Pasiyentdə ST-segment depressiyasının ST-segment  elevasiyası ilə birlikdə  Holter monitorinq zamanı diaqnostikası.

İ. E.  Xəlilov; Ülvi Mirzəyev

doi:10.28942/acj.v1i6y2014.71

Abstrakt

Stabil koronar arteriya xəstəliyinin diaqnostikası anamnez, koronar yemməzliyi epizodu zamanı elektrokardioqrammada (Holter monitorinq vasitəsi ilə) dəyişikliyin təsdiqi, Talllium – 201 və digər izotopların vasitəsi ilə işemik zonaların görüntülənməsi, işemik epizod zamanı zəifləmiş sol mədəcik funksiyasının ölçülməsi və sonda koronar arteriografiya ilə təyin edilir. Optimal nəticə, bu metodların hər bir xəstə üçün fərdi olaraq düzgün seçilməsi zamanı baş verir. Bu klinik müşahidədə, ST seqmentində olan dəyişikliyin qeyd olunmasında Holter monitorinqin əhəmiyyəti müzakirə olunacaq.

Əsas mətn

In our cases a 62-year-old male patient reported episodes of palpitation and chest discomfort during last 10 days, (about 2 episode/day in ordinary daily life). His life style is active, driver. Weight – 70 kg, he was not ill during 62 y., had not hypertension, Diabetes and hereditary predisposition. He used alcohol non regular and was not heavy smoker.
During examination in Oxygen Clinic Hospital there were no echocardiographic, electrocardiographic changes or elevated troponin. The patient 5 time complaint of chest discomfort during 24 hours (Holter monitoring period) and 2 times severe ST-segment changes was detected during an chest discomfort episode. The patient was admitted in Medex hospital, where was performed CAG. Coronary angiogram showed 2 severe stenosis - 90 and 70% respectively at proximal part of LAD. The patient successfully was stented.

Discussion
In the 1970s, several groups of investigators began to use ambulatory monitoring of the ECG, and with this new technique, they described that ST depression, a cardinal sign of myocardial ischemia on the ECG, can occur in patients with IHD without accompanying pain.1-3Holter monitoring of ST - segment changes is a unique method of studying the character of transient myocardial ischemia that occurs during ordinary daily life. Detailed studies in patients with chronic stable angina have shown that transient ischemia is frequently silent and prolonged, and may occur without evidence of physical exertion. Silent myocardial ischemia is defined as objective documentation of myocardial ischemia in the absence of angina or anginal equivalents.4-5In our cases, patient with severe coronary artery diseases had not anysignificant complaints or (ECG) manifestation. İn this cases, for the first time we found not only the ST segment depression and also observed ST-segment elevation in this patient.

Conclusion:
Patient complaints, resting ECG, Color Doppler Echocardiography and also Blood exam was not informative for correct diagnosis in this cases. In other hand Stress - exercise treadmill test dangerous and contraindicated for such patients. We concluded, that HM as an indirect method suggesting of Coronary artery blood blok, may be considered as an 1st non invasive diagnostic procedure for all patients with Unstable Angina pectoris and pain free form of IHD. And all the such patients must be admitted on the CCU for emergency CAG.

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İstinadlar

1. Stern S, Tzivoni D. Early detection of silent ischemic heart disease by 24-hour electrocardiographic monitoring of active subjects. Br Heart J. 1974;36: 481–486.
2. Schang SJ, Pepine CJ. Transient asymptomatic ST segment depression during daily activity. Am J Cardiol. 1977;39: 396–402.
3. Gettes LS, Winternitz SR. Monitoring to detect “silent” ischemia.In: Stern S, ed. Ambulatory ECG
Monitoring. Chicago, Ill: Year Book Medical Publishers, Inc; 1978:93–106.
4. Kristin E. F., MD, MPH, FACC, Jessica Z., RN, MS, and Barbara J D., RN, PhD. The New Universal Definition of Myocardial Infarction Criteria Improves Electrocardiographic Diagnosis of Acute Coronary Syndrome. J. Electrocardiol. 20011 Jan – Feb.: 44(1): 69-73
5. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-
elevation myocardial infarction. J Am Coll Cardiol. 2007; 50:1–157.