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Diagnostische Abklärung des akuten Koronarsyndroms bei älteren Patienten in der Notaufnahme

Diagnostic evaluation of acute coronary syndrome in elderly patients at the emergency department

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Zusammenfassung

Abklärungsalgorithmus in der Notaufnahme

Ältere Patienten, die sich mit akuten Thoraxschmerzen in der Klinik vorstellen, müssen zeitnah und strukturiert abgeklärt werden. Die Abklärung eines akuten Koronarsyndroms umfasst neben einer ausführlichen Erhebung der Krankenbeschwerden die körperliche Untersuchung, die Aufzeichnung eines 12-Kanal-Elektrokardiogramms (EKG), die Bestimmung von kardialen Biomarkern, meist von Troponin T oder I und eine echokardiographische Untersuchung. Häufig schließt sich eine mehrstündige Beobachtungsphase mit EKG- und Troponin-Monitoring und ggf. einem Belastungstest an.

Diagnose

Unter Zusammenschau aller Befunde kann die Diagnose eines akuten Myokardinfarkts gestellt werden. Die Diagnosestellung bei älteren Patienten ist häufig schwierig, da sie vielfach atypische Beschwerden aufweisen. Patienten, die aufgrund entsprechender Befunde ein hohes oder intermediäres Risiko für zukünftige kardiovaskuläre Ereignisse haben, müssen einer invasiven Diagnostik zugeführt werden. Patienten mit niedrigem Risiko haben eine günstige Prognose und können ambulant weiterbetreut werden. Dieser Beitrag beinhaltet eine Übersicht zur strukturierten Abklärung des akuten Koronarsyndroms bei älteren Patienten.

Abstract

Diagnostic algorithm in the emergency department

Elderly patients admitted to hospital with acute chest pain must be investigated in a timely and structured manner. The evaluation of an acute coronary syndrome includes a physical examination, recording of a 12-lead electrocardiogram (ECG), measurement of cardiac biomarkers, usually of troponin T or I and an echocardiographic examination in addition to the past medical history. The evaluation is frequently followed by an observation period with monitoring of ECG and troponin and possibly by a stress test.

Diagnosis

With consideration of all findings the diagnosis of an acute myocardial infarction can be made. The diagnosis among elderly patients is frequently difficult as they often exhibit atypical complaints. Patients who are at high or intermediate risk for future cardiovascular events should undergo an invasive evaluation. Low-risk patients have a favorable prognosis and can be treated as outpatients. This article provides an overview on the diagnosis of acute coronary syndrome in elderly patients.

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Conflict of interest

P. Bahrmann holds a scholarship from the Robert Bosch Foundation (Forschungskolleg Geriatrie der Robert-Bosch-Stiftung). He also receives research grants from ThermoFisher Scientific. T. Bertsch und M. Christ receive research grants from Roche Diagnostics.

 

This article does not contain any studies with human or animal subjects.

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Authors and Affiliations

  1. Institut für Biomedizin des Alterns, Universität Erlangen - Nürnberg, Heimerichstraße 58, 90419, Nürnberg, Deutschland

    P. Bahrmann FESC & C.C. Sieber

  2. Klinik für Notfallmedizin und Internistische Intensivmedizin, Klinikum Nürnberg, Nürnberg, Deutschland

    S. Popp & M. Christ

  3. Institut für Klinische Chemie, Laboratoriumsmedizin und Transfusionsmedizin, Klinikum Nürnberg, Nürnberg, Deutschland

    T. Bertsch

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  1. P. Bahrmann FESC
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  5. M. Christ
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Correspondence to P. Bahrmann FESC.

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Bahrmann, P., Popp, S., Bertsch, T. et al. Diagnostische Abklärung des akuten Koronarsyndroms bei älteren Patienten in der Notaufnahme. Notfall Rettungsmed 16, 284–290 (2013). https://doi.org/10.1007/s10049-012-1622-5

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