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Medicinski pregled
2018, vol. 71, br. 7-8, str. 265-269
jezik rada: engleski
vrsta rada: prikaz slučaja
doi:10.2298/MPNS1808265I
Ekvivalent infarkta miokarda sa elevacijom ST segmenta - elektrokardiogram De Vinterovog T-talasa
aInstitute of Cardiovascular Diseases of Vojvodina, Clinic of Cardiology, Sremska Kamenica + University of Novi Sad, Faculty of Medicine
bUniverzitet u Novom Sadu, Medicinski fakultet, Institut za kardiovaskularne bolesti

e-adresa: igor.ivanov@mf.uns.ac.rs

Sažetak

Uvod. Brza dijagnostika akutnog infarkta miokarda je neophodna zbog pravilnog lečenja i smanjenja mortaliteta bolesnika. Važna uloga u dijagnostici pripada elektrokardiogramu. Akutni infarkt miokarda sa ST elevacijom zahteva urgentnu reprfuziju, prvenstveno primarnu perkutanu angioplastiku. Postoji mala grupa bolesnika koja ima akutni infarkt miokarda sa denivelacijom ST segmenta u više odvoda i elevacijom ST segmenta u aVR; elektrokardiografski se prikazuje kao infarkt miokarda bez ST elevacije, ali klinički tok i težina bolesti odgovaraju anteriornom infarktu miokarda sa ST elevacijom. Elektrokardiogram de Vinterovog T-talasa. Jedan od tih oblika je poznat kao De Vinterov T-talas. Karakteriše ga depresija ST segmenta i J tačke (> 1 mm) u prekordijalnim odvodima, odsustvo elevacije ST segmenta u prekordijalnim odvodima, visok, šiljat i simetričan Ttalas u prekordijalnim odvodima i, u većini slučajeva, blaga elevacija ST segmenta (0,5 mm do 1 mm) u aVR. Ovi bolesnici imaju okluziju glavnog stabla leve koronarne arterije, okluzije proksimalnog segmenta prednje silazne arterije ili tešku višesudovnu koronarnu bolest. Bolesnici sa pomenutim elektrokardiogramom, koji predstavlja ekvivalent akutnog infarkta miokarda sa elevacijom ST segmenta, zahtevaju razmatranje urgentne reperfuzione terapije jer imaju veći mortalitet u poređenju sa drugim bolesnicima sa akutnim infarktom miokarda bez ST elevacije. Preporučuje se primarna perkutana intervencija, ali u slučaju da u blizini ne postoji referentni centar, može se razmotriti i fibrinolitička terapija. Za sada, s obzirom da ne postoje jasne smernice, odlučivanje o načinu lečenja je individualno, od slučaja do slučaja. Zaključak. Neophodne su velike prospektivne studije da bi se ovaj ekvivalent akutnog infarkta mikarda sa ST elevacijom ekvivalent brzo prepoznao i adekvatno lečio kao prednji ST elevirani infarkt miokarda.

Ključne reči

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