On the example of the clinical case of newly diagnosed ST-elevation myocardial infarction combination of different reperfution strategies and their benefit was discussed. Recommendations on lifestyle modification and medicament treatment tactics are described. From one hand, in spite of side-effects of treatment as an increased risk of stroke and hemorrhagic stroke, prehospital FL is associated with a decreased risk of cardiogenic shock and its effectiveness depends on the time from symptom onset to reperfusion. From other hand, despite the fact that PPCI is the recommended default reperfusion strategy, its effectiveness depends also on time limits and absence of the majority of PPCI-facilated hospitals worldwide. Combination of prehospital single-bolus FL following after 3–24h early routine angiography and PCIcan improve post-STEMI survival and help to avoid hyperreactivity and thrombin-induced platelet activation after FL, which can be a key to success in effective treatment and rehabilitationafter STEMI in patients without high risk factors of potential bleeding or stroke.
Immunological mechanisms of appearance and therapeutic treatment strategies were discussed on example of the rare granulomatosis with polyangiitis clinical case in young patient. This vasculitis, formerly known as Wegener’s granulomatosis, is a rare multisystem autoimmune disease with necrotizing granulomatous inflammation and pauci-immune vasculitis in small- and medium-sized blood vessels. Autoimmune diseases affect 5 to 7% of people, are commoner in women of childbearing age, and are frequently encountered in pregnancy. They may remit or improve during pregnancy, butcan flare or present in pregnancy with disastrous consequences. Otorhinolaryngologist is the first physician to contact for the majority of patients with GPA. This diagnosis must always be taken into consideration in patients with recurrent upper respiratory tract infections, otitis, mucosal ulcers and laryngitis. Proper and early diagnosis is crucial for imminent therapy implementation and allows avoiding irreversible organ damage.
On the example of the clinical case of newly diagnosed mural thrombus in patient with post ST-elevation myocardial infarction chronic aneurysm formation, probable risk of further tromboembolism and anticoagulation benefit was discussed. Recommendations on lifestyle modification and medicament treatment tactics are described for prevention of new mural thrombi formation. Left ventricular thrombus is an important complication of acute myocardial infarction that impacts embolic event risk and anticoagulant therapy. Improved understanding of post-MI thrombus in the current era is critical for optimization of diagnostic testing strategies. Advances in MI management, including prompt and effective coronary reperfusion, have yielded improvements in LV function and remodeling. Widespread use of antiplatelet agents may potentiate the benefits of reperfusion, thereby lessening the likelihood of LV thrombus.
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