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Instabil angina pectoris

Senast uppdaterad: Senast reviderad:
Sakkunnig:
Definition:
Symtom som misstänks bero på kardiell ischemi, utlöses av minimal/ingen aktivitet men utan tecken på kardiell skada.
Förekomst:
Av alla fall med akuta bröstsmärtor är cirka 10 % instabil angina pectoris.
Symtom:
Anginösa bröstsmärtor i vila eller efter minimal ansträngning. 
Kliniska fynd:
Oftast inga.
Diagnostik:
Bör utredas som möjlig hjärtinfarkt, där EKG och troponinnivåer ingår. Ibland behövs angiografi.
Behandling:
Akut behandling mot ischemi, trombocythämning. Eventuellt revaskularisering. Sekundärprevention med läkemedel. Förändringar i levnadsvanor är oftast aktuellt.
  1. Barstow C, Rice M, McDivitt JD. Acute Coronary Syndrome: Diagnostic Evaluation. Am Fam Physician 2017; 95(3): 170-177. pmid:28145667 PubMed  
  2. Akut kranskärlssjukdom – Rekommendationer för bedömning, behandling och sekundärprevention (2015). Svenska Kardiologföreningen. cardio.se  
  3. 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  
  4. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 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; 28(4): 294-300. pmid:28306587 PubMed  
  5. Socialstyrelsen. Statistikdatabas för diagnoser i sluten vård. www.socialstyrelsen.se  
  6. Bob-Manuel T, Ifedeli I, Reed G, et al. Non-ST Elevation Acute Coronary Syndromes: A Comprehensive Review. Curr Probl Cardiol 2017; 42(9): 266-305. pmid:28764841 PubMed  
  7. Grech ED, Ramsdale DR. Acute coronary syndrome: unstable angina and non-ST segment elevation myocardial infarction. BMJ 2003; 326: 1259-61. PubMed  
  8. Knuuti J, Wijns W, Saraste A, et al. 2019 Guidelines on Chronic Coronary Syndromes. European Society of Cardiology. European Heart Journal, ehz425. DOI:10.1093/eurheartj/ehz425. DOI  
  9. Gräni C, Senn O, Bischof M, et al. Diagnostic performance of reproducible chest wall tenderness to rule out acute coronary syndrome in acute chest pain: a prospective diagnostic study. BMJ Open 2015; 5(1): e007442. pmid:25631316 PubMed  
  10. Lagerqvist B, Husted S, Kontny F, et al. 5-year outcomes in the FRISC-II randomised trial of an invasive versus a non-invasive strategy in non-ST-elevation acute coronary syndrome: a follow-up study. Lancet 2006; 368: 998-1004. PubMed  
  11. Alame AJ, Karatasakis A, Karacsonyi J, et al . Comparison of the American College of Cardiology/American Heart Association and the European Society of Cardiology guidelines for the management of patients with non-ST-segment elevation acute coronary syndromes. Coron Artery Dis 2017; 28(4): 294-300. pmid:28306587 PubMed  
  12. Mehta SR, Cannon CP, Fox KA, et al. Routine vs selective invasive strategies in patients with acute coronary syndrome. A collaborative meta-analysis of randomized trials. JAMA 2005; 293: 2908-17. Journal of the American Medical Association  
  13. O'Donoghue M, Boden WE, Braunwald E, et al. Early invasive vs conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction. A meta-analysis. JAMA 2008; 300: 71-80. Journal of the American Medical Association  
  14. Al-Anee K, Al-Ani A, Henriksen M, Halvorsen BA, Sirnes PA. Dødelighet etter akutt koronarsyndrom. Tidsskr Nor Lægeforen 2007; 127: 1628-30. PubMed  
  15. Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. J Am Coll Cardiol 2002;40: 1366-74. PubMed  
  16. Jahnke C, Paetsch I, Nehrke K, et al. Rapid and complete coronary arterial tree visualization with magnetic resonance imaging: feasibility and diagnostic performance. Eur Heart J 2005; 26: 2313-9. European Heart Journal  
  17. Bertrand ME, Simoons ML, Fox KA, Wallentin LC, Hamm CW, McFadden E, et al. Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation. Recommendations of the Task Force of the European Society of Cardiology. Eur Heart J 2000;21: 1406-32. European Heart Journal  
  18. European Medicines Agency recommends changes to the use of metoclopramide www.ema.europa.eu  
  19. Miettinen TA, Pyorala K, Olsson AG, et al. Cholesterol-lowering therapy in women and elderly patients with myocardial infarction or angina pectoris: findings from the Scandinavian Simvastatin Survival Study (4S). Circulation 1997; 96: 4211-18. Circulation  
  20. Läkemedelsverket 150413/Alla nyheter/Uppdaterade råd för användning av höga doser ibuprofen. Efter en granskning av den europeiska läkemedelsmyndighetens säkerhetskommittée, PRAC lakemedelsverket.se  
  21. Heart 2007;93:1357-1362
  22. The joint European Society of Cardiology/American College of Cardiology Committee. Myocardial infarction redefined - a consensus document of the joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Eur Heart J 2000; 21: 1502-13. European Heart Journal  
  23. Ludwig DS, Pereira MA, Kroenke CH, Hilner JE, Horn LV, Slattery ML, Jacobs DR. Dietary Fiber, Weight Gain, and Cardiovascular Disease Risk Factors in Young Adults. A Prospective cohort-study. JAMA 1999; 282:1539-1546. Journal of the American Medical Association  
  • Remy Waardenburg, specialist i allmänmedicin, medicinsk redaktör Medibas

Tidigare sakkunniga

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