Bouma M, Rutten F H, Bohnen A M, Wiersma Tj
Nederlands Huisartsen Genootschap, afd. Richtlijnontwikkeling en Wetenschapsbeleid, Postbus 3231, 3502 GE Utrecht.
Ned Tijdschr Geneeskd. 2004 Nov 6;148(45):2221-5.
Typical angina pectoris is characterised by retrosternal complaints that are provoked by exertion, cold, emotional stress or heavy meals and are relieved by rest within 15 minutes or within a few minutes of using sublingual nitroglycerin. If 2 or 3 of these symptoms are present then the term 'atypical angina pectoris' is used. The general practitioner can estimate the risk of significant coronary artery disease on the basis of the anamnesis. Additional diagnostics in the form of an exercise ECG is only worthwhile if the pretest probability of coronary artery disease lies between 30% and 70% (atypical angina pectoris) and not if the diagnosis is extremely likely or extremely unlikely. Patients with angina pectoris should be informed about the alarm symptoms which can be indicative of unstable angina pectoris or acute myocardial infarction. Sublingual nitrate therapy is used for the short-term control of angina. If more than 2 attacks per week occur, a maintenance treatment consisting of beta-blockers, nitrates, or calcium channel blockers should be started in this order of preference. For secondary prevention, acetylsalicylic acid and statins should be prescribed and lifestyle advice should be given, such as smoking cessation, sufficient physical exercise and a healthy diet.
典型心绞痛的特征是胸骨后不适，由劳累、寒冷、情绪压力或饱餐诱发，休息15分钟内或使用舌下硝酸甘油几分钟内可缓解。如果出现其中2或3种症状，则使用“非典型心绞痛”这一术语。全科医生可根据病史评估严重冠状动脉疾病的风险。只有当冠状动脉疾病的预测试概率在30%至70%之间（非典型心绞痛）时，运动心电图形式的额外诊断才是值得的，而如果诊断极有可能或极不可能时则不然。应告知心绞痛患者可能提示不稳定型心绞痛或急性心肌梗死的警示症状。舌下硝酸盐疗法用于心绞痛的短期控制。如果每周发作超过2次，应按此优先顺序开始使用β受体阻滞剂、硝酸盐或钙通道阻滞剂进行维持治疗。对于二级预防，应开具阿司匹林和他汀类药物，并给出生活方式建议，如戒烟、充足的体育锻炼和健康饮食。
