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Hochrisiko-EKG bei akutem Thoraxschmerz

Akute Ischämiezeichen abseits des STEMI

High-risk ECGs in acute chest pain

Signs of acute ischemia beyond STEMI

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Zusammenfassung

Hintergrund

Das Elektrokardiogramm (EKG) stellt den Goldstandard für die initiale Diagnostik des atraumatischen Thoraxschmerzes dar. Für eine optimale Versorgung des Patienten ist dabei eine umfassende Expertise des Behandlers im Erkennen von Frühzeichen einer Myokardischämie essenziell. Um frühzeitig eine Myokardischämie zu erkennen, müssen neben einer klinischen Beurteilung auch typische EKG-Veränderungen umgehend erkannt werden.

Methoden

Es wurde eine selektive Literaturrecherche in internationalen Datenbanken (PubMed [US National Library of Medicine, Bethesda, MD, USA], Cochrane Library [Wiley, Hoboken, NJ, USA], Google Scholar [Google, Mountain View, CA, USA]) sowie Auswertung und Durchsicht themenspezifischer Webseiten und Fachbüchern durchgeführt.

Ergebnisse

Neben klassischen Kriterien des ST-Hebungs-Infarkts (STEMI) sowie von STEMI-Äquivalenten existieren weitere, subtilere EKG-Veränderungen, die auf eine Myokardischämie hinweisen können.

Schlussfolgerung

Für eine adäquate Beurteilung des EKG im Zusammenhang mit atraumatischem Thoraxschmerz müssen neben klassischen Ischämiezeichen wie dem STEMI auch subtile Hinweise erkannt werden, um den Patienten schnellstmöglich einer notwendigen Koronarintervention zuzuführen.

Abstract

Background

Obtaining an electrocardiogram (ECG) is the gold standard for initial diagnostics of atraumatic chest pain. To provide optimal patient care, the treating physician has to be proficient in recognizing early signs of myocardial ischemia. Information from the clinical assessment and typical ECG signs have to be recognized promptly in order to diagnose myocardial ischemia early.

Methods

A selective literature search in international databases (PubMed, Cochrane Library, Google Scholar) was conducted; current, topic-specific websites and literature were also included and evaluated.

Results

Several subtle ECG abnormalities exist besides the typical ST-elevation myocardial infarction (STEMI) and well-known STEMI equivalents and may point to possible myocardial ischemia.

Discussion

To fully evaluate the ECG in patients with atraumatic chest pain, typical signs of ischemia like STEMI as well as subtle ECG signs should be recognized to allow early cardiac intervention.

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Authors and Affiliations

  1. Klinik für Kardiologie, Zentrale Notaufnahme Klinikum Süd, Klinikum Nürnberg, Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Nürnberg, Deutschland

    Klaus Fessele

  2. Zentrale Notaufnahme, Sozialstiftung Bamberg/Klinikum Bamberg, Bamberg, Deutschland

    Martin Fandler

  3. Zentrale Notaufnahme, Klinikum Fürth, Jakob-Henle-Str. 1, 90766, Fürth, Deutschland

    Philipp Gotthardt

Authors
  1. Klaus Fessele
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  2. Martin Fandler
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  3. Philipp Gotthardt
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Correspondence to Philipp Gotthardt.

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K. Fessele, M. Fandler und P. Gotthardt geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Fessele, K., Fandler, M. & Gotthardt, P. Hochrisiko-EKG bei akutem Thoraxschmerz. Med Klin Intensivmed Notfmed 117, 510–516 (2022). https://doi.org/10.1007/s00063-021-00802-7

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  • DOI: https://doi.org/10.1007/s00063-021-00802-7

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