Клиническая картина стрессорной кардиомиопатии (синдром такотсубо) и проблема дифференциальной диагностики с острым инфарктом миокарда
Аннотация
Представленные данные свидетельствуют, что синдром такотсубо (СТ) характеризуется отсутствием обструкции коронарных артерий, сократительной дисфункцией сердца, апикальным баллонированием, сердечной недостаточностью, у части пациентов – подъемом сегмента ST и удлинением интервала QTc. У каждого десятого пациента с СТ развиваются желудочковые аритмии. У большинства пациентов с СТ отмечается подъем уровня маркеров некроза (тропонин I, тропонин Т, креатинфосфокиназа-МВ (КФК-МВ)), который существенно меньше, чем у больных с острым инфарктом миокарда (ОИМ) с подъемом сегмента ST. Уровень N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP), напротив, существенно выше у больных с СТ, чем у пациентов с ОИМ. Дифференциальная диагностика СТ и ОИМ должна базироваться на комплексном подходе, заключающемся в использовании ангиографии коронарных сосудов, эхокардиографии, анализе ЭКГ, магнитно-резонансной томографии, однофотонной эмиссионной компьютерной томографии, определении уровня тропонинов, КФК-МВ, NT-proBNP.
Об авторах
Е. С. Прокудина
«Научно-исследовательский институт кардиологии», «Томский национальный исследовательский медицинский центр» Российской академии наук, Томск, Россия
Россия
к.м.н., н.с. лаборатории экспериментальной кардиологии
Россия
к.м.н., н.с. лаборатории экспериментальной кардиологии
Б. К. Курбатов
«Научно-исследовательский институт кардиологии», «Томский национальный исследовательский медицинский центр» Российской академии наук, Томск, Россия
Россия
Россия
аспирант. лаборатории экспериментальной кардиологии
Л. Н. Маслов
«Научно-исследовательский институт кардиологии», «Томский национальный исследовательский медицинский центр» Российской академии наук, Томск, Россия
Россия
д.м.н., профессор, руководитель лаборатории экспериментальной кардиологии
Россия
д.м.н., профессор, руководитель лаборатории экспериментальной кардиологии
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При поддержке: Работа выполнена при поддержке Российского научного фонда грант 21‑15‑00037. Раздел, посвященный BNP при синдроме такотсубо, выполнен в рамках государственного задания АААА-А15‑115120910024‑0. Конфликт интересов не заявлен.
Для цитирования:
Прокудина Е.С., Курбатов Б.К., Маслов Л.Н. Клиническая картина стрессорной кардиомиопатии (синдром такотсубо) и проблема дифференциальной диагностики с острым инфарктом миокарда. Кардиология. 2020;60(11):137–147. https://doi.org/10.18087/cardio.2020.11.n777
For citation:
Prokudina E.S., Kurbatov B.K., Maslov L.N. Clinical Manifestation of Stressful Cardiomyopathy (Takotsubo Syndrome) and the Problem of Differential Diagnosis with Acute Myocardial Infarction. Kardiologiia. 2020;60(11):137–147. (In Russ.) https://doi.org/10.18087/cardio.2020.11.n777
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