FACTORES DE RIESGO EN SÍNDROME CORONARIO AGUDO SIN ELEVACIÓN DEL SEGMENTO ST

Elver Leguia Valentin, Carlos Pino Morales, Sergio Moreno Martinez, Felix Revilla Manchego

Resumen


Resumen.  Mujer de  56 años, con historia de Diabetes Mellitus 2, diagnosticada hace 3 años  -en tratamiento irregular con Glimepirida y  Metformina oral- y tabaquismo (1 cajetilla/día, hasta hospitalización). Historia de 2 días caracterizada  por palpitaciones asociadas a disnea de esfuerzo,  diaforesis y frialdad de extremidades, presentando  24 horas después   2 episodios de angina,  que ceden con nitritos. En  el Hospital Dos de Mayo (HNDM), le diagnostican  Sindrome Coronario Agudo, sin elevación del segmento ST (SCA-SEST).   Frecuencia cardiaca: 120 lat/min, frecuencia respiratoria: 18 resp/min, presión arterial: 90/60 mm Hg,      ventilando espontáneamente, en decúbito supino, no visualizándose  choque de la punta, ni  palpándose  impulso ventricular  derecho ni izquierdo.  Hemoglobina: 14,2g/dl, glucosa: 180 mg/dl, Creatinina: 1.24 mg/dl, Depuración de Creatinina: 62.5 mg/dl,  CPK- MB: 19.5  UI/L(N: 0-16), Troponina T: 19.54ug/L(N: <0.06).Colesterol total: 245.4 mg/dl, HbA1c: 9.79%. Orina: Proteínas: ++,Albúminuria: 369.1 mg/dl, Ecocardiograma:Ventrículo izquierdo: hipertrofia concéntrica moderada. Hipoquinesia inferior e inferoseptal medial.Derrame pericárdico posterior leve.  GRACE y TIMI  SCORE109  y  3 puntos, respectivamente.   Coronariografia-angiográfia: enfermedad coronaria severa con afectación de arteria descendente anterior proximal  y arteria circunfleja distal.  Diagnóstico:Síndrome coronario agudo, sin elevación de segmento ST.  Infarto agudo de Miocardio, de riesgo moderado. Enfermedad coronaria obstructiva crónica multivaso, DM2, tabaquismo. Se decide  cirugía de revascularización coronaria.

Palabras clave:Síndrome coronario agudo,  sin elevación del segmento ST, infarto de miocardio, enfermedad coronaria multivaso. 


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Referencias


REFERENCIAS BIBLIOGRAFICAS

Ezra A.Amsterdam,Nanette K.Wenger,Ralph G. Brindis, Donald E. Casey Jr, , Theodore G. Ganiats, David R. Holmes Jr et al. 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes A Report of the American College of Cardiology/American H Association in Collaboration With the Society for Cardiovascular Angiography and Interventions and Society of Thoracic Surgeons Endorsed by the American Association for Clinical Chemistry.2014. Disponible en: Circulation.130:e344-e426. ttp://circ.ahajournals.org/content/130/25/e344.full.pdf+html Citado el 2016,01.01.

Henry Chang, James K. Min, Sunil V. Rao, Manesh R. Patel, Orlando P. Simonetti, Giuseppe Ambrosio, Subha V. Raman. Non–ST-Segment Elevation Acute Coronary Syndromes Targeted Imaging to Refine Upstream Risk Stratification. Circulation Cardiovasc Imaging. 2012;5:536-546.

Chan MY, Sun JL, Newby LK, Shaw LK, Lin M, Peterson ED, Califf RM, Kong DF, Roe MT. Long-term mortality of patients undergoing cardiac catheterization for ST-elevation and non-ST-elevation myocardial infarction. Circulation. 2009;119:3110–3117.

Roe MT, Peterson ED, Newby LK, Chen AY, Pollack CV Jr, Brindis RG, Harrington RA, Christenson RH, Smith SC Jr, Califf RM, Braunwald E, Gibler WB, Ohman EM. The influence of risk status on guideline adherence for patients with non-ST-segment elevation acute coronary syndromes. Am Heart J. 2006; 151:1205–1213

Libby P, Ridker PM, Hansson GK; Leducq Transatlantic Network on Atherothrombosis. Inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol. 2009; 54:2129–2138.

Dekker MS, Mosterd A, van ‘t Hof AW, Hoes AW. Novel biochemical markers in suspected acute coronary syndrome: systematic review and critical appraisal. Heart.2010; 96:1001–1010.

Antman EM, Cohen M, Bernink PJ, McCabe CH, Horacek T, Papuchis G, Mautner B, Corbalan R, Radley D, Braunwald E. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making. JAMA.2000; 284:835–842.

Gale CP, Manda SO, Weston CF, Birkhead JS, Batin PD, Hall AS. Evaluation of risk scores for risk stratification of acute coronary syndromes in the Myocardial Infarction National Audit Project (MINAP) database. Heart. 2009;95:221–227. 19.

Eagle KA, Lim MJ, Dabbous OH, Pieper KS, Goldberg RJ, Van de Werf F, et al.A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry.JAMA. 2004 9; 291 (22): 2727-33.

Eek C, Grenne B, Brunvand H, Aakhus S, Endresen K, Smiseth OA et al. Strain echocardiography predicts acute coronary occlusion in patients with non-ST-segment elevation acute coronary syndrome. Eur J Echocardiogr. 2010; 11:501–508.

Yanai Ben-Gal, Jeffrey W. Moses, Roxana Mehran, Alexandra J. Lansky, GioraWeisz, Eugenia Nikolskyet al.Surgical Versus Percutaneous Revascularization forMultivessel Disease in Patients With Acute Coronary Syndromes Analysis From the ACUITY (Acute Catheterization and Urgent Intervention Triage Strateg).JAAC: Cardiovascular interventions. 2010, 3 (10):1059–67.

De Bruyne B. Multivessel disease: From reasonably incomplete to functionally complete revascularization. Circulation.2012; 125: 2557-2559.

Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, et al. Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).Eur Heart J. 2011: 32 (23):2999-3054.

Young H, Young K, Challender P. Cardiac Imaging and Catheterization. En: Patophysiology of Heart Disease. 5° edición.Lippincot Williams & Wilkins, Wolter Kluwer. 2011.

-Reeder G, Holmes D, DetreJr, Costigan T, Kelsey S. Degree of revascularization in patients with multivessel coronary disease. Circulation.1988; 77: 638-644.

Inaba Y, Chen J, Bergmann S. Quantity of viable myocardium required to improve survival with revascularization in patients with ischemic cardiomyopathy: A meta-analysis. Journal of Nuclear Cardiology. 2010; 17 (4): 646-54

ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM.2009 Appropriate Use Criteria for Cardiac Radionuclide Imaging. Circulation 2009; 119: e561-e587 . Disponible en:http://circ.ahajournals.org/content/119/22/e561.full.pdf.Citado el 2016.01,01.

Berman DS, Hachamovitch R, Shaw LJ, Friedman JD, Hayes SW, Thomson LE, Fieno DS, Germano G, Wong ND, Kang X, Rozanski A. Roles of nuclear cardiology, cardiac computed tomography, and cardiac magnetic resonance: noninvasive risk stratification and a conceptual framework for the selection of noninvasive imaging tests in patients with known or suspected coronary artery disease. J NuclMed. 2006; 47:1107–1118.

-Albert Francesc and Castell Joan. Valoración de la viabilidad miocárdica mediante gated-SPECT de perfusión miocárdica. Rev Esp Cardiol Supl 2008; 8: 35B-48B. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3426608. Citado el 2016,01,01/


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