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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">medsovet</journal-id><journal-title-group><journal-title xml:lang="ru">Медицинский Совет</journal-title><trans-title-group xml:lang="en"><trans-title>Meditsinskiy sovet = Medical Council</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2079-701X</issn><issn pub-type="epub">2658-5790</issn><publisher><publisher-name>REMEDIUM GROUP Ltd.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.21518/ms2023-417</article-id><article-id custom-type="elpub" pub-id-type="custom">medsovet-7951</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>КАРДИОЛОГИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>CARDIOLOGY</subject></subj-group></article-categories><title-group><article-title>Особенности течения и возможности терапии обструктивной гипертрофической кардиомиопатии у женщины</article-title><trans-title-group xml:lang="en"><trans-title>Clinical features and treatment options for obstructive hypertrophic cardiomyopathy in women</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7298-8965</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Мосина</surname><given-names>В. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Mosina</surname><given-names>V. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Мосина Валентина Анатольевна - к.м.н., доцент кафедры госпитальной терапии и иммунологии с курсом ПО, Красноярский ГМУ имени профессора В.Ф. Войно-Ясенецкого; врач-кардиолог, Краевая клиническая больница.</p><p>660022, Красноярск, ул. Партизана Железняка, д. 1; 660022, Красноярск, ул. Партизана Железняка, д. 3А</p></bio><bio xml:lang="en"><p>Valentina A. Mosina - Cand. Sci. (Med.), Associate Professor of the Department of Hospital Therapy and Immunology with Postgraduate Education Course, Krasnoyarsk SMU named after Professor V.F. Voino-Yasenetsky; Сardiologist, Krasnoyarsk Regional Clinical Hospital</p><p>1, Partizan Zheleznyak St., Krasnoyarsk, 660022; 3А, Partizan Zheleznyak St., Krasnoyarsk, 660022</p></bio><email xlink:type="simple">carolina@kraslan.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-8982-5292</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Демко</surname><given-names>И. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Demko</surname><given-names>I. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Демко Ирина Владимировна - д.м.н., профессор, заведующий кафедрой внутренних болезней и иммунологии с курсом ПО, Красноярский ГМУ имени профессора В.Ф. Вой но-Ясенецкого; заведующий легочно-аллергологическим центром, Краевая клиническая больница</p><p>660022, Красноярск, ул. Партизана Железняка, д. 1; 660022, Красноярск, ул. Партизана Железняка, д. 3А</p></bio><bio xml:lang="en"><p>Irina V. Demko - Dr. Sci. (Med.), Professor, Head of Department of Hospital Therapy and Immunology with Postgraduate Education Course, Krasnoyarsk SMU named after Professor V.F. Voino-Yasenetsky; Head of Pulmonary Allergology Сenter, Krasnoyarsk Regional Clinical Hospital.</p><p>1, Partizan Zheleznyak St., Krasnoyarsk, 660022; 3А, Partizan Zheleznyak St., Krasnoyarsk, 660022</p></bio><email xlink:type="simple">demko64@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-0586-8349</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Гордеева</surname><given-names>Н. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Gordeeva</surname><given-names>N. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Гордеева Наталья Владимировна - к.м.н., доцент кафедры внутренних болезней и иммунологии с курсом ПО, Красноярский ГМУ имени профессора В.Ф. Войно-Ясенецкого; врач-пульмонолог, Краевая клиническая больница.</p><p>660022, Красноярск, ул. Партизана Железняка, д. 1; 660022, Красноярск, ул. Партизана Железняка, д. 3А</p></bio><bio xml:lang="en"><p>Natalia V. Gordeeva - Cand. Sci. (Med.), Associate Professor of the Department of Hospital Therapy and Immunology with Postgraduate Education Course, Krasnoyarsk State Medical University named after Professor V.F. Voino-Yasenetsky; Pulmonologist, Krasnoyarsk Regional Clinical Hospital.</p><p>1, Partizan Zheleznyak St., Krasnoyarsk, 660022; 3А, Partizan Zheleznyak St., Krasnoyarsk, 660022</p></bio><email xlink:type="simple">natagorday@yandex.