Espinosa CDA, Reyes DI, Gutiérrez MSY, Almaraz RA, Ojeda RC, Zaga CNE

Language: Spanish
References: 19
Page: 284-292
PDF size: 1659.59 Kb.

ABSTRACT

Introduction: ST-segment elevation myocardial infarction (STEMI) is one of the leading causes of death in Mexico and worldwide. Percutaneous coronary intervention is the treatment of choice to achieve acute vascular reperfusion. However, in some patients, ischemia persists despite vessel patency, a phenomenon known as "no reflow". Objective: bibliographical review of the phenomenon of non-ebb in a case. Identification of cardiovascular risk factors, coronary pre-angioplasty associated with non-reflux phenomenon in a patient with STEMI in the first 12 hours of evolution.Clinical case: a 52-year-old Caucasian female patient with the following cardiovascular risk factors: sedentary lifestyle, BMI 54.1 kg/m², type 2 diabetes and chronic kidney disease. He enters the emergency department for having precordial pain of cardiogenic type, in the physical examination he presents bilateral infrascapular rattles. Laboratory and cabinet studies were carried out in which the exacerbation of chronic kidney disease was verified, as well as the acute coronary syndrome type of acute STEMI. An ECOTT was performed with the following findings: left ventricle expulsion fraction (LVEF) of 51%, basal lower akinesia, posterobasal and anteromedial hypokinesia. Primary angioplasty and implantation of three stents in the right coronary artery were performed, with the use of intracoronary adenosine, glycoprotein IIB/IIIA inhibitor (tirofiban), clopidogrel, acetylsalicylic acid and low molecular weight heparin. Conclusions: the phenomenon of non-ebb manifested by flow less than TIMI 3, which is a common situation in patients with acute myocardial infarction (AMI), with previous cardiovascular risk factors, which has been little described in Mexico despite its high incidence and prevalence. It is a multifactorial entity that can be prevented with the early identification of patients with AMI, having as a gold standard for the diagnosis coronary angiography, being the most accepted treatment the administration of intracoronary and systemic drugs, management of comorbidities and hemodynamic monitoring during the following hours post-revascularization.

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