75 mg. With Fibrinolizin - 300 m "title =" (! LANG: (! LANG: Aspirin should be given to all patients, who do not have a counter-indication, from the first nasal dose, it is necessary to get 150-325 mg. 300 mg, with wіtsі> 75 rokіv - 75 mg. With fіbrinolіzin - 300 m" class="link_thumb"> 6 !}!} Aspirin should be given to all patients, who do not have a proxy, from the first nascent dose, how to become mg. Ticagrelor in a nasal dose of 180 mg, or Klopidogrel - at a nasal dose of 300 mg, with a dose of> 75 mg - 75 mg. With Fibrinolizin - 300 mg. With a planned PCI of 600 mg for a larger ear of corn, Atropin in a dose of 0.5-1 mg (maximum 2 mg) intravenously in the case of bradycardia in the event of hemodynamic instability. 75 rockiv - 75 mg. With Fibrinolizin - 300 m "> 75 rokiv - 75 mg. With Fibrinolizin - 300 mg. With planned PCI 600 mg for a larger ear of corn, Atropin in a dose of 0.5-1 mg (maximum 2 mg) intravenously in the case of bradycardia in due to hemodynamic instability. "> 75 rocky - 75 mg. With Fibrinolizin - 300 m "title =" (! LANG: (! LANG: Aspirin should be given to all patients, who do not have a counter-indication, from the first nasal dose, it is necessary to get 150-325 mg. 300 mg, with vіtsі> 75 rokіv - 75 mg. With fibrinolіzin - 300 m"> title="Aspirin should be given to all patients, who do not have a contraindication, from the first nascent dose, which should be 150-325 mg. Ticagrelor in a nasal dose of 180 mg or Klopidogrel is a navantage dose of 300 mg, with a dose of> 75 mg - 75 mg. With Fibrinolizin - 300 m"> !}!}

0.1 mm, minimum 2 breast insertions or in 2 insertions "title =" (! LANG: (! LANG: Fibrinolytic therapy Carried out for such minds: I have not taken 12 years, 2. On the EKG it is designated as ST segment> 0.1 mm, as the minimum of 2 breast insertions or in 2 insertions" class="link_thumb"> 8 !}!} Fibrinolytic therapy Carried out for the following minds: 1. At least an hour from an ear of angina attacks 4-6 hours, I have not changed for 12 years, 2. On the EKG it is indicated that the ST segment is> 0.1 mm, as the minimum of 2 breast cases in 2 cases -x introduced as a matter of fact, or there is a new blockade of LNBI. 3. When EKG signs of a true rear IM 0.1 mm, as the minimum of 2 breast insertions, or in 2 insertions "> 0.1 mm, as the minimum of 2 breast insertions, but in 2 insertions of cases, if there is a new 3D blockade of LNPH. With EKG signs of a true posterior IM "> 0.1 mm, as a minimum of 2 breast insertions, or in 2 insertions" title = "(! LANG :(! LANG: Fibrinolytic therapy To be carried out for such minds: 1. About an hour) an ear of angina attacks 4-6 hours, at least 12 years old;"> title="Fibrinolytic therapy Carried out for the following minds: 1. At least an hour from an ear of angina attacks 4-6 hours, I have not changed for 12 years, 2. On the EKG it is indicated that the ST segment is> 0.1 mm, as the minimum of 2 breast cases in 2 cases -x introduction"> !}!}

Alteplase is administered intravenously following the "bolus + infusion" regimen. The dose to the drug is 1 mg / kg (not more than 100 mg): 15 mg is administered as a bolus; the next dose is 0.75 mg / kg for 30 minutes (not more than 50 mg), then 0.5 mg / kg (not more than 35 mg) for 60 minutes. Abo Tenecteplase intravenously 30 mg with weight up to 60 kg, 35 mg - kg, 40 mg - kg, 45 mg - kg, 50 mg - more than 90 kg, bolus administered for 5-10 seconds. Abo Streptokinase IV OD for xv on fiz. solutions. Often the development of hypotensives, state-of-the-art allergic reactions is referred to.

Prototype indication before FT Absolute: Earlier transfers of hemorrhagic stroke or impairment of cerebral blood flow of unaccountable genesis; Recently great trauma, surgery, head loss (3 months left). Pukhlina to the brain, primordial or metastatic. Changes in the structure of the cerebral vessels, the appearance of arteriovenous malformations, arterial aneurysms. Dose for aortic aneurysm. Shlunkovo-intestinal bleeding last month. There is a sign of bleeding because of a hemorrhagic diagnosis. Puncture in the misses is not given a delay (for example, liver biopsy, transverse puncture).

Vіdnosnі: Transient іshemіchny attacking ostannі 6 months at Refractory arterіalna gіpertenzіya (SAD180 mmHg, DAD110 mmHg) priyah antikoagulyantіv nepryamoї dії (warfarin) Stan vagіtnostі abo protyagom 1 tizhnya pіslya pologіv Zahvoryuvannya pechіnki and progresuyuchіy stadії Zagostrennya virazkovoї hvorobi shlunk or two-fingered intestines infectious endocarditis

Anticoagulant therapy without reperfusion therapy (when contraindicated before fibrinolytic therapy and during the daytime undergoing PCI) Fondaparinkus - 2.5 mg sc 2 times, 2.5 mg once per dose. Abo Enoksaparin i.v. bolus 30 mg, then 15 khvilin s / c in a dose of 1 mg / kg skin for 12 years. For ailments older than 75 years, the bolus does not get stuck, the s / c dose changes to 0.75 mg / kg skin 12 years, the first dose is not guilty of 75 mg. Abo Non-fractionated heparin - i.v. bolus 60 U / kg, not more than 4000 u., Poten i.v. 12 U / kg / year, maximum - 1 yew. Od / year.

