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Angina pectoris, inndeling

Det er vanlig å dele angina (hjertekrampe) inn i det vi kaller "stabil" angina pectoris og "ustabil" angina pectoris.

Brystsmerter
En stabil angina pectoris er en tilstand man kan leve med over mange år.

Sist oppdatert:

12. okt. 2021

Inndeling av angina

Forsnevring i blodåreForsnevring i blodåre

Det er vanlig å dele angina (hjertekrampe) inn i det vi kaller "stabil" angina pectoris og "ustabil" angina pectoris. Den sistnevnte tilstanden er som navnet antyder, en mer ustabil tilstand med økt risiko for utvikling av hjerteinfarkt. En pasient med ustabil angina bør snarlig til undersøkelse og eventuell behandling i sykehus.

Annonse

En stabil angina pectoris er en tilstand man kan leve med over mange år. Selv om det er ubehagelig og kan legge begrensninger på dagliglivet, er det ikke stor fare for utvikling av hjerteinfarkt selv om risikoen for å få hjerteinfarkt er noe økt. For å holde en angina mest mulig stabil anbefales livsstilstiltak (hjerteriktig kost og mosjon) og noen medikamenter.

Stabil angina

De fleste med angina pectoris tilhører gruppen stabil angina, og dette er vanligvis også hva vi mener når vi snakker om angina på folkemunne. Tilstanden er karakterisert ved at du får angina-symptomer - smerter/klem i brystet, tung pust - i bestemte situasjoner, og de opptrer så lovmessig at du kan forutsi at du vil få ubehag i disse situasjonene, f.eks. ved fysiske anstrengelser i kaldt vær, ved å gå opp en bestemt bakke, el. l. Normalt varer angina-anfallene varer mindre enn fem minutter, og de bedres vanligvis ved hvile eller etter inntak av nitroglyserin i tablettform eller som munnspray. Dersom hvile og nitroglyserin ikke får smerten til å gå over, bør du tilkalle hjelp.

Ustabil angina

Dette er en bekymringsfull tilstand hvor anginaplagene kommer i hvile eller etter små anstrengelser, og ikke gir seg like raskt ved hvile.  De fleste med ustabile symptomer henvises til eller legges inn på sykehus for om mulig å unngå utvikling av et hjerteinfarkt.

Tegn på at en stabil angina har blitt ustabil

  • Anginaplagene endrer seg
  • Du våkner om natten av anginasmerter
  • Anginaplagene blir verre enn du er vant med
  • Episodene med ubehag/smerte i brystet opptrer hyppigere og etter mindre anstrengelser enn vanlig
  • Anginasmertene varer lengre enn de pleier
  • Du må benytte mer nitroglyserin enn det du er vant med for at et angina-anfall skal gi seg, eller smertene går ikke bort ved bruk av nitroglycerin

Vil du vite mer

Dette dokumentet er basert på det profesjonelle dokumentet Kronisk koronare syndromer . Referanselisten for dette dokumentet vises nedenfor

