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Hjärtinfarkt

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Definition:
Akut skada/död av hjärtmuskelceller på grund av ischemi, vanligtvis orsakad av ocklusion av kransartären.
Förekomst:
Ökar med åldern och är högre hos män än hos kvinnor under hela livet.
Symtom:
Typiskt är akut insättande och ihållande retrosternal smärta som åtföljs av illamående, yrsel, andnöd, ångest. Kan stråla ut mot arm, hals och/eller käke. 
Kliniska fynd:
Patienten är oftast smärtpåverkad, orolig och kallsvettig. Eventuell takypné.
Diagnostik:
Hjärtenzymer (troponin), EKG, ekokardiografi och eventuell koronarangiografi.
Behandling:
Akutbehandling med nitroglycerin, syrgas, ASA, morfin, eventuell trombolys. PCI utförs omedelbart om möjligt.
  1. ESC Guidelines, European Society of Cardiology, 2012 www.escardio.org  
  2. Holm A, Andersen K, Simonsson M. Fokus på individuell behandling vid akut koronart syndrom utan ST-höjning. Lakartidningen.se 2021-01-18. lakartidningen.se  
  3. Statistik om hjärtinfarkter 2015 www.socialstyrelsen.se  
  4. Singh T, Chapman AR, Dweck MR, Mills NL, Newby DE. MINOCA: a heterogenous group of conditions associated with myocardial damage. Heart. 2021 Sep;107(18):1458-1464. doi: 10.1136/heartjnl-2020-318269. Epub 2021 Feb 10. PMID: 33568434 PubMed  
  5. Paffenbarger RS, Hyde RT, Wing AL, Hsieh C-C. Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med 1986; 314: 605-13. PubMed  
  6. Manson JE, Hu FB, Rich-Edwards JW, Colditz GA, Stampfer MJ, Willett WC et al. A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. N Engl J Med 1999; 341: 650-8. PubMed  
  7. Sandvik L, Erikssen J, Thaulow E, Erikssen G, Mundal R, Rodahl K. Physical fitness as a predictor of mortality among healthy, middle-aged Norwegian men. N Engl J Med 1993; 328: 533-7. New England Journal of Medicine  
  8. Kodama S, Saito K, Tanaka S, Maki M, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women. A meta-analysis. JAMA 2009; 301: 2024 - 35. Journal of the American Medical Association  
  9. Powell KE, Thompson PD, Caspersen CJ, Kendrick JS. Physical activity and the incidence of coronary heart disease. Ann Rev Public Health 1987; 8: 253-87. PubMed  
  10. Murabito JM, Pencina MJ, Nam BH, et al. Sibling cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adults. JAMA. 2005; 294: 3117-23. PubMed  
  11. Kamstrup PR, Tybjærg-Hansen A, Steffensen R, Nordestgaard BG. Genetically elevated lipoproten(a) and increased risk of myocardial infarction. JAMA 2009; 301: 2331-9. Journal of the American Medical Association  
  12. Gotto AM jr., LaRosa JC, Hunninghake D, Grundy SM, Wilson PW, Clarkson TB et al. The cholesterol facts. A summary of the evidence relating dietary fats, serum cholesterol, and coronary heart disease. A joint statement by the American Heart Association and the National Heart, Lung and Blood Institute. Circulation 1990; 81: 1721-33. Circulation  
  13. Liu C, Dhindsa D, Almuwaqqat Z, et al. Association Between High-Density Lipoprotein Cholesterol Levels and Adverse Cardiovascular Outcomes in High-risk Populations. JAMA Cardiol 2022. pmid:35583863 PubMed  
  14. Fowler G. Tobacco and cardiovascular disease: achieving smoking cessation . I: Yusuf S, red. Evidence based cardiology. London: BMJ Books, 1998: 179-90.
