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Cardiologie pp 193-196 | Cite as

22 Instabiele angina pectoris en myocardinfarct zonder ST-elevatie op het ECG

  • R. J. De Winter
  • P. Sinnaeve
Part of the Quintessens book series (QUI)

Samenvatting

Een acuut coronair syndroom zonder ST-elevatie is een werkdiagnose die bij opname wordt gesteld bij patiënten die zich presenteren met pijn op de borst van ischemische origine, maar bij wie geen sprake is van ST-elevatie op het ECG. Deze werkdiagnose kan worden gesteld op basis van het risicoprofiel van de patiënt (belaste familieanamnese en aanwezigheid van risicofactoren voor hart- en vaatziekten zoals roken, hypertensie, hypercholesterolemie, diabetes mellitus) en op basis van de anamnese, terwijl er geen ECG-afwijkingen zijn. Meestal zullen er echter wel afwijkingen op het ECG zichtbaar zijn, zoals horizontale of ‘downsloping’ ST-depressie of T-golfveranderingen. De afwijkingen nemen toe tijdens pijn en verminderen wanneer de pijnklachten afnemen, bijvoorbeeld na toediening van nitroglycerine sublinguaal. In tegenstelling tot het acute coronaire syndroom mét ST-elevatie, waarbij de infarctgerelateerde coronaire arterie volledig is afgesloten en er transmurale hartischemie aanwezig is, komt er meestal geen transmurale ischemie voor en is de coronaire arterie in de regel nog doorgankelijk. Meestal is er dan ook geen indicatie voor reperfusietherapie en is er meer tijd voor verdere diagnostiek en evaluatie van het effect van de ingestelde behandeling.

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Copyright information

© Bohn Stafleu van Loghum, Houten 2008

Authors and Affiliations

  • R. J. De Winter
    • 1
  • P. Sinnaeve
    • 2
  1. 1.Academisch Medisch Centrum-Universiteit van AmsterdamAmsterdam
  2. 2.Universitaire Ziekenhuizen LeuvenLeuven

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