Beqaror stenokardiya

Beqaror stenokardiya
Belgilari	Ko‘krak qafasidagi og‘riq yoki dam olish paytida ko‘krak qafasidagi noqulaylik,
Asoratlari	Yurak-qon tomir kasalliklari

Beqaror stenokardiya – stenokardiyaning^[1] bir turi boʻlib muntazam boʻlmagan yoki osonlikcha qoʻzgʻatiladigan turlari qatoriga kiradi^[2]. Bu o‘tkir koronar sindromning bir turi sifatida tasniflanadi^[3]. Nostabil stenokardiyani ST-segmenti koʻtarilmagan (Q-tishchali boʻlmagan) miokard infarktidan farqlash qiyin boʻlishi mumkin^[4]. Ular asosan ishemiyaning yurak miokardi oʻpka hujayralariga yetarli darajada zarar yetkazishi va shikastlanish belgisi, odatda troponin T yoki troponin I ning aniqlanadigan miqdorini chiqarishi bilan farq qiladi^[5]^[6]. Oʻtkir koronar sindromga xos ishemik belgilari bor, ammo troponin darajasida oʻzgarishlar kuzatilmagan bemorlarda beqaror stenokardiya mavjud deb hisoblanadi. Bu holat elektrokardiogrammada ishemiyani koʻrsatuvchi oʻzgarishlar (masalan, ST segmentining pasayishi, vaqtinchalik koʻtarilishi yoki yangi T toʻlqin inversiyasi) boʻlishi yoki boʻlmasligidan qatʼi nazar kuzatilishi mumkin^[5].

Belgilari

Beqaror stenokardiya belgilari stabil stenokardiya belgilariga oʻxshash namoyon boʻladi^[7]. Beqaror stenokardiyada yurakda qon oqimining pasayishi bilan bogʻliq alomatlar tinch holatda yoki minimal zoʻriqishda paydo boʻlishi mumkin^[5]. Belgilar barqaror stenokardiyaga qaraganda uzoqroq davom etishi, dam olish yoki dori-darmonlarga chidamli boʻlishi va vaqt oʻtishi bilan yomonlashishi mumkin^[7]^[8]. Yurakda qon oqimining keskin pasayishining asosiy belgisi siqilish, koʻkrakda kuyish shaklida kechuvchi ogʻriq hisoblanadi^[4]. Ogʻriq koʻpincha koʻkrak atrofida yoki ustida boʻladi. Ogʻriq qoʻl, yelka, boʻyin, qorin yoki jagʻga tarqalishi yoki joylashishi mumkin^[4]. Bu terlash, ko‘ngil aynishi, yoki nafas qisishi bilan bogʻliq boʻlishi mumkin^[4].

Patofiziologiyasi

Beqaror stenokardiyaning patofiziologiyasi haqida turli fikrlar mavjud. Avvallari beqaror stenokardiya ateroskleroz plakasining yemirilishi natijasida yuzaga keladigan koʻkrak qafasi ogʻrigʻi deb hisoblanardi. Bu jarayonda qisman tromboz va ehtimol, emboliya yoki vazospazm ham kuzatilib, miokard ishemiyasiga olib keladi, deb taxmin qilingan edi^[9]^[10]. Biroq, sezgir troponin tahlillari miokardning hatto yengil ishemiyasi holatlari bilan qon oqimida yurak troponinining oshishini koʻrsatadi^[11]. Nostabil stenokardiya troponin ajralib chiqmagan oʻtkir miokard ishemiyasi sharoitida yuzaga keladi deb taxmin qilinganligi sababli, nostabil stenokardiya tushunchasi shubha ostiga olinadi va baʼzilar bu atamani butunlay olib tashlashga chaqiradi^[12].