  15. Kessous R, Shoham-Vardi I, Pariente G, et al. Long-term maternal atherosclerotic morbidity in women with pre-eclampsia. Heart 2014. doi:10.1136/heartjnl-2014-306571 DOI  
  16. Gustavsson P, Ljungman P. Snabb arbetsåtergång efter hjärtinfarkt möjlig för de flesta. Läkartidningen. 2020;117:20083. lakartidningen.se  
  17. Lakka H-M, Lakka TA, Tuomilehto J, Salonen JT. Abdominal obesity is associated with increased risk of acute coronar events in men. Eur Heart J 2002; 23: 706-13. PubMed  
  18. Bogers RP, Bemelmans WJ, Hoogenveen RT, et al. Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: A meta-analysis of 21 cohort studies including more than 300 000 persons. Arch Intern Med 2007; 167: 1720-8. PubMed  
  19. Nilsson G, Hedberg P, Jerzy Leppert J and Ohrvik J. Basic Anthropometric Measures in Acute Myocardial Infarction Patients and Individually Sex- and Age-Matched Controls from the General Population. J Obes. 2018 Oct 2;2018:3839482. PMID: 30533220 PubMed  
  20. Hsia J, Larson JC, Ockene JK, et al. Resting heart rate as a low tech predictor of coroanary events in women: prospective cohort study. BMJ 2009; 338: b219. BMJ (DOI)  
  21. Lindhardsen J, Ahlehoff O, Gislason GH, et al. The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: a Danish nationwide cohort study. Ann Rheum Dis 2011; 70: 929-934. PubMed  
  22. Mehta NN, Yu Y, Pinnelas R, et al. Attributable risk estimate of severe psoriasis on major cardiovascular events. Am J Med 2011; 124: 775. PubMed  
  23. Hooper L, Martin N, Abdelhamid A, Davey Smith G. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev. 2015 Jun 10;(6):CD011737. PMID: 26068959. The Cochrane Library  
  24. de Souza RJ, Mente A, Maroleanu A, et al. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ. 2015 Aug 11;351:h3978. PMID: 26268692.
  25. Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr. 2010 Mar;91(3):535-46. PMID: 20071648.
  26. Siri-Tarino PW, Chiu S, Bergeron N, Krauss RM. Saturated Fats Versus Polyunsaturated Fats Versus Carbohydrates for Cardiovascular Disease Prevention and Treatment. Annu Rev Nutr. 2015;35:517-43. PMID: 26185980. PubMed  
  27. Ruidavets J-B, Ducimetiére P, Evans A, et al. Patterns of alcohol consumption and ischaemic heart disease in culturally divergent countries: the Prospective Epidemiological Study of Myocardaial Infarction (PRIME). BMJ 2010; 341: c6077. BMJ (DOI)  
  28. Kwong JC, Schwartz KL, Campitelli MA, et al. Acute myocardial infarction after laboratory-confirmed influenza infection. N Engl J Med 2018 Jan 25; 378(4): 345-353. pmid:29365305 PubMed  
  29. Frøberg O, Götberg M, Erlinge D, et al. Influenza Vaccination after Myocardial Infarction: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. Circulation 2021. pmid:34459211 PubMed  
  30. Arbetsmiljöns betydelse för hjärt-kärlsjukdom – exponering för kemiska ämnen. SBU utvärderar. Rapport 261/2017. www.sbu.se  
  31. Jenkins DJA, Spence JD, Giovannucci EL, et al. Supplemental Vitamins and Minerals for CVD Prevention and Treatment. J Am Coll Cardiol. 2018 Jun 5;71(22):2570-2584. PubMed  
  32. Abdelhamid AS, Brown TJ, Brainard JS, et al. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev 2018; 7: CD003177. doi:10.1002/14651858.CD003177.pub3 DOI  
  33. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J 2019; 40: 237-69. PMID:30571520. PubMed  