  1. Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes: Developed by the task force for the management of chronic coronary syndromes of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2024. doi:10.1093/eurheartj/ehae177 DOI
  2. Ricci F, Banihashemi B, Pirouzifard M. et al. Familial risk of vasospastic angina: a nationwide family study in Sweden. Open Heart 2023; 10: e002504. pmid:38056914 PubMed
  3. Schef KW, Tornvall P, Alfredsson J, et al. Prevalence of angina pectoris and association with coronary atherosclerosis in a general population. Heart 2023. pmid:37225242 PubMed
  4. Folkehelseinstituttet. Hjerte- og karregisteret. Diagnoser 2018. statistikkbank.fhi.no
  5. Schoenhagen P, Ziada RM, Kapadia SP, Crowe TD, Nissen SE, Tuzcu EM. Extent and direction of arterial remodeling in stable versus unstable coronary syndromes: an intravascular ultrasound study. Circulation 2000; 101: 598-603. Circulation
  6. Halcox JP, Schenke WH, Zalos G, et al. Prognostic value of coronary vascular endothelial dysfunction. Circulation 2002; 106: 653-8. Circulation
  7. Sinha A, Dutta U, Demir OM, et al. Rethinking False Positive Exercise Electrocardiographic Stress Tests by Assessing Coronary Microvascular Function. J AM Coll Cardiol 2024; 83: 291-299. pmid:38199706 PubMed
  8. Opie LH, Commerford PJ, Bersh BJ. Controversies in stable coronary artery disease. Lancet 2006; 367: 69-78. PubMed
  9. Kaski JC. Pathophysiology and management of patients with chest pain and normal coronary arteriograms (cardiac syndrome X). Circulation 2004; 109: 568-72. Circulation
  10. 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
  11. 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
  12. Rosengren A, Hawken S, Ôunpuu S, et al. Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364: 953-62. PubMed
  13. 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
  14. Yusuf S, Hawken S, Ôunpuu S et al. Obesity and the risk of myocardial infarction in 27 000 participants from 52 countries: a case-control study. Lancet 2005; 366: 1640-9. PubMed
  15. Smith JK, Dykes R, Douglas JE, Krishnaswamy G, Berk S. Long-term Exercise and Atherogenic Activity og Blood Mononuclear Cells inPersons at Risk of Developing Ischemic Heart Disease. JAMA 1999; 281:1722-1727. Journal of the American Medical Association
  16. van der Meer RE, Maas AH. The Role of Mental Stress in Ischaemia with No Obstructive Coronary Artery Disease and Coronary Vasomotor Disorders. Eur Cardiol 2021; 16: e37. pmid:34721671 PubMed
  17. Tirosh A, Shai I, Tekes-Manova D et al. Normal fasting plasma glucose levels and type 2 diabetes in young men. N Engl J Med 2005; 353: 1454-62. New England Journal of Medicine
  18. Sattar N, Gaw A, Scherbakova O, et al. Metabolic syndrome with and without C-reactive protein as a predictor of coronary heart disease and diabetes in the West of Scotland Coronary Prevention Study. Circulation 2003; 108: 414-9. Circulation
  19. Prior JO, Quinones MJ, Hernandez-Pampaloni M, et al. Coronary circulatory dysfunction in insulin resistance, impaired glucose tolerance, and type 2 diabetes mellitus. Circulation 2005; 111: 2291-8. Circulation
  20. Fan C, Wang H, Gu Y. Recurrent Angina After Alcohol Consumption. JAMA Intern Med 2023. doi:10.1001/jamainternmed.2022.5411 DOI
  21. Bello N, Mosca L. Epidemiology of coronary heart disease in women. Prog Cardiovasc Dis 2004; 46: 287-95. PubMed
  22. Bugiardini R, Bairey Merz CN. Angina with "normal" coronary arteries: a changing philosophy. JAMA 2005; 293: 477-84. Journal of the American Medical Association
  23. Abrams J. Chronic stable angina. N Engl J Med 2005; 352: 2524-33. PubMed
  24. Sekhri N, Feder GS, Junghans C, et al. Incremental prognostic value of the exercise electrocardiogram in the initial assessment of patients with suspected angina: cohort study. BMJ 2008; 337: a2240. BMJ (DOI)
  25. The DISCHARGE Trial Group. CT or Invasive Coronary Angiography in Stable Chest Pain. N Engl J Med 2022. pmid:35240010 PubMed
