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Akut koronart syndrom

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Sakkunnig:
Definition:
Akut koronart syndrom (AKS) omfattar ett spektrum av akuta kranskärlssjukdomar som instabil angina pectoris, hjärtinfarkt med ST-höjning (STEMI, Q-vågsinfarkt) och hjärtinfarkt utan ST-höjning (NSTEMI).
Förekomst:
Vanlig orsak till inläggning på sjukhus.
Symtom:
Akuta bröstsmärtor som kan stråla ut mot arm och käke, illamående, blek och fuktig hud.
Fynd:
Ofta smärtpåverkad, blek hud, snabb puls.
Diagnostik:
Bygger på EKG, troponin och eventuellt andra undersökningar på sjukhus. 
Behandling:
Akutbehandling består av acetylsalicylsyra, morfin, nitroglycerin och eventuellt syrgas. På sjukhus kan PCI/angiografi göras och andra läkemedel sättas in vid bekräftad myokardskada.
  1. Amsterdam EA, Wenger NK, Brindis RG, et al. AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 130: e344-426. PMID: 25249585 PubMed  
  2. Roffi M, Patrono C, Collet J, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2016; 37: 267-315. doi:10.1093/eurheartj/ehv320 DOI  
  3. Kolte D, Libby P, Jang I-K. New Insights Into Plaque Erosion as a Mechanism of Acute Coronary Syndromes. JAMA 2021. pmid:33616637 PubMed  
  4. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Circulation 2018; 138(20): e618-651. pmid:30571511 PubMed  
  5. Svenska kardiologföreningen. Akut kranskärlssjukdom - rekommendationer för bedömning, behandling och sekundärprevention . 2015. cardio.se  
  6. Grønvold T, Evang JA, Stensæth KH. En 51 år gammel kvinne med akutte brystsmerter. Tidsskr Nor Legeforen 2008; 128: 2836-8. Tidsskrift for Den norske legeforening  
  7. Goodacre S, Locker T, Morris F, Campbell S. How useful are clinical features in the diagnosis of acute, undifferentiated chest pain? Acad Emerg Med 2002; 9: 203-8. PubMed  
  8. Feldman JA, Fish SS, Beshansky JR, Griffith JL, Woolard RH, Selker HP. Acute cardiac ischemia in patients with cocaine-associated complaints: results of a multicenter trial. Ann Emerg Med 2000; 36: 469-76. PubMed  
  9. Lee TH, Cook EF, Weisberg M, Sargent RK, Wilson C, Goldman L. Acute chest pain in the emergency room. Identification and examination of low-risk patients. Arch Intern Med 1985; 145: 65-9. PubMed  
  10. Rouan GW, Lee TH, Cook EF, Brand DA, Weisberg MC, Goldman L. Clinical characteristics and outcome of acute myocardial infarction in patients with initially normal or nonspecific electrocardiograms (a report from the Multicenter Chest Pain Study). Am J Cardiol 1989; 64: 1087-92. PubMed  
  11. Goldberger AL. Clinical electrocardiography: a simplified approach. 6th ed. St. Louis: Mosby, 1999: 81-100.
  12. Jain S, Ting HT, Bell M, et al. Utility of left bundle branch block as a diagnostic criterion for acute myocardial infarction. Am J Cardiol. 2011;107(8):1111–1116. PMID:21296327. PubMed  
  13. Barstow C, Rice M, McDivitt JD. Acute coronary syndrome: Diagnostic evaluation. Am Fam Physician 2017; 95(3): 170-177. pmid:28145667 PubMed  
  14. Williams MC, Hunter A, Shah AS, et al. Use of Coronary Computed Tomographic Angiography to Guide Management of Patients With Coronary Disease. J AM Coll Cardiol 2016; 67: 1759-68. pmid:27081014 PubMed  
  15. Yan AT, Tan M, Fitchett D et al. for the Canadian Acute Coronary Syndromes Registry Investigators. One-year outcome of patients after acute coronary syndromes (from the Canadian Acute Coronary Syndromes Registry). Am J Cardiol 2004; 94: 25-9. PubMed  
  16. Karha J, Murphy SA, Kirtane AJ et al, for the TIMI study group. Evaluation of the association of proximal coronary culprit artery location with clinical outcomes in acute myocardial infarction. Am J Cardiol 2003; 92: 913-8. PubMed  
  17. Elsman P, van`t Hof AWJ, Hoorntje JCA et al. Effect of coronary occlusion site on angiographic and clinical outcome in acute myocardial infarction patients treated with early coronary intervention. Am J Cardiol 2006; 97: 1137-41. PubMed  
  18. Pope JH, Selker HP. Diagnosis of acute cardiac ischemia. Emerg Med Clin North Am 2003; 21: 27-59. PubMed  
  19. Hoffman U, Truong QA, Schoenfeld DA, et al. Coronary CT angiography versus standard evaluation in acute chest pain. N Engl J Med 2012; 367: 299-308. New England Journal of Medicine  
  20. Moss AJ, Newby DE. CT coronary angiographic evaluation of suspected anginal chest pain. Heart 2015. doi:10.1136/heartjnl-2015-307860 DOI  
  21. Mehta SR, Tanguay J-F, Eikelboom JW, et al. Double-dose versus standard-dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7): a randomised factorial trial. Lancet 2010; : DOI:10.1016/S0140-6736(10)61088-4. DOI  
  22. Schuster EH, Griffith LSC, Bulkley BH. Predonderance of acute proximal left anterior descending coronary arterial lesion in fatal myocardial infarction: a clinicopathologic study. Am J Cardiol 1981; 47: 1189-96. PubMed  
  23. Hamm CW, Goldmann BU, Heeschen C, Kreymann G, Berger J, Meinertz T. Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I. N Engl J Med 1997; 337: 1648-53. New England Journal of Medicine  
  • Remy Waardenburg, specialist i allmänmedicin, medicinsk redaktör Medibas

Tidigare sakkunniga

  • Eva Swahn, professor och överläkare, Kardiologiska kliniken, Universitetssjukhuset Linköping