Повторна стенокардія після реваскуляризації міокарда: механізми, діагностика, медикаментозна терапія. Частина 1
DOI:
https://doi.org/10.37987/1997-9894.2015.5(191).222564Ключові слова:
повторна стенокардія, стентування коронарних артерій, івабрадин, ранолазин, нікорандилАнотація
Повторна стенокардія у пацієнтів, які перенесли черезшкірне коронарне втручання (ЧКВ), визначається як рецидив болю або дискомфорту в грудній клітці. Ретельну оцінку рекомендують проводити для визначення несерцевих і серцевих причин. Останні можуть бути пов'язані зі структурними змінами («stretch pain», рестеноз стента, тромбоз стента, неповна реваскуляризація, прогресування коронарного атеросклерозу) або функціональними (мікроваскулярна дисфункція, коронарний спазм). Діагностичний алгоритм включає проведення електрокардіографічних (ЕКГ) навантажувальних тестів, магнітно-резонансної томографії (МРТ) та комп’ютерної томографії (КТ) серця або інвазивну оцінку коронарного кровотоку за допомогою фракційного резерву кровоплину – ФРК (FFR – fractional flow reserve), коронарного резерву кровоплину – КРК (CFR – intracoronary flow reserve) та проби для провокації коронарного спазму. Якщо повторна реваскуляризація не показана – терапевтичні підходи мають бути спрямовані на основні механізми виникнення повторної стенокардії шляхом застосування різних препаратів, таких як блокатори β-адренорецепторів, блокатори кальцієвих каналів, івабрадин, ранолазин чи нікорандил.
Посилання
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