  26. Papachristidis A, Vaughan GF, Denny SJ, et al. Comparison of NICE and ESC proposed strategies on new onset chest pain and the contemporary clinical utility of pretest probability risk score. Open Heart. 2020 May;7(1):e001081. doi: 10.1136/openhrt-2019-001081. PMID: 32467136. PubMed
  27. Maron DJ, Hochman JS, Reynolds HR, et al. Initial Invasive or Conservative Strategy for Stable Coronary Disease. N Engl J Med 2020; 382: 1395-407. pmid:32227755 PubMed
  28. Benenati S, De Maria GL, Kotronias R, et al. Why percutaneous revascularisation might not reduce the risk of myocardial infarction and mortality in patients with stable CAD? Review. Open Heart 2023. doi:10.1136/openhrt-2023-002343 DOI
  29. von Koch S, Koul S, Grimfjärd P, et al. Percutaneous coronary intervention plus medical therapy versus medical therapy alone in chronic coronary syndrome: a propensity score-matched analysis from the Swedish Coronary Angiography and Angioplasty Registry. Heart 2024. pmid:39214681 PubMed
  30. Anderson L, Brown JP, Clark AM, Dalal H, Rossau HKK, Bridges C, et al. Patient education in the management of coronary heart disease. Cochrane Database Syst Rev 2017;6:CD008895. PMID: 28658719 PubMed
  31. Stead LF, Buitrago D, Preciado N, Sanchez G, Hartmann-Boyce J, Lancaster T. Physician advice for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD000165. DOI: 10.1002/14651858.CD000165.pub4. DOI
  32. Barnoya J and Glantz SA. Cardiovascular effects of secondhand smoke: nearly as large as smoking. Circulation 2005; 111: 2684-98. Circulation
  33. Weitzman M, Cook S, Auinger P, et al. Tobacco smoke exposure is associated with the metabolic syndrome in adolescents. Circulation 2005; 112: 862-9. Circulation
  34. Sabatine MS, Giugliano RP, Keech AC, et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med 2017. pmid:28304224 PubMed
  35. Virani SS, Newby LK, Arnold SV, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: a report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148: e9. PMID: 37471501 PubMed
  36. Colhoun HM, Betteridge DJ, Durrington PN, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet 2004; 364: 685-96. PubMed
  37. LaRosa JC, Grundy SM, Waters DD, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med 2005; 352: 1425-35. New England Journal of Medicine
  38. Nidorf SM, Fiolet ATL, Mosterd A, et al. Colchicine in Patients with Chronic Coronary Disease. N Engl J Med. 2020 Aug 31. PMID: 32865380 PubMed
  39. Salazar CA, Basilio Flores JE, Veramendi Espinoza LE, et al. Ranolazine for stable angina pectoris. Cochrane Database Syst Rev. 2017 Feb 8;2:CD011747. doi: 10.1002/14651858.CD011747.pub2. (Review) PMID: 28178363 PubMed
  40. Al-Lamee RA, Nowbar AN, Francis DP. Percutaneous coronary intervention for stable coronary artery disease. Heart 2019; 105: 11-19. doi:10.1136/heartjnl-2017-312755 DOI
  41. Clar C, Oseni Z, Flowers N, Keshtkar‐Jahromi M, Rees K. Influenza vaccines for preventing cardiovascular disease. Cochrane Database of Systematic Reviews 2015, Issue 5. Art. No.: CD005050. DOI: 10.1002/14651858.CD005050.pub3. Accessed 01 February 2022. The Cochrane Library
  42. Udell JA, Zawi R, Bhatt DL, et al. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a meta-analysis. JAMA 2013 Oct 23;310(16):1711-20. PubMed
  43. Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler A-D, Taylor RS. Exercise‐based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews 2021, Issue 11. Art. No.: CD001800. DOI: 10.1002/14651858.CD001800.pub4. Accessed 01 February 2022. The Cochrane Library
  44. Lagerros YT, Grotta A, Freyland S, et al. Risk of Death in Patients With Coronary Artery Disease Taking Nitrates and Phosphodiesterase-5 Inhibitors. J AM Coll Cardiol 2024; 83: 417-426. pmid:38233015 PubMed
  45. Hemingway H, Marmot M. Psychosocial factors in the primary and secondary prevention of coronary heart disease: a systematic review. I: Yusuf S, Cairns JA, Camm AJ, Fallen EL, Gersh BJ, red. Evidence based cardiology. London: BMJ Books, 1998: 269-85.
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