Shaposhnyk O. A., Shevchenko T. I., Sorokina S. I., Yakymyshyna L. I., Kudrya I. P.
The article presents a clinical case of a myocardial infarction painless variant, complicated by the formation of chronic left ventricular aneurysm with a parietal thrombus. The case of practice demonstrating the rare atypical course of acute myocardial infarction, with timely diagnosis, has determined the early onset of adequate treatment and favorable course of the disease. The purpose of the study is to update the problem of diagnosis of coronary heart disease at a young age. Object and methods. There is a patient G., born in 1987, who was admitted to the cardiology department of the Poltava Regional Clinical Hospital. M.V. Sklifosovsky (PRCH), with the changes at the electrocardiogram which were detected during the prophylactic examination. During the period of patient’s observation, on the basis of the cardiology department of the PRCH, general-clinical, laboratory and instrumental examinations were carried out. The patient was not at the dispensary supervision of cardiologist. During an annual prophylactic examination, ECG changes are detected. However, due to the absence of any complaints, clear clinical manifestations, the CHD was not timely diagnosed, special clinical monitoring, examination and treatment were not offered. The pain in the area of the heart and behind the sternum does not bother. From anamnesis of life: the pathology of heart in the closest relatives denies. He smokes one pack of cigarettes for two days. Objectively: the general condition is satisfactory, the skin is pale pink, there are no swelling, clear lung sounds above the lungs, vesicular breathing at auscultation. Pulse 89 ppm, rhythmic, satisfactory filling. Blood pressure (BP) – 120/80 mm Hg. Art., oxygen saturation – 99%. Gastrointestinal, urinary, nervous and endocrine pathology were not detected. The signs of Q-positive anterior myocardial infarction (MI) were detected at electrocardiogram from 10.04.2019. In order to clarify the diagnosis of the patient, coronary angiography was performed, during which the occlusion of the middle part of the anterior interventricular branch of the left coronary artery was diagnosed. Clinical diagnosis: CHD: postinfarctional cardiosclerosis (diffused with the Q wave myocardial infarction of the left ventricle anterior wall according to ECG and echocardioscopy, coronaroangiography (17.04.19) – chronic aneurysm of the apex and interventricular septum with left ventricular parietal thrombus, mitral valve insufficiency I-II st., HF I st., with a lower left ventricular ejection fraction (EF- 35%, echocardioscopy at15.04.19), FC II. According to the recommendations, the patient is operated at the National Institute of Cardiovascular Surgery named after MM. Amosov. The case of an atypical MI in a young patient demonstrated the possibility of modern diagnostic methods using, as well as the ability to evaluate the functioning of affected coronary vessels and to choose the correct tactics of surgical treatment.
myocardial infarction, late diagnosis, treatment methods, optimization of the prognosis
«Bulletin of problems biology and medicine» Issue 2 Part 2 (151), 2019 year, 176-179 pages, index UDK 616.127-005.8-053.6