  34. Missad hjärtinfarkt var ofta relaterad till atypisk anamnes. Systematisk genomgång av bakomliggande orsaker till anmälda fall av felaktig diagnostik vid akut hjärtinfarkt. Läkartidningen. 15 mars, 2017. vol 114. 445-520. lakartidningen.se  
  35. McSweeney JC, Cody M, Sullivan P, et al. Women's early warning symptoms of acute myocardial infarction. Circulation 2003; 108: 2619-23. Circulation  
  36. Milner KA, Vaccarino V, Arnold AL, et al. Gender and age differences in chief complaints of acute myocardial infarction. Am J Cardiol 2004; 93: 606-8. PubMed  
  37. Ebell MH, White LL, Weismantel D. A systematic review of Troponin T and I values as a prognostic tool for patients with chest pain. J Fam Pract 2000; 49: 746-53. PubMed  
  38. Ammann P, Pfisterer M, Fehr T, Rickli H. Raised cardiac troponins. BMJ 2004; 328: 1028-9. PubMed  
  39. Ingkanisorn WP, Kwong RY, Bohme NS, et al. Prognosis of negative adenosine stress magnetic resonance in patients presenting to an emergency department with chest pain. J Am Coll Cardiol 2006;47:1427–1432. PMID:16580532. PubMed  
  40. Lockie T, Nagel E, Redwood S, Plein S, et al. Use of cardiovascular magnetic resonance imaging in acute coronary syndromes. Circulation 2009;119:1671–1681. PMID:19332480. PubMed  
  41. Kwong RY. Schussheim AE. Rekhraj S Aletras AH, et al. Detecting acute coronary syndrome in the emergency department with cardiac magnetic resonance imaging. Circulation 2003;107:531–537. PMID:2566362. PubMed  
  42. Goldstein JA, Gallagher MJ, O'Neill WW, Ross MA, O'Neil BJ, Raff GL. A randomized controlled trial of multi-slice coronary computed tomography for evaluation of acute chest pain. J Am Coll Cardiol 2007; 49: 863-71. PubMed  
  43. Bøhmer E, Hoffmann P, Abdelnoor M, et al. Efficacy and safety of immediate angioplasty versus ischemia-guided management after thrombolysis in acute myocardial infarction in areas with very long transfers. J Am Coll Cardiol 2009; : PMID:19747792. PubMed  
  44. Akut kranskärlssjukdom – Rekommendationer för bedömning, behandling och sekundärprevention (2015). Svenska Kardiologföreningen. cardio.se  
  45. Hofmann R, James SK, Jernberg T et al. Oxygen Therapy in Suspected Acute Myocardial Infarction. N Engl J Med. 2017 Sep 28;377(13):1240-1249. PMID: 28844200 PubMed  
  46. Cabello JB, Burls A, Emparanza JI, et al. Oxygen therapy for acute myocardial infarction. Cochrane Database Syst Rev. 2016 Dec 19;12:CD007160. PMID: 27991651. PubMed  
  47. Sepehrvand N, James SK, Stub D, et al. Effects of supplemental oxygen therapy in patients with suspected acute myocardial infarction: a meta-analysis of randomised clinical trials. Heart 2018. pmid:29599378 PubMed  
  48. Morrison LJ, et al. Mortality and prehospital thrombolysis for acute myocardial infarction. JAMA 2000; 283: 2686-92. Journal of the American Medical Association  
  49. Keeley EC, Hillis LD. Primary PCI for myocardial infarction with ST-segment elevation. N Engl J Med 2007; 356: 47-54. PubMed  
  50. Gershlick AH, Stephens-Lloyd A, Hughes S, et al. Rescue angioplasty after failed thrombolytic therapy for acute myocardial infarction. N Engl J Med. 2005; 353: 2758-68. PubMed  
  51. Grech ED, Ramsdale DR. Acute coronary syndrome: ST segment elevation myocardial infarction. BMJ 2003; 326: 1379-81. PubMed  
  52. Andersen HR, Nielsen TT, Rasmussen K, et al. A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Engl J Med. 2003; 349: 733–742. PMID:12930925. PubMed  
  53. De Luca G, Dirksen MT, Spaulding C, et al. Drug-eluting vs bare-metal stents in primary angioplasty. Arch Intern Med 2012; 172: 611-21. PMID:22529227. PubMed  
