Rutten Frans H
Universiteit Utrecht, UMC Utrecht, divisie Julius Centrum voor Gezondheidswetenschappen en Eerstelijns Geneeskunde, afd. Huisartsgeneeskunde.
Contact: F.H. Rutten (
Ned Tijdschr Geneeskd. 2018 Dec 5;162:D3540.
In patients presenting with acute chest pain, acute myocardial infarction should first be ruled out as a cause as these patients will often need coronary revascularisation. In the remaining patients, those with normal high-sensitivity cardiac troponin levels should undergo additional cardiac investigations to discriminate patients with an episode of unstable angina pectoris from those who have a non-cardiac cause of the chest pain. In the large majority (86%), the medical history does not raise suspicion of angina pectoris and an exercise test will show normal results; in these patients, further cardiac imaging does not seem to be indicated. In conclusion, less cardiac imaging and more non-cardiac investigations are required in patients with acute chest pain and normal high-sensitivity cardiac troponin levels.
对于出现急性胸痛的患者，应首先排除急性心肌梗死作为病因，因为这些患者通常需要进行冠状动脉血运重建。在其余患者中，高敏心肌肌钙蛋白水平正常的患者应接受额外的心脏检查，以区分不稳定型心绞痛发作的患者和胸痛由非心脏原因引起的患者。在绝大多数（86%）患者中，病史不会引起对心绞痛的怀疑，运动试验结果将显示正常；在这些患者中，似乎不需要进一步的心脏成像检查。总之，对于急性胸痛且高敏心肌肌钙蛋白水平正常的患者，需要的心脏成像检查较少，而非心脏检查较多。
