Skip to main content
SpringerLink
Log in

Intensivtherapie bei akutem Koronarsyndrom, Myokardinfarkt und instabiler Angina pectoris

Die Intensivmedizin

Part of the book series: Springer Reference Medizin ((SRM))

  • 970 Accesses

Zusammenfassung

Kardiovaskuläre Erkrankungen sind die führenden Todesursachen in den westlichen Industrienationen. Unter den kardiovaskulären Erkrankungen ist die koronare Herzerkrankung die häufigste Ursache. Das Spektrum der koronaren Herzkrankheit reicht von der stillen Ischämie über die stabile Angina pectoris bis hin zum akuten Koronarsyndrom (ACS) inkl. dem akuten Myokardinfarkt und plötzlichem Herztod. Trotz Einführung der Intensivmedizin und modernster therapeutischer Behandlungskonzepte sind Morbidität und Mortalität des akuten Koronarsyndroms weiterhin hoch.

Dieses Kapitel stellt die Pathophysiologie, das diagnostische und therapeutische Vorgehen der koronaren Herzkrankheit dar und widmet sich darüber hinaus den infarktbedingten Komplikationen und deren Therapie sowie der Sekundärprophylaxe.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Similar content being viewed by others

Literatur

  • Ahmet WH, Bittl JA, Braunwald E (1993) Relation between clinical presentation and angiographic findings in unstable angina pectoris and comparison with stable angina. Am J Cardiol 72:544–550

    Article  Google Scholar 

  • Antithrombotic Trialists’ Collaboration (2002) Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 324:71–86

    Article  Google Scholar 

  • Braunwald E (1989) Unstable angina: a classification. Circulation 80:410–414

    Article  CAS  PubMed  Google Scholar 

  • Breuckmann F, Post F, Erbel R, Münzel T (2009) Acute thoracic pain: chest pain unit – the certification campaign of the German Society of Cardiology. Herz 34:218–223

    Article  PubMed  Google Scholar 

  • Brignole M et al (2013) ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J 34(29):2281–2329

    Article  PubMed  Google Scholar 

  • Cannon CP, McCabe CH, Stone PH, Rogers WJ, Schactman M, Thompson BW, Pearce DJ, Diver DJ, Kells C, Feldman T, Williams M, Gibson RS, Kronenberg MW, Ganz LI, Anderson HV, Braunwald E (1997) The electrocardiogram predicts one-year outcome of patients with unstable angina and non-Q wave myocardial infarction: results of the TIMI III Registry ECG Ancillary Study. Thrombolysis in Myocardial Ischemia. J Am Coll Cardiol 30:133–140

    Article  CAS  PubMed  Google Scholar 

  • Canto JG, Fincher C, Kiefe CI, Allison JJ, Li Q, Funkhouser E, Centor RM, Selker HP, Weissman NW (2002) Atypical presentations among medicare beneficiaries with unstable angina pectoris. Am J Cardiol 90:248–253

    Article  PubMed  Google Scholar 

  • Chen ZM, Jiang LX, Chen YP, Peto R, Collins R, Jiang LX, Xie JX, Liu LS, COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group (2005) Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo- controlled trial. Lancet 366:1607–1621

    Article  CAS  PubMed  Google Scholar 

  • Ciszewski A, Bilinska ZT, Brydak LB, Kepka C, Kruk M, Romanowska M, Ksiezycka E, Przyluski J, Piotrowski W, Maczynska R, Ruzyllo W (2008) Influenza vaccination in secondary prevention from coronary ischaemic events in coronary artery disease: FLUCAD study. Eur Heart J 29:1350–1358

    Article  PubMed  Google Scholar 

  • Danchin N, Cucherat M, Thuillez C, Durand E, Kadri Z, Steg PG (2006) Angiotensinconverting enzyme inhibitors in patients with coronary artery disease and absence of heart failure or left ventricular systolic dysfunction: an overview of long-term randomized controlled trials. Arch Intern Med 166:787–796

    Article  CAS  PubMed  Google Scholar 

  • Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR, Liu K, Shea S, Szklo M, Bluemke DA, O’Leary DH, Tracy R, Watson K, Wong ND, Kronmal RA (2008) Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 358:1336–1345

    Article  CAS  PubMed  Google Scholar 

  • Davies MJ, Thomas AC, Knapman PA, Hangartner JR (1986) Intramyocardial platelet aggregation in patients with unstable angina suffering sudden ischemic cardiac death. Circulation 73:418–427

    Article  CAS  PubMed  Google Scholar 

  • European Resuscitation Council Guidelines for Resuscitation (2005) Resuscitation 67(suppl I):1–181