Manbalar

↑ "Unstable angina pectoris". N. Engl. J. Med. 342 (2): 101–14. January 2000. doi:10.1056/NEJM200001133420207. PMID 10631280.
↑ Andoza:DorlandsDict
↑ Wiviott, S. D.; Braunwald, E (2004). "Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction: Part I. Initial Evaluation and Management, and Hospital Care". American Family Physician 70 (3): 525–32. PMID 15317439. https://www.aafp.org/pubs/afp/issues/2004/0801/p525.html.
↑ ^4,0 ^4,1 ^4,2 ^4,3 Gulati, Martha; Levy, Phillip D.; Mukherjee, Debabrata; Amsterdam, Ezra; Bhatt, Deepak L. et al. (2021-11-30). "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines" (en). Circulation 144 (22): e368–e454. doi:10.1161/CIR.0000000000001029. ISSN 0009-7322. PMID 34709879.
↑ ^5,0 ^5,1 ^5,2 Collet, Jean-Philippe; Thiele, Holger; Barbato, Emanuele; Barthélémy, Olivier; Bauersachs, Johann et al. (2021-04-07). "2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation". European Heart Journal 42 (14): 1289–1367. doi:10.1093/eurheartj/ehaa575. ISSN 1522-9645. PMID 32860058. "Unstable angina is defined as myocardial ischaemia at rest or on minimal exertion in the absence of acute cardiomyocyte injury/necrosis. [...] Compared with NSTEMI patients, individuals with unstable angina do not experience acute cardiomyocyte injury/necrosis."
↑ Barthélémy, Olivier; Jobs, Alexander; Meliga, Emanuele et al. (2021-04-07). "Questions and answers on workup diagnosis and risk stratification: a companion document of the 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation". European Heart Journal 42 (14): 1379–1386. doi:10.1093/eurheartj/ehaa602. ISSN 1522-9645. PMID 32860030. PMC 8026278. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=8026278. "NSTEMI is characterized by ischaemic symptoms associated with acute cardiomyocyte injury (=rise and/or fall in cardiac troponin T/I), while ischaemic symptoms at rest (or minimal effort) in the absence of acute cardiomyocyte injury define unstable angina. This translates into an increased risk of death in NSTEMI patients, while unstable angina patients are at relatively low short-term risk of death."
↑ ^7,0 ^7,1 „Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) - Heart and Blood Vessel Disorders“ (en). MSD Manual Consumer Version. Qaraldi: 2023-yil 12-fevral.
↑ „Unstable Angina“ (en). www.heart.org. American Heart Association. 2023-yil 15-martda asl nusxadan arxivlangan. Qaraldi: 2023-yil 5-may.
↑ Robbins. Pathologic Basis of Disease, 7th, 2005.
↑ Braunwald, E. (1998). "Unstable Angina: An Etiologic Approach to Management". Circulation 98 (21): 2219–2222. doi:10.1161/01.CIR.98.21.2219. PMID 9826306.
↑ Sabatine, M. S.; Morrow, R. W.; de Lemos, J.A.; Jarolim, P.; Braunwald, E. (2009). "Detection of acute changes in circulating troponin in the setting of transient stress test-induced myocardial ischaemia using an ultrasensitive assay: results from TIMI 35". European Heart Journal 30 (2): 162–169. doi:10.1093/eurheartj/ehn504. PMID 18997177. PMC 2721709. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2721709.
↑ Braunwald, E.; Morrow, R. W. (2013). "Unstable Angina. Is It Time for a Requiem?". Circulation 127 (24): 2452–2457. doi:10.1161/CIRCULATIONAHA.113.001258. PMID 23775194.

[pmid10631280-1] "Unstable angina pectoris". N. Engl. J. Med. 342 (2): 101–14. January 2000. doi:10.1056/NEJM200001133420207. PMID 10631280.

[2] Andoza:DorlandsDict

[AAFP2004-3] Wiviott, S. D.; Braunwald, E (2004). "Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction: Part I. Initial Evaluation and Management, and Hospital Care". American Family Physician 70 (3): 525–32. PMID 15317439. https://www.aafp.org/pubs/afp/issues/2004/0801/p525.html.

[AHA2021-4] 4,0 ^4,1 ^4,2 ^4,3 Gulati, Martha; Levy, Phillip D.; Mukherjee, Debabrata; Amsterdam, Ezra; Bhatt, Deepak L. et al. (2021-11-30). "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines" (en). Circulation 144 (22): e368–e454. doi:10.1161/CIR.0000000000001029. ISSN 0009-7322. PMID 34709879.

[ESC2020-5] 5,0 ^5,1 ^5,2 Collet, Jean-Philippe; Thiele, Holger; Barbato, Emanuele; Barthélémy, Olivier; Bauersachs, Johann et al. (2021-04-07). "2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation". European Heart Journal 42 (14): 1289–1367. doi:10.1093/eurheartj/ehaa575. ISSN 1522-9645. PMID 32860058. "Unstable angina is defined as myocardial ischaemia at rest or on minimal exertion in the absence of acute cardiomyocyte injury/necrosis. [...] Compared with NSTEMI patients, individuals with unstable angina do not experience acute cardiomyocyte injury/necrosis."

[ESC2020_QA-6] Barthélémy, Olivier; Jobs, Alexander; Meliga, Emanuele et al. (2021-04-07). "Questions and answers on workup diagnosis and risk stratification: a companion document of the 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation". European Heart Journal 42 (14): 1379–1386. doi:10.1093/eurheartj/ehaa602. ISSN 1522-9645. PMID 32860030. PMC 8026278. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=8026278. "NSTEMI is characterized by ischaemic symptoms associated with acute cardiomyocyte injury (=rise and/or fall in cardiac troponin T/I), while ischaemic symptoms at rest (or minimal effort) in the absence of acute cardiomyocyte injury define unstable angina. This translates into an increased risk of death in NSTEMI patients, while unstable angina patients are at relatively low short-term risk of death."

[MSD_ACS-7] 7,0 ^7,1 „Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) - Heart and Blood Vessel Disorders“ (en). MSD Manual Consumer Version. Qaraldi: 2023-yil 12-fevral.

[8] „Unstable Angina“ (en). www.heart.org. American Heart Association. 2023-yil 15-martda asl nusxadan arxivlangan. Qaraldi: 2023-yil 5-may.

[9] Robbins. Pathologic Basis of Disease, 7th, 2005.

[10] Braunwald, E. (1998). "Unstable Angina: An Etiologic Approach to Management". Circulation 98 (21): 2219–2222. doi:10.1161/01.CIR.98.21.2219. PMID 9826306.

[11] Sabatine, M. S.; Morrow, R. W.; de Lemos, J.A.; Jarolim, P.; Braunwald, E. (2009). "Detection of acute changes in circulating troponin in the setting of transient stress test-induced myocardial ischaemia using an ultrasensitive assay: results from TIMI 35". European Heart Journal 30 (2): 162–169. doi:10.1093/eurheartj/ehn504. PMID 18997177. PMC 2721709. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2721709.

[12] Braunwald, E.; Morrow, R. W. (2013). "Unstable Angina. Is It Time for a Requiem?". Circulation 127 (24): 2452–2457. doi:10.1161/CIRCULATIONAHA.113.001258. PMID 23775194.

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