actabiomedicaActa Biomedica ScientificaActa Biomedica Scientifica2541-94202587-9596Scientific Centre for Family Health and Human Reproduction Problems10.29413/ABS.2018-3.2.22actabiomedica-572Research ArticleСЛУЧАЙ ИЗ ПРАКТИКИCASE REPORTSИнфаркт миокарда в постпартальном периоде у молодой женщины с дефицитом протеина СAcute myocardial infarction in the postpartum period in the young woman with protein C deficiencyЕнисееваЕ. С.EniseevaE. S.eniseeva-irk@yandex.ruПротасовК. В.ProtasovK. V.k.v.protasov@gmail.comРеутЮ. А.ReutY. A.julreut@mail.ruСендероваО. М.SenderovaO. M.o_senderova@mail.ruЩербаковаН. В.ShcherbakovaN. V.wert41@yandex.ruПетрончакН. В.PetronchakN. V.natapetronchak@gmail.comИркутская государственная медицинская академия последипломного образования - филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России; ФГБОУ ВО «Иркутский государственный медицинский университет» Минздрава РоссииIrkutsk State Medical Academy of Postgraduate Education - Branch Campus of the Russian Medical Academy of Continuing Professional Education; Irkutsk State Medical UniversityИркутская государственная медицинская академия последипломного образования - филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииIrkutsk State Medical Academy of Postgraduate Education - Branch Campus of the Russian Medical Academy of Continuing Professional Education; Irkutsk State Medical UniversityГБУЗ «Иркутская ордена «Знак почёта» областная клиническая больница»Irkutsk Regional Clinical HospitalОГАУЗ «Ангарская городская больница скорой медицинской помощи»Angarsk Emergency Hospital20182804201832121124Copyright © Енисеева Е.С., Протасов К.В., Реут Ю.А., Сендерова О.М., Щербакова Н.В., Петрончак Н.В., 20182018Енисеева Е.С., Протасов К.В., Реут Ю.А., Сендерова О.М., Щербакова Н.В., Петрончак Н.В.Eniseeva E.S., Protasov K.V., Reut Y.A., Senderova O.M., Shcherbakova N.V., Petronchak N.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.actabiomedica.ru/jour/article/view/572

Инфаркт миокарда у молодых женщин без факторов кардиоваскулярного риска развивается редко. Беременность увеличивает риск инфаркта миокарда в сравнении с небеременными женщинами того же возраста. Причиной инфаркта миокардау женщин в перипартальном периоде может быть спазм, тромбоз без атеросклеротического поражения, спонтанная диссекция коронарной артерии. Тромбоз коронарной артерии при отсутствии атеросклероза развивается вследствие гиперкоагуляционного статуса, связанного с антифосфолипидным синдромом, наследственными тромбофилиями. При наличии тромбоза необходимо обследование на тромбофилии, исключение антифосфолипидного синдрома. Представлен случай инфаркта миокарда с подъёмом сегмента ST у женщины 34 лет без традиционных факторов риска, развившийся в постпартальном периоде в результате тромбоза передней нисходящей артерии, не связанного с атеросклерозом. У пациентки нормальные результаты исследования антитромбина 111, протеина S, не выявлены мутации гена протромбина, фактора V Leiden, антитела к фосфолипидам. Обнаружено снижение активности протеина С (43 %) в сочетании с генетическими маркерами тромбогенного риска: полиморфизмом генов тромбоцитарного рецептора Па коллагена ITGA2: 807 C>T, тромбоцитарного рецептора IIIb фибриногена ITGB:1565 T>C, MTHFR 677 C>T, MTRR 66 A>G.

Women of childbearing age without cardiovascular risk factors have low risk of acute myocardial infarction. Pregnancy has been shown to increase the risk of myocardial infarction compared to the risk in non-pregnant women of similar age. Acute myocardial infarction during pregnancy or postpartum period as a rule develops due to coronary spasm or non-atherogenic thrombosis or spontaneous coronary dissection. Thrombosis is most likely related to hypercoagulable state of pregnancy and postpartum period. It is worth considering the importance of defects of coagulation, such as Leiden factor, protein C, protein S, antithrombin III and mutations of propter genes. There is also the significant role of antiphospholipid antibodies in young women. We present the clinical case of acute ST-elevation myocardial infarction in 34-years old woman without traditional cardiovascular risk factors, which was developed after childbirth due to non-atherogenic left anterior coronary artery thrombosis. Her coagulation profile showed normal results for antithrombin III, protein S, prothrombin gene mutation, factor V Leiden and antiphospholipid antibody syndrome. At the same time the protein C activity decreased to 43 % as well as trombophilia genetic markers MTHFRC677T, MTRR 66A>G, ITGA2:807 C>T and ITGB:1565 T>C genetic polymorphisms were revealed.

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