ORIT Provide post-treatment, monitoring life important functionsі rich-channel monitoring of EKG. Kisen - through nasal catheters with a supply of 4-8 l / hv,

Nitrate - NG i / v mcg / xv with increased doses up to 200 mcg / xv or 1-10 mg / year with isosorbid dinitrate with protection, reliably titrated dose until symptoms are detected. Neutration in the state phase IM cn ST is not recommended. Beta-blocker - Metoprolol tartrate i / v 5 mg 2-3 times with an interval of at least 2 minutes to an initial dose of 15 mg, before the control of AT and heart rate.

ChKV Nevidkladne - the next step is to carry out the yakomog earlier when there was a fibrinolysin effect. Fibrinolysin consumption - vikonuvati in between from 3 to 24 years of age of successfully conducted fibrinolysin Chi is not recommended for the formation of IM from z.Q.

Anticoagulant therapy for primary PCI Non-refractive heparin - cob IV bolus to become 100 IU / kg (60 IU / kg, with one-hour detection of Ingibitoriv GP IIb / IIIa). If the procedure is carried out under the control of ABC, heparin is prescribed in a dose, as it is used for pіdtrimuval at rіvnі s. The introduction of the drug should be finished at once from the end of the procedure.

Disaster management of whiskey Aimed at cardiological rehabilitation / secondary prevention programs. Aspirin mg - take all your life. Klopidogrel 75 mg - once a day for 12 months, or Ticagrelor 90 mg twice a day for at least 1 month.

Oral anticoagulants - under the control of INR (in the range of 2.0-3.0) are recommended before aspirin therapy in patients with with a high rizik development of thromboembolism (AF, thrombosis of LS, the presence of piece valves in the heart). Beta-blocker, ІАПФ - to all patients, as well as not hesitate to show them. Statini - to indicate to all patients when they are on the go, the indication is directly related to cholesterol. рівень Х-ЛНЩ

Updated: October 2018

Under the term "gostry coronary syndrome", relying on respect is even more important for life. In general, the blood flow through one of the arteries, to liven up the heart, to change the floor, to a larger or smaller myocardium, or to cease to function normally, or to call the guinea. The diagnosis is competent to deprive by stretching the first to finish the development of the camp, leaving the differentiation - in humans, unstable angina pectoris manifested itself in such a way - an ear of myocardial infarction. At the same time (while the diagnostics is being carried out), cardiologists report on all possible visits, and learn about the progress of the school artery.

Gostry coronary syndrome As soon as I am talking about myocardial infarction, then only by stretching out the first (if there are cob symptoms) 90 chilin can be administered more, which can break a blood clot in the vital heart of the artery. Pislya 90 hilin likari can only help the body to change the area of the healthy food, to improve the basic living functions and to improve the efficiency of the process. To this, a raptor beat has developed in the heart, if you do not go through a stretch of decilkokhiline for some reason, you can see a symptom that has appeared for the first time, in the form of a safe wiklik "Shvidkoy help". Do not be afraid to become a panicker and turn for medical help, and even with the skin quilting, there are no cells in the myocardium that accumulate.

Far away, for any symptoms, like a pain in the heart, it is necessary to be respected, but it is necessary to grow up to the arrival of "Shvidkoi". We would like to say a few words about those who have a greater chance of developing a severe coronary syndrome.

Three lectures on terminology

In the last hour we are going to host coronary syndrome in two countries, which manifest themselves with the following symptoms:

unstable angina

Unstable stenocardia is a camp, when there is no physical pressure on the chest, but there is a bite behind the breastbone, but it has a very oppressive, oozing, abnormally squeaky character. Such a b_l is seen in a crack, a left hand, a left shoulder blade. It can be manifested і by pains in the abdomen, tediousness.

Talk about unstable angina, if there are any symptoms:

tilki vinikli (tobto earlier than lyudin viconuvav on the job without heart pains, zadishki abo uncommon views in the belly);
Have a chance to win with a little navantazhennі;
have become stronger or more trivial;
Were going to be in peace.

In the basis of unstable angina pectoris - a spasm or spasm of enlightenment with a greater or lesser artery, as to live, apparently, a greater or lesser amount of myocardium. Moreover, the price of the ringing is guilty of being more than 50% of the diameter of the artery in the middle of the day, or the transfer to the path of blood (even if there is an atherosclerotic plaque), it is not fixed, but it goes into the flow of blood, that is more, more, less.

Myocardial infarction

Myocardial infarction - without ST-segment infarction, or with an infarction of the ST segment (it is advisable to use only the EKG). Win winykah, if 70% of the artery diameter is crossed, and also, if a plaque is "broken", a blood clot or a drop of fat is clogged in the artery in the same muscle.

Gostria coronary syndrome without an ST segment is usually unstable angina, or an infarction without a second segment. At the stage before the hospitalization in the cardiological station, there is no differentiation - for the whole number of necessary minds and apparatus. If the cardiogram is visible on the ST segment, it is possible to diagnose "Gostry myocardial infarction."