  54. McNamara RL, Wang Y, Herrin J, et al, for the NRMI Investigators. Effect of door-to-balloon time on mortality in patients with ST-segment elevation myocardial infarction. J Am Coll Cardiol 2006; 47: 2180-6. PubMed  
  55. Hochman JS, Lamas GA, Buller CE, et al. Coronary intervention for persistent occlusion after myocardial infarction. N Engl J Med 2006; 355: 2395-2407. New England Journal of Medicine  
  56. Cantor WJ, Fitchett D, Borgundvaag B, et al, for the TRANSFER-AMI Trial Investigators. Routine early angioplasty after fibrinolysis for acute myocardial infarction. N Eng J Med 2009; 360: 2705-18. PubMed  
  57. Babapulle MN, Joseph L, Bélisle P, Brophy JM, Eisenberg MJ. A hierarchical Bayesian meta-analysis of randomised clinical trials of drug-eluting stents. Lancet 2004; 364: 583-91. PubMed  
  58. Vik-Mo H. Warfarin saman med blodplatehemming. Tidsskr Nor Legeforen 2011; 131: 252-3. Tidsskrift for Den norske legeforening  
  59. Yin SH, Xu P, Wang B, et al. Duration of dual antiplatelet therapy after percutaneous coronary intervention with drug-eluting stent: systematic review and network meta-analysis. BMJ 2019; 365: l2222. pmid:31253632 PubMed  
  60. Sørensen R, Hansen ML, Abildstrom SZ, et al. Risk of bleeding in patients with acute myocardial infarction treated with different combinations of aspirin, clopidogrel, and vitamin K antagonists in Denmark: a retrospective analysis of nationwide registry data. Lancet 2009; 374: 1967-74. PubMed  
  61. Bennett MH, Lehm JP, Jepson N. Hyperbaric oxygen therapy for acute coronary syndrome. Cochrane Database Syst Rev. 2015 Jul 23;7:CD004818. Cochrane (DOI)  
  62. Hohnloser SH, Kuck KH, Dorian P, et al. Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction. N Engl J Med 2004; 351: 2481-88. New England Journal of Medicine  
  63. Stamcellsterapi efter akut hjärtinfarkt. SBU kommenterar (2016). www.sbu.se  
  64. Läkemedelsverket. Läkemedel med omega-3 inte effektiva för att förebygga hjärtsjukdom. 2019-03-29 (hämtad 2019-04-08). lakemedelsverket.se  
  65. Bradt J, Dileo C, Potvin N. Music for stress and anxiety reduction in coronary heart disease patients. Cochrane Database Syst Rev. 2013 Dec 28;12:CD006577. doi: 10.1002/14651858.CD006577.pub3. DOI  
  66. Gulliksson M, Burell G, Vessby B, et al. Randomized Controlled Trial of Cognitive behavioral therapy vs standard treatment to prevent recurrent cardiovascular events in patients with coronary heart disease. Arch Intern Med 2011; 171: 134-40. PubMed  
  67. Wallert J, Olsson EM, Pingel R et al. Attending Heart School and long-term outcome after myocardial infarction: A decennial SWEDEHEART registry study.Eur J Prev Cardiol. 2019 Sep 13:2047487319871714. PMID: 31514507 PubMed  
  68. Levine GN, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease. Circulation 2016. doi:10.1161/CIR.0000000000000404 DOI  
  69. Socialstyrelsen. Nationella riktlinjer för hjärtsjukvård (2015, översyn 2018). www.socialstyrelsen.se  
  70. Szummer K, Montez-Rath ME, Alfredsson J, et al. Comparison Between Ticagrelor and Clopidogrel in Elderly Patients With an Acute Coronary Syndrome: Insights From the SWEDEHEART Registry. Circulation. 2020;142(18):1700-1708. PMID:32867508. PubMed  
  71. SBU. Klopidogrel vid dubbel trombocythämning jämfört med tikagrelor för patienter som vårdats för akut koronart syndrom. 2021-05-20 (Hämtad 21-06-23). www.sbu.se  