    Google Scholar 

  • Freemantle N, Cleland J, Young P, Mason J, Harrison J (1999) Beta blockade after myocardial infarction: systematic review and meta regression analysis. BMJ 318:1730–1737

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Fuster V, Moreno PR, Fayad ZA, Corti R, Badimon JJ (2005) Atherothrombosis and high-risk plaque: part I: evolving concepts. J Am Coll Cardiol 46:937–954

    Article  PubMed  Google Scholar 

  • Insull W Jr (2009) The pathology of atherosclerosis: plaque development and plaque responses to medical treatment. Am J Med 122:S3–S14

    Article  CAS  PubMed  Google Scholar 

  • Katz JN, Stebbins AL, Alexander JH, Reynolds HR, Pieper KS, Ruzyllo W, Werdan K, Geppert A, Dzavik V, Van de Werf F, Hochman JS, TRIUMPH Investigators (2009) Predictors of 30-day mortality in patients with refractory cardiogenic shock following acute myocardial infarction despite a patent infarct artery. Am Heart J 158:680–687

    Article  PubMed  Google Scholar 

  • Keeley EC, Boura JA, Grines CL (2003) Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 361:13–20

    Article  PubMed  Google Scholar 

  • Killip T, Kimball JT (1967) Treatment of myocardial infarction in a coronary care unit: a two year experience of 250 patients. Am J Cardiol 20:457–464

    Article  PubMed  Google Scholar 

  • Libby P (2001) Current concepts of the pathogenesis of the acute coronary syndromes. Circulation 104:365–372

    Article  CAS  PubMed  Google Scholar 

  • Lindahl B, Toss H, Siegbahn A, Venge P, Wallentin L (2000) Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary artery disease. FRISC Study Group. Fragmin during Instability in Coronary Artery Disease. N Engl J Med 343:1139–1147

    Article  CAS  PubMed  Google Scholar 

  • Mizuno K, Satomura K, Miyamoto A, Arakawa K, Shibuya T, Arai T, Kurita A, Nakamura H, Ambrose JA (1992) Angioscopic evaluation of coronary-artery thrombi in acute coronary syndromes. N Engl J Med 326:287–291

    Article  CAS  PubMed  Google Scholar 

  • Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML, Multicenter Automatic Defibrillator Implantation Trial II Investigators (2002) Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 346:877–883

    Article  PubMed  Google Scholar 

  • Neumann FJ, Kastrati A, Pogatsa-Murray G, Mehilli J, Bollwein H, Bestehorn HP, Schmitt C, Seyfarth M, Dirschinger J, Schomig A (2003) Evaluation of prolonged antithrombotic pretreatment (‘cooling-off’ strategy) before intervention in patients with unstable coronary syndromes: a randomized controlled trial. JAMA 290:1593–1599

    Article  CAS  PubMed  Google Scholar 

  • Nyman I, Areskog M, Areskog NH, Swahn E, Wallentin L (1993) Very early risk stratification by electrocardiogram at rest in men with suspected unstable coronary heart disease. The RISC Study Group. J Intern Med 234:293–301

    Article  CAS  PubMed  Google Scholar 

  • Panju AA, Hemmelgarn BR, Guyatt GH, Simel DL (1998) The rational clinical examination. Is this patient having a myocardial infarction? JAMA 280:1256–1263

    Article  CAS  PubMed  Google Scholar 

  • Pitt B, White H, Nicolau J, Martinez F, Gheorghiade M, Aschermann M, van Veldhuisen DJ, Zannad F, Krum H, Mukherjee R, Vincent J, EPHESUS Investigators (2005) Eplerenone reduces mortality 30 days after randomization following acute myocardial infarction in patients with left ventricular systolic dysfunction and heart failure. J Am Coll Cardiol 46:425–431

    Article  CAS  PubMed  Google Scholar 

  • Pope JH, Aufderheide TP, Ruthazer R, Woolard RH, Feldman JA, Beshansky JR, Griffith JL, Selker HP (2000) Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med 342:1163–1170

    Article  CAS  PubMed  Google Scholar 

  • Rittersma SZ, van der Wal AC, Koch KT, Piek JJ, Henriques JP, Mulder KJ, Ploegmakers JP, Meesterman M, de Winter RJ (2005) Plaque instability frequently occurs days or weeks before occlusive coronary thrombosis: a pathological thrombectomy study in primary percutaneous coronary intervention. Circulation 111:1160–1165

