medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2021-42-34-41medalphabet-2402Research ArticleНЕОТЛОЖНАЯ МЕДИЦИНАEMERGENCY MEDICINEПатофизиологические аспекты развития инфаркта миокарда 2 типа при субклиническом гипотиреозеPathophysiological aspects of development myocardial infarction type 2 in subclinical hypothyroidismhttps://orcid.org/0000-0002-9738-1801ИванниковА. А.IvannikovA. A.

Иванников Александр Александрович, клинический ординатор по специальности «кардиология»

eLibrary SPIN: 3934–5062

Ivannikov Aleksandr A., clinical resident specializing in cardiology

eLibrary SPIN: 3934–5062

Moscow

https://orcid.org/0000-0001-6118-1405КаниболоцкийА. А.KanibolotskyA. A.

Каниболоцкий Александр Алексеевич, к. м. н., зав. патологоанатомическим отделением

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Kanibolotskiy Aleksandr A., PhD Med, head of Pathological Dept.

eLibrary SPIN: 3976–1662

Moscow

https://orcid.org/0000-0002-6229-8629АлиджановаХ. Г.AlidzhanovaKh. G.

Алиджанова Хафиза Гафуровна, д. м. н., с. н. с.

eLibrary SPIN: 5179–1260

Alidzhanova Khafiza G., DM Sci (habil.), senior researcher

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Moscow

https://orcid.org/0000-0002-1050-1867БратищевИ. В.BratischevI. V.

Братищев Игорь Викторович. врач – анестезиолог-реаниматолог, преподаватель учебного центра

 

Bratishchev Igor V., anesthesiologist-resuscitator, teacher of Training Centre

Moscow

bratischev@mail.ruГБУЗ г. Москвы «Научно-исследовательский институт скорой помощи имени Н. В. Склифосовского Департамента здравоохранения Москвы»РоссияResearch Institute of Emergency Care n. a. N. V. SklifosovskyRussian Federation202127122021042Кардиология. Неотложная медицина (4)3441Copyright © Иванников А.А., Каниболоцкий А.А., Алиджанова Х.Г., Братищев И.В., 20212021Иванников А.А., Каниболоцкий А.А., Алиджанова Х.Г., Братищев И.В.Ivannikov A.A., Kanibolotsky A.A., Alidzhanova K.G., Bratischev I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/2402

Работа посвящена одной из актуальных и малоизученных проблем кардиологии и эндокринологии – лечению и прогнозу пациентов с тяжелой коронарной патологией и субклиническим гипотиреозом (СГ). Рассматриваются патофизиологические аспекты развития инфаркта миокарда 2 типа (ИМ2) при СГ и вопросы лечения гормональной заместительной терапией. СГ – модифицируемый фактор риска (ФР) сердечно-сосудистых заболеваний (ССЗ) и смертности, не зависящий от традиционных сердечно-сосудистых ФР. СГ ассоциируется с высоким риском развития ИБС, инфаркта миокарда (ИМ), сердечной недостаточности и смертности от CCЗ. Частота СГ увеличивается с возрастом, протекает мало- или бессимптомно и приводит к ряду патологических состояний, вызывающих дисбаланс между потребностью и доставкой кислорода к миокарду, с возможным развитием ИМ2. Представлен клинический случай развития ИМ2 у пациента с тяжелым коронарным атеросклерозом и СГ. В механизме развития ИМ2 при СГ ведущую роль играет недостаточное поступление кислорода (О2) к кардиомиоцитам вследствие многососудистого стенозирующего атеросклероза коронарных артерий и резкого увеличения потребности в О2 в результате гипертрофии кардиомиоцитов. Пациентам старших возрастов с тяжелой кардиальной патологией и СГ от лечения левотироксином следует воздержаться или начать лечение после проведения реваскуляризации миокарда, подбирая дозу препарата индивидуально

The main purpose of the following article is to highlight one of the most pressing and poorly studied issues both for cardiology and endocrinology – treatment and prognosis for patients with severe coronary pathology and subclinical hypothyroidism (SH). Pathophysiological mechanisms of type 2 myocardial infarction (MI) development with SH as a background and hormone replacement therapy issues are considered. SH is a modifiable risk factor (RF) for cardiovascular diseases (CVD) and mortality that does not depend on traditional cardiovascular RF. SH is associated with high risk of developing coronary artery disease, MI, heart failure, and CVD mortality. SH incidence of morbidity increases with age, usually the course is oligo- or asymptomatic. SH leads to a number of pathological conditions that cause an imbalance between the myocardial oxygen demand and delivery with a possible development of type 2 MI. Clinical case of type 2 MI development in a patient with severe coronary atherosclerosis and SH is presented. The key point of type 2 MI development mechanism is insufficient oxygen (O2) supply to cardiomyocytes due to multivessel coronary artery atherosclerotic stenosis and sharp increase in O2 demand as a result of cardiomyocyte hypertrophy. Older patients with severe cardiac pathology and SH should refrain from treatment with levothyroxine or start treatment after myocardial revascularization, selecting the dose of the drug individually.

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The authors declare that there are no conflicts of interest present.