  72. Conolly SJ, Eikelboom JW, Bosch J, et al. Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet 2017; 391: 205-18. pmid:29132879 PubMed  
  73. Anand SS, Bosch J, Eikelboom JW, et al. Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet 2017; 391: 219-29. pmid:29132880 PubMed  
  74. ESC Clinical Practice Guidelines. 2017. Acute Myocardial Infarction in patients presenting with ST-segment elevation (Management of). (Hämtad 2018-02-14) www.escardio.org  
  75. European Society of Cardiology. 2020 Acute Coronary Syndromes (ACS) in Patients Presenting without Persistent ST-Segment Elevation (Management of) Guidelines. Published in 2020 (Hämtad 2021-02-04). www.escardio.org  
  76. NICE guideline [NG185]. Acute coronary syndromes. 2020-11-18. (Hämtad 2021-02-04) www.nice.org.uk  
  77. Kim J, Kang D, Park H, et al. Long-termβ-blocker therapy and clinical outcomes after acute myocardial infarction in patients without heart failure: nationwide cohort study. Eur Heart J 2020; 41: 3521. pmid:32542362 PubMed  
  78. Cholesterol Treatment Trialists? (CTT) Collaboration, Baigent C, Blackwell L, Emberson J, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010; 376: 1670-81. PubMed  
  79. Pitt B, White H, Nicolau J, et al. Eplerenone reduces mortality 30 days after randomization following acute myocardial infarction in patients with left ventricular systolic dysfunction and heart failure. J Am Coll Cardiol 2005; 46: 425-31. PubMed  
  80. Ezekowitz JA, McAlister FA. Aldosteron blockade and left ventricular dysfunction: a systematic review of randomized clinical trials. Eur Heart J 2009; 30: 469-77. European Heart Journal  
  81. Cucherat M, Bonnefoy E, Tremeau G. Primary angioplasty versus intravenous thrombolysis for acute myocardial infarction. Oxford: The Cochrane Library, issue 2, 2002. The Cochrane Library  
  82. Bangalore S, Makani H, Radford M, et al. Clinical Outcomes with beta-Blockers for Myocardial Infarction: A Meta-analysis of Randomized Trials. Am J Med. 2014 Oct;127(10):939-53. PMID:24927909. PubMed  
  83. McAlister FA, Lawson FME, Teo KT et al. Randomised trials of secundary prevention programmes in coronary heart disease: systemic review. BMJ 2001; 323: 957-62. British Medical Journal  
  84. Dalal HM, Zawada A, Jolly K, Moxham T, Taylor RS. Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis. BMJ 2010; 340: b5631. BMJ (DOI)  
  85. Sinclair AJ, Conroy SP, Davies M, Bayer AJ. Post-discharge home-based support for older cardiac patients: a randomised controlled trial. Age Ageing 2005; 34: 338-43. PubMed  
  86. Hildebrandt PR, Gøtzsche C-O. Akut koronart syndrom. Retningslinier for diagnostik og behandling. Dansk Cardiologisk Selskab. Ugeskr Læger 2001; 163 (suppl 3).
  87. Solomon SD, Zelenkofske S, McMurray JJ, et al, for the Valsartan in Acute Myocardial Infarction Trial (VALIANT) Investigators. Sudden death in patients with myocardial infarction and left ventricular dysfunction, heart failure, or both. N Engl J Med 2005; 352: 2581-8. New England Journal of Medicine  
  88. Lichtman JH, Bigger JT, Blumenthal JA et al. Depression and coronary heart disease. Circulation 2008; 118: .
  89. Vaccarino V, Parsons L, Peterson ED, et al. Sex differences in mortality after acute myocardial infarction. Arch Intern Med 2009; 169: 1767-74. PubMed  
  • Faris Al-Khalili, med dr och specialist, Stockholm Heart Center
  • Josef Sayegh, specialist i allmänmedicin, Stockholm