Uzroci akutnog koronarnog sindroma bez elevacije ST-spojnice u bolesnika s normalnim nalazom koronarografije

master's thesis

• Title (english): Causes of acute coronary syndrome without ST-segment elevation in patients with a normal coronary angiogram
• Author: Ana Piršljin
• Mentor: Boško Skorić (mentor)
• Committee member: Joško Bulum (predsjednik povjerenstva)
• Committee member: Martina Lovrić Benčić (član povjerenstva)
• Committee member: Boško Skorić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2021-09-11, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Intensive Care

Abstract

Akutni koronarni sindrom definira se kao stanje koje je praćeno novonastalom boli u prsima uslijed akutne ishemije koja dovodi do ozljede miokarda. Akutni koronarni sindrom je na temelju elektrokardiografske (EKG) prezentacije podijeljen je u tri skupine: infarkt miokarda s elevacijom ST-spojnice (STEMI), infarkt miokarda bez elevacije ST-spojnice (NSTEMI) i nestabilna angina pektoris. Svrha ovog preglednog rada je sažeti prikaz nedavnog napretka u saznanjima o MINOCA - infarkta miokarda s neobstruktivnim koronarnim arterijama koji se javlja bez elevacije ST - spojnice. MINOCA je i dalje zagonetan klinički entitet i enigma zbog nedostatka razumijevanja točne patogeneze ovog stanja. Ovaj pregledni rad sastoji se od šest cjelina, od kojih se svaka bavi različitim aspektima pristupa i razumijevanja iznenadne boli u prsima kod pacijenta bez povišenja ST-segmenta na EKG-u, povećane razine troponina u krvi i bez nalaza značajne stenoze koronarne arterije (<50%) na učinjenoj koronarografiji. Prvi dio opisuje vrste akutnog koronarnog sindroma, epidemiologiju, kliničku sliku i različitu elektrokardiografsku (EKG) prezentaciju. Drugi dio preusmjerava fokus na epidemiologiju i prevalenciju MINOCA-e i ukazuje da se uvelike razlikuje od klasičnog infarkta miokarda poput STEMI-ja, te također pokazuje da ti pacijenti imaju manje tradicionalnih čimbenika rizika za kardiovaskularne bolesti. Drugi, treći, četvrti i peti dio objašnjavaju neke od najčešćih uzroka i objašnjavaju temeljne patofiziološke entitete koji bi mogli dovesti do ove neuobičajene kliničke slike u pacijenata. Također, ovi dijelovi objašnjavaju koje se metode preporučuju za dijagnosticiranje takvog entiteta; koji se pristup pokazao najuspješnijim prema Europskom kardiološkom društvu i drugim dostupnim meta-analizama. Opisuje se i odabir najbolje ciljane terapije kako bi se osigurao oporavak i poboljšala kvaliteta života i prognoza kod ovih pacijenata.

Abstract (english)

Acute coronary syndrome is defined as a condition which is followed by new onset of chest pain due to acute ischemia that leads to myocardial injury. According to definition of acute coronary syndrome, based on electrocardiographic (ECG) presentation, it is divided into three groups: ST- segment elevation myocardial infarction (STEMI), non-ST- segment elevation myocardial infarction (NSTEMI) and unstable angina. The purpose of this review paper is to succinctly review recent progress in the knowledge of MINOCA - myocardial infarction with nonobstructive coronary arteries that presents without ST-segment elevation. MINOCA still remains a puzzling clinical entity and an enigma due to lack of understanding the precise pathogenesis of this condition. This review paper is composed of six chapters, each of them dealing with different aspects of approaching and understanding sudden onset chest pain in a patient without ST-segment elevation on ECG, increased troponin level in blood stream and with no finding of significant coronary artery stenosis (<50%) after coronarography is done. Part one describes the types of acute coronary syndrome, its epidemiology, clinical presentation and different electrocardiographic (ECG) presentation. A part two shift focus to epidemiology and prevalence of MINOCA and leads to conclusion that it differs widely from classic myocardial infarction like STEMI and also shows that these patients have fewer traditional cardiac risk factors. Parts two, three, four and five explain some of the most common causes and explain underlying pathophysiology entities that could lead to this uncommon clinical presentation in patients. Also, these parts explain which methods are recommended to diagnose such entity; which approach is shown to be the most successful according to the European Cardiology Society and other available meta-analysis. Finally, adequate diagnosis of underlying pathophysiology cause is crucial for planning the best targeted therapy in order to provide recovery and improve quality of life and prognosis in these patients.

• Keywords: akutni koronarni sindrom; infarkt miokarda bez elevacije ST-spojnice; MINOCA; koronarografija
• Keywords (english): acute coronary syndrome; non-ST- segment elevation myocardial infarction; MINOCA; coronarography
• Language: croatian
• URN:NBN: urn:nbn:hr:105:102977
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-03-25 13:25:36