Because of the fact that you will be ill-fated - with ST, or without a new one - and lie down for a severe coronary syndrome.

Even on the EKG one can immediately see the illumination of the glib ("infarction") Q wave, the diagnosis is "Q-myocardial infarction", and not the coronary syndrome. Tse talk about those who are affected by a great coronary artery, and in the presence of a great myocardium (great myocardial infarction). Also, a convalescence of a vine in case of occlusion of the great artery of the coronary artery by a thrombotic mass.

If it is necessary to take gostry coronary syndrome

You need to beat the trivia, if you are, or your relative, presents such skargi:

Beel behind the breastbone, Expanded as to show with a fist, not a finger (to hurt a great dilyanka). Bіl baking, yak oven, strong. It is not necessarily evil, but it can be localized in the middle or from the right side of the sternum. Viddaє to the left side of the body: half of the lower slit, arm, shoulder, shoulder, back. The intensity does not change in the presence of the condition, but there is a possibility (which is typical for the syndrome with ST segment syndrome) to prevent attacks of such pain, but sometimes it is practically painless.
Vona does not know about nitroglycerin or other drugs. Until the pain I come to fear, at til vistupaє pit, maybe it’s boring or blues.
zadishka, Yaka is often supervised to see failures. If a symptom develops as a sign of a lot of legends, then there is a build-up of breath, there is a cough, and you can cough up a mouthful of sputum.
broken rhythm I can see that there are interruptions in the robot heart, discomfort in the chest, sharp clothes about ribs, pauses with heart speed. As a result of such irregular, very quickly the velmi shvidko insists on the loss of svidomosty, in short - the headball grows, zapamorochennya.
More can be seen in the upper abdomen and supravodzhuvatisya weakened style, nudota, blues, Yaka does not bring lulling. Vona is also supervised by fear, inodi - to see an accelerated heart, irregular, fast hearts, zadishka.
Doctors have coronary syndrome you can check out the info.
Є Variant to overcome the severe coronary syndrome, which appears dirty, bloody, nudota, In some cases - in the presence of symptoms (asymmetric individuals, paralysis, paresis, broken down and so far).

The guilty ones also did their best, or more often the pain behind the sternum, because of the drive of such people, I know that this is how angina pectoris manifests itself, the zadishka and vtoma did it. Through a few days, about 2/3 of people develop coronary syndrome.

A particularly high risik develops a severe cardiac syndrome in such people:

kurtsiv;
osob with overworldly carriage;
ominous with alcohol;
lovers of salty grasses;
how to lead a little-rugged way of life;
kavomaniv;
May the loss of lipid exchange (for example, a high level of cholesterol, LPNSCH or LPDNSCH in blood analysis on a lipidogram);
with the establishment of a diagnosis of atherosclerosis;
for the presence of an accurate diagnosis of unstable angina pectoris;
there are atherosclerotic plaques in one of the vintsev (like to live the heart) arteries;
I have already had myocardial infarction;
lovers of chocolate.

Persha dopoga

To get additional help, you need to fix it at home. At the time of the first day, the buti wiklik "Shvidkoy dopomogi" is guilty. Give an offensive algorithm:

It is necessary to lay the man on the side, on his back, on his back, with his head and shoulders guilty of being raised, stacking with the tulub cout 30-40 degrees.
Odyag and a belt were needed to grow, but the dichotomy of the people did not bother anything.
If you don't know a lot of legends, give people 2-3 tablets to aspirin ("Aspekard", "Aspeter", "Cardiomagnil", "Aspirin-Cardio") or "clopidogrel" (tobto 160-325 mg aspirin). Їх it is necessary to rozjuvati. This is how to improve the ability to diagnose a blood clot, which (by itself, or by looking for atherosclerotic plaques) will overwhelm one of the arteries, as to live the heart.
Look at the quaters anyway (which is necessary, people need to be included): this way, more sourness will come to the sick.
If the arterial vise is larger than 90/60 mm Hg, give the person 1 tablet of nitroglycerin per tongue (the drug is wider for the heart). Re-give nitroglycerin can be given 2 times, with an interval of 5-10 minutes. Navigating a 1-3-fold reception of people has become more beautiful, more passed, it is impossible to see from the hospital in any case!
Until then, Lyudin took drugs from a group of beta-blockers (Anaprilin, Metoprolol, Atenolol, Korvitol, Bisoprolol), sending aspirin to a yomu need to give 1 tablet of this drug. In order to reduce the need for myocardium in sourness, giving them the opportunity to innovate. Brutal respect! Beta-blocker can be given, as arterial vise is more than 110/70 mm Hg, and the pulse is often more than 60 beats per chilina.
If Lyudin is taking antiarrhythmic drugs (for example, "Arithmil" or "Kordaron"), if the rhythm is broken, it is necessary to take a pill. At the same time, the ailment himself is guilty of fixing a lot and coughing a lot before the arrival of "Shvidkoi".
The whole hour before the arrival of "Shvydkoi" it will be necessary to transfer the order with the people, spostering behind the camp. Just as ailments in witness and seeming to feel fear, panic, it is necessary to calm down, or not to solder it with a valerian-motherfucker (you may know reanimation, if you can reanimate it in just words, ask for help)
In the presence of the court, there is a commission from a person who is guilty of helping to prevent the passing of the dickheads. For the whole it is necessary, having taken by the cut of the lower slots and the area before the bottom slots, thrust the lower slot so that the lower teeth appear in front of the upper ones. With such a position, it is possible to work out the piece of work in the mouth, as the self-consciousness has disappeared.
As soon as Lyudin stopped dichati, twist the pulse on the shoulder (two sides from the Kadik), and if the pulse is dumb, proceed before the resuscitation calls: 30 pushing with straight hands on the lower part of the breastbone (the cyst went down) for the mouth. The lower slot, when you need to trim for the area before the bottom, so that the bottom teeth were in front of the top.
Know the EKG pills and preparations, how to take ailments, and show them to the medical practitioners. It’s not a good idea to know it, but it’s necessary.