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2528-9037</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Пелиновская</surname><given-names>Л. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Pelinovskaya</surname><given-names>L. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Пелиновская Лилия Ивановна - к.м.н., ассистент кафедры госпитальной терапии и иммунологии с курсом последипломного образования, Красноярский ГМУ имени профессора В.Ф. Войно-Ясенецкого; врач-кардиолог, Краевая клиническая больница.</p><p>660022, Красноярск, ул. Партизана Железняка, д. 1; 660022, Красноярск, ул. Партизана Железняка, д. 3А</p></bio><bio xml:lang="en"><p>Liliya I. Pelinovskaya - Cand. Sci. (Med.), Associate Professor of the Department of Hospital Therapy and Immunology with Postgraduate Education Course, Krasnoyarsk SMU named after Professor V.F. Voino-Yasenetsky; Сardiologist, Krasnoyarsk Regional Clinical Hospital.</p><p>1, Partizan Zheleznyak St., Krasnoyarsk, 660022; 3А, Partizan Zheleznyak St., Krasnoyarsk, 660022</p></bio><email xlink:type="simple">peliiv@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1045-0932</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Вериго</surname><given-names>Я. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Verigo</surname><given-names>Ya. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Вериго Яна Игоревна - к.м.н., врач-кардиолог.</p><p>660022, Красноярск, ул. Партизана Железняка, д. 3А</p></bio><bio xml:lang="en"><p>Yana I. Verigo - Cand. Sci. (Med.), Сardiologist.</p><p>3А, Partizan Zheleznyak St., Krasnoyarsk, 660022</p></bio><email xlink:type="simple">yana.verigo@yandex.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-8423-7157</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Маштакова</surname><given-names>О. Б.</given-names></name><name name-style="western" xml:lang="en"><surname>Mashtakova</surname><given-names>O. B.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Маштакова Оксана Борисовна - к.м.н., заведующий отделением функциональной диагностики.</p><p>660022, Красноярск, ул. Партизана Железняка, д. 3А</p></bio><bio xml:lang="en"><p>Oksana B. Mashtakova - Cand. Sci. (Med.), Нead of the Department of Functional Diagnostics.</p><p>3А, Partizan Zheleznyak St., Krasnoyarsk, 660022</p></bio><email xlink:type="simple">mashtakova911@gmail.com</email><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Красноярский государственный медицинский университет имени профессора В.Ф. Войно-Ясенецкого; Краевая клиническая больница</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Krasnoyarsk State Medical University named after Professor V.F. Voino-Yasenetsky; Krasnoyarsk Regional Clinical Hospital</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Краевая клиническая больница</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Krasnoyarsk Regional Clinical Hospital</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2023</year></pub-date><pub-date pub-type="epub"><day>18</day><month>01</month><year>2024</year></pub-date><volume>0</volume><issue>23</issue><fpage>32</fpage><lpage>39</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Мосина В.А., Демко И.В., Гордеева Н.В., Пелиновская Л.И., Вериго Я.И., Маштакова О.Б., 2024</copyright-statement><copyright-year>2024</copyright-year><copyright-holder xml:lang="ru">Мосина В.А., Демко И.В., Гордеева Н.В., Пелиновская Л.И., Вериго Я.И., Маштакова О.Б.</copyright-holder><copyright-holder xml:lang="en">Mosina V.A., Demko I.V., Gordeeva N.V., Pelinovskaya L.I., Verigo Y.I., Mashtakova O.B.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.med-sovet.pro/jour/article/view/7951">https://www.med-sovet.pro/jour/article/view/7951</self-uri><abstract><p>Гипертрофическая кардиомиопатия (ГКМП) – генетически детерминированное заболевание, связанное с наличием мутаций в генах, кодирующих синтез сократительных белков миокарда. Наличие обструкции в выходном тракте левого желудочка (ВТЛЖ) является мощным предиктором неблагоприятных исходов и служит показанием к хирургическому лечению. Одна из частых «масок», с которыми поступают пациенты с ГКМП, – острый коронарный синдром или порок сердца. В статье представлен клинический случай: больная 43 лет длительно сохраняла хорошую толерантность к физическим нагрузкам. Имеет 2 детей. Беременности протекали без