    Article  PubMed  Google Scholar 

  • Rioufol G, Finet G, Ginon I, Andre-Fouet X, Rossi R, Vialle E, Desjoyaux E, Convert G, Huret JF, Tabib A (2002) Multiple atherosclerotic plaque rupture in acute coronary syndrome: a three-vessel intravascular ultrasound study. Circulation 106:804–808

    Article  CAS  PubMed  Google Scholar 

  • Statisches Bundesamt (2011) Pressemitteilung Nr. 354 vom 23.09.2011

    Google Scholar 

  • Steg PG, Dabbous OH, Feldman LJ, Cohen-Solal A, Aumont MC, López-Sendón J, Budaj A, Goldberg RJ, Klein W, Anderson FA Jr, Global Registry of Acute Coronary Events Investigators (2004) Determinants and prognostic impact of heart failure complicating acute coronary syndromes: observations from the Global Registry of Acute Coronary Events (GRACE). Circulation 109:440–442

    Article  Google Scholar 

  • Stone PH (2004) Triggering myocardial infarction. N Engl J Med 351:1716–1718

    Article  CAS  PubMed  Google Scholar 

  • Stone GW, Witzenbichler B, Guagliumi G (2008) Bivalirudin during primary PCI in acute myocardial infarction. N Engl J Med 358:2218–2230

    Article  CAS  PubMed  Google Scholar 

  • Svilaas T, Vlaar PJ, van der Horst IC, Diercks GF, de Smet BJ, van den Heuvel AF, Anthonio RL, Jessurun GA, Tan ES, Suurmeijer AJ, Zijlstra F (2008) Thrombus aspiration during primary percutaneous coronary intervention. N Engl J Med 358:557–567

    Article  CAS  PubMed  Google Scholar 

  • Tate JR (2008) Troponin revisited 2008: assay performance. Clin Chem Lab Med 46:1489–1500

    Article  CAS  PubMed  Google Scholar 

  • Thygesen K, Alpert JS, Jaffe AS et al, and the Writing Group on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction (2012) Third universal definition of myocardial infarction. Eur Heart J 33:2551–2567

    Google Scholar 

  • TIMI Study Group (1985) The Thrombolysis in Myocardial Infarction (TIMI) trial. Phase I findings. N Engl J Med 312:932–936

    Article  Google Scholar 

  • Tunstall-Pedoe H, Kuulasmaa K, Mähönen M, Tolonen H, Ruokokoski E, Amouyel P (1999) Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet 353:1547–1557

    Article  CAS  PubMed  Google Scholar 

  • Van de Werf F, Bax J, Betriu A et al (2008) Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 29:2909–2945

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Universitätsklinikum Frankfurt, Zentrum der Inneren Medizin, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    Stephan Fichtlscherer

  2. Medizinische Klinik III: Kardiologie, Angiologie/Hämostaseologie, Nephrologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    Andreas M. Zeiher

  3. Medizinische Klinik II – Kardiologie und Angiologie, Sana-Kliniken Lübeck GmbH, Kronsforder Alle 71-73, 23560, Lübeck, Deutschland

    Joachim Weil

Authors
  1. Stephan Fichtlscherer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andreas M. Zeiher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joachim Weil
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stephan Fichtlscherer .

Editor information

Editors and Affiliations

  1. Klinik für Anästhesiologie, RWTH Aachen Universitätsklinikum Aachen, Aachen, Germany

    Gernot Marx

  2. Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Germany

    Elke Muhl

  3. Dir. der Klinik fuer Anaesthesie Intensivmed. und Schmerzther., Frankfurt, Hessen, Germany

    Kai Zacharowski

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Berlin Heidelberg

About this entry

Cite this entry

Fichtlscherer, S., Zeiher, A.M., Weil, J. (2015). Intensivtherapie bei akutem Koronarsyndrom, Myokardinfarkt und instabiler Angina pectoris. In: Marx, G., Muhl, E., Zacharowski, K. (eds) Die Intensivmedizin. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54675-4_62-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-54675-4_62-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Online ISBN: 978-3-642-54675-4

  • eBook Packages: Springer Referenz Medizin

Publish with us

Policies and ethics

Chapter history

  1. Latest

    Intensivtherapie bei akutem Koronarsyndrom, Myokardinfarkt und instabiler Angina pectoris
    Published:
    31 May 2023

    DOI: https://doi.org/10.1007/978-3-642-54675-4_62-2

  2. Original

    Intensivtherapie bei akutem Koronarsyndrom, Myokardinfarkt und instabiler Angina pectoris
    Published:
    01 April 2015

    DOI: https://doi.org/10.1007/978-3-642-54675-4_62-1

Search

Navigation