Who is guilty of robiti of "Shvidkoy Dopomogi"

Medical help with coronary syndrome to fix in one hour:

safety of life important functions... For whome to serve kissen: if the energy is self-contained, then through the nasal cannulas, if the activity is on the day, then to carry out the tracheal intubation and piece ventilation. As the arterial grip is critically low, it is necessary to repair the injecting of special preparations into the vein, as it will be necessary to move;
parallel reconstruction of electrocardiograms... By them wonder, є go ST chi ni. If there is no way, then, as there is no possibility of a quick delivery of ailments in the specialization of a cardiological hospital (for a sufficient staffing of the brigade), you can fix the posture of thrombolysis. When there is no ST, if there is an imbalance, clogging the artery with a blood clot "fresh", which can be broken, it can be taken to a cardiac or medical hospital, de.
Usuneniya pain syndrome... For introducing narcotic or non-narcotic drugs;
in parallel, for the help of express tests (smugs, kudi sprinkle blood stains, and show stench, negative or positive result)- markers in myocardial necrosis. In the norm, the level of troponin is to blame for the negative.
as there is no sign of bleeding, for the school to administer anticoagulants: "Kleksan", "Heparin", "Fraxiparin" abo іnshі;
if necessary, internally inject "Nitroglycerin" or "Isoket" in drops;
internal beta-blockers can also be introduced To reduce the need for myocardium in acid.

Brutal respect! It is possible to transport the sick person to the car only in the lying position.

Find out about the number of changes on the EKG for those scars, characteristic of the coronary syndrome

Likuvannya in the stationary

On the other hand, the EHC is re-familiarized in 10 entries for further therapy, which is necessary for the training of vital functions.
Repeatedly, using the same method, use the same troponins and other enzymes (MB-creatine phosphokinase, AST, myoglobin), as well as additional markers of myocardial bend.
In case of ST segment pidyomy, there is no contraindication, thrombolysis procedure is performed.
Prototype indications prior to thrombolysis, such as:
- internal bleeding;
- traumatic brain injury, transferred less than 3 months ago;
- "Upper" vice visce 180 mm Hg. or "lower" - a vische 110 mm Hg;
- Dose for aortic growth;
- transfer іnstroke or pukhlin to the brain;
- how lyudin has long been taking anticoagulant drugs (razrіzhuyut shelter);
- as if there was a trauma, or be-yak (laser correction) operation in the best 6 types;
- vagіtnіst;
- stiffening with virazkovoi ailment;
- hemorrhagic ailments of the eyes;
- The last stage of cancer, whether it is localization, is an important step in the lack of liver or nirok.
If there is any decrease in the ST segment, or if there is an inversion of the T waves, if there is a failure of the blockade of the left lower part of the Gus bundle, the need for thrombolysis should be done on an individual basis - GRACE. Vona vrahovuє vіk sickly, the frequency of the heart is very fast, rіven arterial vise, Evidence of chronic heart failure. At rozrakhunok, it is also taken those who have a heart to the point of nadhozhdennya, changes in ST, high chi troponin. Correspondingly, cardiology is considered to be on the basis of the scale of cardiology, which is indicated for the therapy, the detection of a thrombus.
Markers of myocardial activity will start for 6-8 years in the first place, I will do it right from the thrombolytic therapy that was carried out: they will be used to judge the dynamics of the process.
Obviously, there are some indicators of robotics to the body: equal glucose, electrolytes, success and creatine, and the standard of exchange. The radiography of the organs of the thoracic empty space will be examined for assessment, I will become a legend and (prioritized) heart. Conducted і ultrasonic examination of the heart with dopplerography - schob assess the blood flow of the heart and the thrombosis, give a prognosis for the development of such acceleration, such as aneurysm of the heart.
Strict post-mortem regime - in the first 7 dB, as coronary syndrome ended with the development of myocardial infarction. As soon as there is a diagnosis of unstable angina pectoris, people are allowed to get up earlier - by 3-4 additional ailments.
For people who have suffered coronary coronary syndrome, people should be prescribed a few drugs for post-use. Tse ingibitori of angiotensin converting enzyme ("Enalapril", "Lisinopril"), statini, blood-thinning cakes ("Prasugrel", "Klopidogrel", "Aspirin-cardio").
If necessary, for the prevention of raptor death, establish a piece water rhythm (cardiostimulator).
After a decade (in the fallowness I will become ailing and the nature of the changes on the EKG), there is no proof, there is also a follow-up, such as coronary angiography. Tse roentgenologichesky method, if through a catheter, conduction through the stegovy of the judgment into the aorta, injecting a contrast line. You have been drinking in the coronary arteries and barbed, it is clearly seen by the licenses that the passages of the court are very clear. It is possible to carry out additional procedures, as the first diameter of the judgment is to be taken into account.

forecast

The general mortality rate in patients with coronary artery syndrome becomes 20-40%, with a large number of patients in the ginseng before being delivered to the hospital (a lot of such deadly arrhythmias such as fibrillation of slugs). About those people who have a high rizik of death, you can say behind such signs:

people over 60 years old;
at the new lowered arterial grip;
more often sertsebittya grew;
the gostra sertseva developed a lack of food of the 1st class according to Kilip, so that є for only vologs wheezing in legends, or even a growing grip in legendary artery Above the rise of a bunch of legends, or a shock camp from the fall of the arterial grip, changes in the number of vidokremlyuvannoy chas, and the broken svidomosty;
Lyudin is suffering from diabetes;
infarction has developed along the front line;
Lyudin is already suffering myocardial infarction.

