Diferença entre infarto agudo do miocárdio e angina instável

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Você sabe a diferença entre infarto agudo do miocárdio e angina instável? Nas duas doenças o paciente pode apresentar dor precordial, que é descrita como uma dor em aperto, opressiva, com irradiação para membros superiores (principalmente o esquerdo, mas pode ser bilateral), mandíbula, dorso ou epigástrio, podendo ser acompanhada de sudorese fria, dispneia, náuseas e vômitos. Pode ser indicada pelo sinal de Levine, em que o paciente coloca sua mão, geralmente espalmada, sobre o centro do precórdio. É comum que o paciente mantenha a mão fechada sobre essa região. O paciente também pode apresentar sintomas associados: sudorese profusa, náuseas ou vômitos, tontura, pré-sincope ou síncope, dispneia, palpitações e tosse. Principalmente em pacientes idosos, diabéticos, negros e mulheres, o evento isquêmico pode ocorrer com pouca ou nenhuma sensação de desconforto precordial, apresentando apenas um mal-estar ou só um quadro de vômito.

Nas duas situações, podemos encontrar, ainda, o eletrocardiograma sem alterações. Então qual a diferença entre IAM e angina instável?

A diferença são os marcadores de necrose do miocárdio, a CPK e CK-MB começam a aumentar a partir de 6 horas, e a troponina começa a aumentar entre 8 e 12 horas no IAM, o que não ocorre na angina instável. Veja o fluxograma de diagnóstico da Síndrome coronariana aguda abaixo:

Classificação da SCA de acordo com o ECG e exames laboratoriais.
Classificação da SCA de acordo com o ECG e exames laboratoriais.

Referências

1. CANESIN, Manuel Fernandes. Treinamento de emergências cardiovasculares: da Sociedade Brasileira de Cardiologia, avançado. Manole, 2012.

2. DE PAOLA, Angelo A. V.; MONTENEGRO, Sergio; MOREIRA, Maria d. C. V.Livro-texto da Sociedade Brasileira de Cardiologia.Barueri, SP: Manole, 2012.

3. MATINS, HERLON SARAIVA; NETO, RODRIGO ANTONIO bRANDÃO; NETO, AUGUSTO SCALABRINI; VELASCO, IRINEU TAFEU. emergências clínicas: Abordagem prática. Barueri, SP: Monole, 2016.

4. braunwald,e.; zipes, d.p.; et al. tratado de doenças cardiovasculares. Rio de janeiro, RJ: elsevier, 2013.

5. piegas,l.s.;timerman, a.; et al. v diretriz da sociedade brasileira de cardioloia sobre tratamento do infarto agudo do miocárdio. Arq bras cardiol, 2015.

6. jr, carlos v. serrano; timerman, ari; stefanini, edson. Tratado de cardiologia socesp. barueri, sp: monole, 2009.

7. aroesty, julian m.; simons, michael; breall, jeffrey a. overview of the acute management of non-st elevation acute coronar syndromes. uptodate, 2018.

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