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Vojnosanitetski pregled
2009, vol. 66, br. 4, str. 323-327
jezik rada: srpski
vrsta rada: saopštenje
doi:10.2298/VSP0904323P


Agregacija trombocita, disfunkcija endotela i akutni infarkt miokarda
Vojnomedicinska akademija

Sažetak

Akutni infarkt miokarda u razvijenim i srednje razvijenim zemljama jedan je od najčešćih uzroka mortaliteta i morbiditeta, pa poznavanje patofiziologije ateroskleroze i aterotromboze predstavlja najveći izazov savremenoj medicini. Najčešći uzrok AIM je ateroskleroza epikardnih koronarnih arterija sa posledičnom rupturom i/ili erozijom aterosklerotskog plaka, nastajanjem intrakoronarne tromboze i prekida cirkulacije arterijske krvi u predelu irigacije infarktne arterije. Sklonost ka aterosklerozi ne znači po pravilu i sklonost ka trombozi, i obrnuto. Mnogobrojni faktori rizika od ishemijske bolesti srca modifikuju funkciju hemostaznog sistema, remete ravnotežu između proagregatornih i antiagregatornih, prokoagulantnih i antikoagulantnih, profibrinolitičkih i antifibrinolitičkih mehanizama. Na taj način genetski uslovljena sklonost ka trombozi potencira se faktorima rizika, što zajedno vodi ka aterotrombozi i akutnom koronarnom sindromu. Fizičko opterećenje je jedan od faktora rizika od ishemijske bolesti srca. Efekat zavisi od vrste opterećenja, dužine trajanja i stepena utreniranosti bolesnika. Umerena fizička aktivnost kroz duži vremenski period ima protektivni značaj kod bolesnika sa ishemijskom bolešću srca, jer poboljšava funkciju endotela, smanjuje oksidativni stres na nivou endotela, smanjuje broj i aktivnost trombocita kao i aktivnost mnogih faktora koagulacije i na taj način smanjuje učestalost ponovnih koronarnih događaja. Nasuprot tome, akutna fizička aktivnost dovodi do izraženog prokoagulantnog stanja što na terenu disfunkcije endotela i specifičnosti hemostaznog sistema može provocirati ponovnu koronarnu trombozu.

Ključne reči

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