For a quote: Kashtalap V.V., Barbarash O.L. Nutritional support for patients with coronary syndrome without ST segment (look around the recommendations of the European Cardiological Association 2015) // RMZ. 2015. No. 26. S. 1524-1527

According to the materials of the recommendations of the European Cardiological Association 2015

For cituvannya. Kashtalap V.V., Barbarash O.L. Nutritional support for patients with coronary syndrome without ST segment (look around the recommendations of the European Cardiological Association 2015) // RMZ. 2015. No. 26. S. 1524-1527.

Nowadays, the problem of choosing the optimal way to guide a patient with coronary syndrome without a steep ST segment on the EKG (ST-ACS) does not intrude its relevance for a practical doctor. Seemingly, ailments with the key and electrocardiographic signs of the OKSbpST - to complete the developmental cohort of patients. You can include patients with clinical manifestations of acute coronary syndrome (GCS) without changes in EKG and reactions of cardiospecific markers (unstable angina pectoris) and patients with myocardial infarction (IM) without ST Most of the time on STE ACS in special hospitals it is necessary to get patients without sickness of the heart-vascular system (with acute osteochondrosis, pathological shlunkovo-intestinal tract, pneumonia).
It is possible to allow allowances for patients with ST-ACS - a greater tolerance for the course of the coronary heart disease group of patients, in some cases we are sick with ST-segment coronary syndrome (ST-ACS). However, this is not the case: hospital mortality in ST-ACS can be 2-3 times overwhelming in patients with ST-ACS, in case of a long-term (normal) period, the frequency of development of repeated heart-and-heart pod_y in patients with ST-ACS who did not know the hospital revascularization, replacing the same in patients with ST-ACS.
On the other hand, practical patients have optimal medical tactics in terms of age before patients from OKSpST.
The tactics of revascularization in patients with OKSbpST is individual and to lay aside the development of factors in the development of an uncomfortable overload of GCS in a particular patient. A major problem REFERENCE patsієntіv of OKSbpST polyagaє in pravilnіy otsіntsі practicality lіkarem іndivіdualnogo riziku i, vihodyachi of tsієї otsіnki, viznachennі hour zastosuvannya іnvazivnoї strategії (Extra at nadhodzhennі; 24 Godin od cob zahvoryuvannya (rannya іnvazivna strategіya) to 72 Godin od cob zahvoryuvannya ( Invasive strategy) for the choice of conservative tactics for the management of the patient with STO.
In connection with the obvious objectival difficulties of practicing practitioners to select the optimal tactics for the study of patients from the OKSbST and the bullets taken in London 2015 at the European Congress of Cardiology Comrades
Clinical manifestation of ACSBPS can be felt in trivial (> 20 min) anginous pain in calmness; for the first time, angina pectoris is II or III functional class (FC) for the Canadian classification; progressive manifestations of earlier stable angina pectoris up to III-IV FC; postinfarction angina.
Have lіtnіkh ailments, women, ailments on diabetics (CD), nirk deficiency and dementia often develop atypical key forms STEACS: abdominal, asthmatic, peripheral, as well as increased respect to the same category of patients.
If there is a suspicion of the presence of an ACS patient with diagnostics of the first line, a 12-channel ECG is recorded in a quiet stretch of 10 minutes as the cob of the patient's first contact with the doctor. 1/3 of the patients with STOs may have an onset of the coronary heart disease, so that they do not need to diagnose a coronary heart disease. In the case of ailments on the EKG, there may be changes in the ST segment: depression, transient (up to 20 min) anemia, changes in the T wave at the back of the inversion. If the patient is suffering from ischemic discomfort, the unchanged EKG is shown, then it turns out to be cinnamon in the first place є the record of additional entries: V7-V9 and right breast (V3R-V4R). In any case, only the visibility on the EKG of the ST segment stiffness should include the patient to the ST category of ailments. In order to preserve the clinical manifestations of myocardial ischemia on the other hand, it is necessary to record the EKG in the dynamics of the patient's progress and to measure the average results.
In the European Recommendations 2015, it is especially noted that biomarkers are assigned to myocardial necrosis є is absolutely binding for all patients with OKSBPS, some results and you can help to develop a child's tactics. That very diagnosis of IM, which is a sign of the remainder of the universes of myocardial necrosis, is generally guilty of the positive results of biomarkers in myocardial necrosis in a different way. Well, they have recommended to themselves such biomarkers of myocardial reduction, such as the CF-fraction of creatine-nase, the back-end fraction of creatine-nase, myoglobin. However, in Danish hour, the leader in cardiospecial troponin (type T abo I), it is most important to use authorizations from patients from OKSbpST. It’s quite a shortcoming for a practical victorious test є any increase in concentration in the blood (in 6-12 years after the ear of IM), however, when a highly sensitive test for troponin (HTT) occurs, it’s not easy for the first year GKS. Protect of the high value of troponin can be developed not only in case of IM, ale and in case of myocarditis, sepsis, shots of any ethology, life-threatening rhythm disturbances, dissection of the aorta and thromboembolism of the lung artery. To protect positive positive results, the troponin test should be treated by patients with ischemic ailment The heart and the important deterioration of the glomerular function, some of the stench can be augmented by the decrease in the glomerular filtration rate (GFR).
