Der Anaesthesist

, Volume 58, Issue 7, pp 665–676

Perioperative Myokardschäden bei nichtkardiochirurgischen Patienten

Leitthema

Zusammenfassung

Perioperative Myokardschäden lassen sich, abhängig von den untersuchten Patienten und dem operativen Eingriff, mit hoher Inzidenz nachweisen und werden zu den bedeutendsten Risikofaktoren für eine erhöhte perioperative Morbidität und Mortalität bei nichtkardiochirurgischen Patienten gezählt. Bis zum heutigen Zeitpunkt sind die pathophysiologischen Prozesse, die an der Entstehung perioperativer Myokardschäden beteiligt sind, nicht hinreichend aufgeklärt. Sowohl Ischämien mit und ohne Koronarverschluss als auch nichtischämische noxische Stimuli können das Herz in der perioperativen Phase einer substanziellen Belastung aussetzen. Anhand des klinischen Erscheinungsbildes lässt sich zwischen ischämischer und nichtischämischer Myokardschädigung oftmals nicht differenzieren. In der Mehrzahl der Fälle verlaufen perioperative Myokardinfarkte (PMI) mit nur wenigen oder sogar ohne jegliche klinischen Symptome. Die Ursache dafür liegt in einer, wahrscheinlich von Nicht-PMI abweichenden Pathophysiologie und Phänotypologie. Aufgrund der bisher nicht geklärten Ätiologie der PMI steht der behandelnde Arzt oftmals vor der Frage, inwieweit sich die üblichen Diagnose- und Therapiealgorithmen des „akuten Koronarsyndroms“ auf die perioperative Situation übertragen lassen. Die vorliegende Übersichtsarbeit reflektiert den aktuellen Wissensstand zu perioperativen Myokardschäden und bietet einen möglichen Ansatz in der Diagnose und Therapie perioperativer myokardialer Schädigungen.

Schlüsselwörter

Perioperativer Myokardinfarkt Ischämie Definition Diagnose Therapie 

Perioperative myocardial damage in non-cardiac surgery patients

Abstract

Perioperative myocardial damage occurs with a high incidence depending on the operative procedure and the patients examined and is considered to be among the most relevant risk factors for increased perioperative morbidity and mortality in patients undergoing non-cardiac surgery. The pathophysiology of myocardial damage in the perioperative period is still not well understood. Both ischemia with and without acute coronary occlusion and non-ischemic stimuli can put a substantial strain on the heart in the perioperative period. However, in many cases the clinical presentation does not allow a clear differentiation between ischemic and non-ischemic myocardial damage. In the majority of cases perioperative myocardial infarctions occur with only mild or even without any clinical symptoms. This is probably due to a considerable difference in phenotype and pathophysiology between perioperative and non-perioperative myocardial infarctions. As a result of this unexplained etiology of perioperative myocardial infarction it remains an open question whether the contemporary diagnostic and therapeutic recommendations for the acute coronary syndrome can be extrapolated to the perioperative situation. The present review reflects the current state of knowledge and presents an optional approach to the diagnosis and therapy of perioperative myocardial injury.

Keywords

Perioperativer myocardial infarction Ischemia Definition Diagnosis Therapy 

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© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Klinik für Anaesthesiologie und IntensivmedizinKlinikum der Universität HeidelbergHeidelbergDeutschland
  2. 2.Klinik für Anaesthesiologie und IntensivmedizinKlinikum der Universität KölnKölnDeutschland

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