патологии со стороны сердечно-сосудистой системы. После вторых родов регистрировалась мягкая артериальная гипертония. В августе 2017 г. больная была госпитализирована с диагнозом «острый коронарный синдром» (ОКС), выполнена диагностическая коронароангиография: коронарные артерии не изменены. При аускультации выслушивался систолический шум над прекардиальной областью. Ранее шумы не выявляли. На ЭхоКГ – диагностирован обструктивный вариант ГКМП с градиентом в ВТЛЖ 150 мм рт. ст. Учитывая высокий градиент обструкции ВТЛЖ, больной выполнена селективная спиртовая абляция. После нее оставался высокий градиент в ВТЛЖ – 96 мм рт. ст. Сохранялись кардиалгии, одышка. Нарушений ритма сердца не зафиксировано. В августе 2019 г. проведена расширенная миоэктомия с хорошим эффектом. На контрольных осмотрах через год после миоэктомии: градиент давления на АоК – 13 мм рт. ст., ВТЛЖ –11 мм рт. ст. Данный пример иллюстрирует необходимость включения ГКМП в круг дифференциального диагноза при обследовании молодого больного с болями в грудной клетке, особенно в сочетании с шумами в сердце. ЭхоКГ с допплеровским исследованием – простой и доступный метод диагностики. Проведенная спиртовая септальная абляция была малоэффективный, а расширенная миоэктомия оказала хороший гемодинамический и клинический эффект и может быть методом выбора терапии у данных пациентов. Особенность данного случая – манифестация заболевания в 43 года, течение 2 беременностей без клинических проявлений патологии сердечно-сосудистой системы.</p></abstract><trans-abstract xml:lang="en"><p>Hypertrophic cardiomyopathy (HCM) is a genetically determined disease associated with the presence of mutations in the genes encoding the synthesis of myocardial contractile proteins. The presence of obstruction in the LVL is a powerful predictor of adverse outcomes and serves as an indication for surgical treatment. One of the frequent “masks” that patients with HCMP come with is “acute coronary syndrome” or “heart defect”. Patient O., 43 years old, maintained a good tolerance to physical exertion for a long time. Has 2 children. Pregnancies proceeded without pathology from the cardiovascular system. Mild arterial hypertension was registered after the second birth. In August 2017, the patient was hospitalized with a diagnosis of ACS, diagnostic coronary angiography was performed: the coronary arteries are not changed. During auscultation, systolic noise was heard over the precardial region. Previously, noises were detected. On an echocardiogram, an obstructive variant of HCMP with a gradient of 150 mmHg was diagnosed. Given the high gradient of LVL obstruction, the patient underwent selective alcohol ablation. After alcohol ablation, there was a high gradient in VTLJ – 96 mmHg. Cardialgia and shortness of breath persisted. No cardiac arrhythmias were recorded. In August 2019, the patient underwent an extended myoectomy with good effect. At control examinations a year after myoectomy: the pressure gradient on the AoC is 13 mmHg, VTLJ is 11 mmHg. This example illustrates the need to include HCMP in the circle of differential diagnosis when examining a young patient with chest pain, especially in combination with heart murmurs. Echocardiography with Doppler examination is a simple and affordable diagnostic method. The alcohol septal ablation performed was ineffective, and the extended myoectomy had a good hemodynamic and clinical effect and may be the method of choice of therapy in these patients. The peculiarity of this case is the manifestation of the disease at the age of 43, during two pregnancies without clinical manifestations of pathology of the cardiovascular system.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>миоэктомия</kwd><kwd>спиртовая абляция</kwd><kwd>обструкция выходного тракта левого желудочка</kwd><kwd>ЭхоКГ</kwd><kwd>допплеровское исследование</kwd></kwd-group><kwd-group xml:lang="en"><kwd>myoectomy</kwd><kwd>alcohol ablation</kwd><kwd>left ventricular outlet tract obstruction</kwd><kwd>echocardiography</kwd><kwd>doppler examination</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Алиева АМ, Алмазова ИИ, Резник ЕВ, Пинчук ТВ, Байкова ИЕ, Кисляков ВА и др. Гипертрофическая кардиомиопатия: современный взгляд на проблему. 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