As an alternative to troponin, if the author is unhappy. European recommendations 2015 R Copeptin - the C-terminal part of the prohormone vasopressin, which can clearly reflect the severity of endogenous stress in children non-slip mills, Including ІМ.
In єvropeyskih rekomendatsіyah 2015 p opisanі dіagnostichnі algorithm scho dozvolyayut on pіdstavі otsіnki klіnіchnih, elektrokardіografіchnih that laboratory danih (serіyne viznachennya HFT) in duzhe korotkі termіni (protyagom 1 abo 3 h od nadhodzhennya patsієnta in statsіonar) pіdtverditi abo sprostuvati nayavnіst necrosis mіokarda i utochniti away the tactics of the patient's management from the OKSbpST for some reason or cause pain in the breasts. There are 2 such algorithms: 1-year (0h / 1h) and 3-year (0h / 3h), which may be of equal importance for a practical victorian. The first algorithm proposes a seriyny assessment of HFT (T or I) when a patient is admitted to the intensive care unit and after 1 year of intensive therapy. The determination of the high-frequency high-frequency radiation concentrations and the dynamic assessment after 1 year allow the distribution of patients into a group of STCS, a group of additional caution and a group of patients with non-dynamic cardiac pain Such an algorithm allows you to achieve a well-defined stratification of patients as soon as possible for the period of the OKS and for more early invasive tactics of dealing with ailments. Let's add a shortcut to the algorithm є read the binding to the parameters in the test of a specific test system virobnik, which are indicated in the recommendations (Elecsys, Architect, Dimension Vista). For the test-systems of cich virobniks, they describe the boundary value of HFT, services for the stratification of patients in the incidence of malnutrition and the onset of pain in the chest.
The 0h / 3h algorithm is available for the practical victorian. I can also help to assess the high-frequency response in a patient with pain syndrome in the chest and without STEMI criteria on the EKG when appropriate to the hospital. If the value of HFT is lower than the upper limit, then it is necessary to assess the triviality of pain syndrome in the chest. If the triviality of such a warehouse patient is more than 6 hours, then the HFT reassessment is not carried out. The patient needs to conduct a sickness, assess the quality of uncomfortable pod_s according to the GRACE scale, indicate anti-aging tests before a visa and conduct a differential diagnosis of some of the other causes of pain in the breast. yaksho pain syndrome After less than 6 hours the patient is in the hospital, then after 3 hours the patient in the intensive care ward needs to re-value the HST value. In case of a 2-fold increase in HFT, the patient is seen as a candidate for invasive treatment. When there are 2 HFT values, the patient is stratified into the group of caution for assessing the risk according to the GRACE scale and for carrying out the tests before the vipisk. If an ailing person with signs of ST-OKS, when it is appropriate to the stationary, starts the value of HFT in the upper range of norms, then it is necessary for an offensive rank: a patient with abnormally high concentrations of HFT (in the case of an unremarkable candidate for a normal candidate) In a situation, if the value of HFT is to change the level of the upper limit values, it is permissible to repeat it after 3 years from the value of 2 values. As soon as I change the upper boundary of the norms, the patient looks like a candidate for coronary angiography, if I don’t change it, then the sick person is shown additional protection in the back ward and early vise for conducting the dental tests. Introduced by algorithms of accelerated assessment of the patient's risk from adolescence on the OKS and differential diagnostics Recommended only if HFT is available for routine clinical trials.
The food industry is not called upon for the practitioners of our country. Main metoyu їh vprovadzhennya at Dumka єvropeyskih kardіologіv, Je mozhlivіst shvidkoї stratifіkatsії ailments of pіdozroyu ACS in zalezhnostі od viyavlenogo riziku nespriyatlivogo result for viznachennya testimony to іnvazivnoї taktitsі Keeping patsієnta, abo for Rann perekladu on an outpatient Etap doobstezhennya pіslya Venue of navantazhuvalnih samples. Recommendations of the European Cardiological Partnership for the management of ailments from the STOPS 2015 in full allow the implementation of such a pidhid.
In the capacity of preadoptive methods of pre-examination in patients with STOs, for differential diagnostics of those who are ill, there may be vicinities: echocardiography in calm and stress-test, magnetic coronary resonance tomography Echocardiography is recommended for the assessment of the regional and global rapid function of a lick in a patient with STD ACS, as well as for the differential diagnosis of pain in the chest. Multispiral computer coronary angiography can be discussed in the quality of a diagnostic test (as a substitute for invasive coronary angiography) in patients with low or intermediate risk, if the EKG data is not biomarker.
Uninvolved on the basis of the algorithms propounded by the algorithms of the advanced strategy of the patients from the STOs when appropriate, the author of the European recommendations does not indicate the need for an individual assessment of the development of an uncomfortable heart disease. For the general use of the GRACE scale for practical drug users in Russia, the GRACE 2.0 scale is analogous to the TIMI scale; The GRACE scale makes it possible to achieve the objectively carrying out the stratification of the patient's risk, when appropriate, as well as when typing. Victory of the well-grounded risk calculator GRACE 2.0 allows you to predict hospital mortality and mortality in patients with STE-ACS in 6, 12 and 36 ms. ... In the GRACE 2.0 scale, there are data on the patient's health, the value of the systolic arterial vise, heart rate, creatine concentration, Killip class of heart failure (HF) when appropriate, appearance of the ST segment. There is no information about the class of heart failure and the values of syrovatkovogo creatinine, the GRACE 2.0 scale has been modified, allowing the assessment of patients on the basis of pre-existing anamnestic data about the manifestation of chronic ailments of nirok and dyspepsia.
Episodi of great bleeding, if there is adequate correction for additional blood transfusion, significantly increases the risk of fatal diseases in patients with ST-ACS. For patients with active vascular diseases in patients with ACS, endovascular preparations that are infused on the throat of blood (combination of antiplatelet agents and anticoagulants), authoritative European recommendations for the prevention of non-vascular diseases The scale for assessing the risk of bleeding in patients with OKSBpST CRUSADE is important for a practical victorian.
All patients with STE ACS, prior to the primary risk-based stratification, require post-mortem monitoring of the EKG for 24 years, or before undergoing a coronary artery bypass grafting (PCI). The knowledge of a patient with a prior diagnosis of ST-ACS in the ward without the ability to monitor the EHC is unacceptable. Monitoring of EKG in patients with ST ACS for more than 24 hours can be stagnant with a high risk of arrhythmic acceleration.
Drug treatment The patients from the STOs in the new recommendations did not know a hundred changes. Beta-adrenergic blockers are recognized as early as possible with symptoms of ischemia in patients without contraindications (GOST CH III-IV classes for Killip). In patients with vasospastic stenocardia, beta-adrenergic blockers followed the reaction from treatment, replacing them with calcium antagonists and nitrovasodilators. Intravenous nitrovasodilators are recommended for sparing ischemic discomfort, uncontrolled hypertension and congestive lesions.
Yak antiplatelet agents in the list of patients from STOs, there are a number of different drugs: acetylsalicylic acid(ASK), clopidogrel, ticagrelor, prasugrel. Recommendations say i new drug s antiaggregant dіyu s in / in a shlakhom introduction - cangrelor.
At the first time a patient is examined by an adolescent on ACS, ASA is designated as a drug in a nasal dose of 150-300 mg in an "uncoated" form; / Sut in the "stolen" form.
The assignment of platelet P2Y12 receptors to platelets before ASA is recommended for 12 months.
Ticagrelor in a nasal dose of 180 mg and supplementary - 90 mg 2 r. / Dobou rekomenduєtsya to priznachennya at vіdsutnostі protipokazan (vnutrіshnocherepny krovoviliv in anamnezі abo prodovzhennya krovotechі) in vsіh patsієntіv of OKSbpST serednogo i temple riziku (s pіdvischenim rіvnem troponіnu) Square od obranoї spochatku tactics, vklyuchayuchi ailments, Yakima ranіshe priznachavsya klopіdogrel in navantazhuvalnoї dozі. Lіkuvannya klopіdogrel slіd pinch, which is the power of the sign of tіcagrelor. The efficiency of ticagrelor is great for the prevention of repeated heart-vascular podiyas in patients with a length of 12 months. Pislya OKSbpST in the case of a bug-clogged bull is shown in the pre-release PLATO.
Prasugrel (in Russia, it is not available for sale) in a nasal dose of 60 mg and an acceptable dose of 10 mg per day is assigned to patients due to the planned invasive tactics of maintenance during the hour of the day.
Clopidogrel in a navantage dose of 300 or 600 mg and an acceptable dose of 75 mg daily recommended to patients who cannot take ticagrelor or prasugrel or the need for additional indications of indirect anticoagulants (fatigue)
The author of the recommendation admits a shortening of the terms of the subordinate antiplatelet therapy up to 3-6 ms. Pislya ACS with implanted stents with lykarskiy pokritty (DES) in patients with high rhizic hemorrhage. However, the authorization to discuss the need for prolongation of sub-antiplatelet therapy is longer than 12 months. in okremikh categories of patients for a retreat assessment of the risk of ischemic conditions and bleeding.
The recommendation for the new drug, cangrelor, is intended to be modest - it can be prescribed for the prevention of PCI in patients with ST-ACS who have not previously taken one of the inhibitors of platelet P2Y12 receptors.
Anticoagulant therapy is indicated for all patients when a GCS diagnosis is established. As anticoagulants in the state of the ST-ACS phase, it is permissible to consume such drugs as:
- unfractionated heparin (only intravenous injection is guilty);
- low molecular weight heparin (enoxaparin, i.v. bolus i s.c. injection);
- fondaparіnuks (n / a introduction);
- bivalirudin (guilty, only intravenous injection).
It is evident that fondaparinux (2.5 mg / day s / c) is recommended as a drug that has an optimal efficiency / safety profile in patients with ST-OCS, as a matter of other tactics of abuse. In case of ill-feeling, fondaparinux is an alternative for anticoagulant therapy - enoxaparin or heparin non-fractionation. It is not allowed to change one type of heparin on the basis of the risk of bleeding.
Bivalirudin is seen as an optimal alternative to unfractionated heparin in combination with IIB / IIIA receptor blockers in platelets and may be stagnant in patients with ST-ACS when using invasive tactics.
Adopt anticoagulant therapy for ST-ACS patients for PCI, as well as daily additional information for general (prevention of venous thrombosis). It also means that in patients with ST-ACS without a dose of 2.5 mg of early and transient ischemic attacks in anamnesis, with a high risk of development of repeated ischemic events and low risk of bleeding during the development of antihypertensive disorders / Dobu stretching 12 ms. at once with ASK and clopidogrel.
Stagnation of statins in patients with ST-ACS needs to be repaired earlier in the hospital at the maximum therapeutic dose and continued for the duration.
Angiotensin converting enzyme (IAPF) is recognized by ST patients in the hospital for 1 dib, if the patient has a lower fraction of the wikid livogo<40%, СН, артериальная гипертензия или СД. Альтернативой иАПФ могут быть сартаны, особенно при непереносимости иАПФ. Назначение осуществляется пожизненно.
Antagonism of minerlocorticoid receptors (not importantly, eplerenone) is recognized in patients with ST-ACS with induced FVLS<35%, клиникой СН или выявленным СД. Однако у пациента не должно быть тяжелых проявлений почечной недостаточности и гиперкалиемии.
Okremo in the 2015 recommendations of the descriptions of the decisions to the choice of invasive tactics for conducting patients from the STOs, based on the individual strategies. Extra invasive tactics (conducting koronarografії to 2 hours od nadhodzhennya patsієnta in statsіonar) zastosovuєtsya at viyavlennі at patsієntіv of OKSbpST Find our duzhe temple riziku (nestabіlnіst gemodinamіki abo kardіogenny shock; zberіgaєtsya іshemіchny bіl in grudnіy klіttsі refractory to medical lіkuvannya; zupinka sericite abo zhіzneugrozhayuschіe breakdown of the rhythm; mechanical accelerated IM (myocardial development); GOSTR CH; recurrent dynamic changes of the ST segment on the EKG, especially transient changes). It is not safe to transfer such patients to a hospital without the possibility of performing an emergency coronary angiography and PCI, they need to be transferred to a special medical intervention center.
The early invasive tactics of conducting a patient from the OCHS is based on the conduct of coronary angiography until the age of 24, as the patient is ill in the hospital and to stay with high-risk patients. Prior to such, there are ailments with typical alterations and decreased markers in myocardial necrosis; dynamic changes on the EKG of the ST segment abo the T wave (including asymptomatic); we will see a few points for the GRACE scale> 140. If such patients are in the hospital without the possibility of carrying out extracoronary angiography and PCI, it is necessary to transfer to the state center for additional special interventions.
The invasive tactics of the patient's management on the basis of coronary angiography until the age of 72 is due to the patient's care in the hospital, as the patient sees the criteria for an industrial patient:<60 мл/мин); характеризуется значением ФВЛЖ <40% или наличием признаков застойной СН; с ранней постинфарктной стенокардией, перенесенными ранее ЧКВ или коронарным шунтированием (КШ); при выявленной сумме баллов по шкале GRACE от 109 до 140. Если такие пациенты находятся в стационаре без возможности проведения экстренной коронарографии и ЧКВ, их необходимо перевести в соответствующий специализированный интервенционный центр в период госпитализации.
Patients with low risk are shown to undergo anesthetic tests and coronary angiography for their results.
When performing coronary angiography and PCI in patients with ST-ACS, it is necessary to provide the maximum amount of radial access and stents in Likarsky pokritty.
Up to 10% of patients with ST-ACS can be known to undergo CABG using the method of repeated myocardial revascularization in multivessel coronary atherosclerosis. In this day, the decision about the best manual method of myocardial revascularization in ST-ACS is taken collectively by patients: cardiologists, cardiac surgeons and anesthesiologists (Heart Team) with an There are no clear recommendations from the school, there are very few results in the randomized children who were assigned to the food of the transfer of PCI or CS in the patients with STOs. CABG emergency stagnates in ST-ACS in case of hemodynamic instability, recurrent myocardial ischemia and in patients with coronary arteries of a very high risk, rightly as a result of the therapy of sublinear disaggregation. In generally stable patients with STOs, there are other antiplatelet agents - ticagrelor or clopidogrel 5 days before KSh, prasugrel - 7 days before. In patients with ST-ACS, it is permissible to assess the function of thrombocytes with the help of the platelet receptor P2Y12 - a platelet receptor for a short hour to clear CABG. The renewal of sub-antiaggregant therapy for CABG can be done in terms of time, which can be used by a doctor who has no ovens for it. At the same time, it is recommended to continue the therapy with low doses of ASA before the time of CABG, moreover, after 6-24 years after CABG it is recommended to update the ASC, as there is no trivial bleeding.
One of the distributions of the European Recommendations of 2015 for the Rock є chapter is assigned to the Zusillas for the way of life for the patient, which has been transferred to the state of the coronary heart. To strive for emphasis on the need for special programs for the purpose of developing and adapting the hospitality of the class of patients.
Let me summarize, but far from all the positions that have been identified in the new recommendations of our European colleagues for the treatment of ailments from the OKSBPS, we may be in a general communication in the introduction into the real classical practice of the stationary workers in Russia. It is necessary to be aware of the principles of the development of the development of a cohort of patients in the context of greater activity of practitioners, as well as the strategy of the Russian risk assessment, and the trial of the development of the

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