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Akuter Myokardinfarkt: Nicht-interventionelle Standardtherapie in der ICU

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Die Notfalltherapie bei akutem Myokardinfarkt

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Abstract

Noninterventional standard treatment measures for acute myocardial infarction in the ICU consist of routine care (medical examination; adequate bedding and bed rest; monitoring; venous access; oxygen and nitroglycerin therapy; analgesia; heparin), measures to reduce infarct size and thereby acute and long term mortality (acetyl salicylic acid; thrombolytics; beta-blockers; ACE inhibitors — at least in case of more severe pump failure) — and — finally — prophylaxis and treatment of infarct complications (heart failure, pulmonary oedema and cardiogenic shock; life-threatening bradycardias and tachycardias; ongoing myocardial ischemia), with consecutive reduction of immediate mortality. While calcium antagonists are no longer drugs of choice in patiens with myocardial infarction, intravenous magnesium and glucose-insulin-potassium solutions do not yet represent established treatment procedures in myocardial infarction. In case of right ventricular infarction and cardiogenic shock noninterventional treatment alone fails to reduce the high mortality; this may only be achieved by additional reopening of the infarct related coronary artery — mostly by coronary angioplasty — yielding a sufficient coronary flow.

Zusammenfassung

Die nichtinterventionelle Standardtherapie des akuten Myokardinfarkts in der ICU besteht in der Basisbetreuung und Basisbehandlung (Untersuchung; adäquate Lagerung und Bettruhe; Monitoring; venöser Zugang; Sauerstoff; Nitroglyzerin; Analgesie; Heparin), in der Infarktgrößenreduktion mit Senkung der Akut- und Langzeitletalität (Azetylsalizylsäure; Thrombolytika; Betabiocker; zumindest bei höhergradiger Pumpfunktionseinschränkung auch ACE-Hemmer) sowie in der Prophylaxe und Therapie von Infarktkomplikationen (Herzinsuffizienz, Lungenödem und kardiogener Schock; bradykarde und tachykarde Rhythmusstörungen; anhaltende Myokardischämie) mit Senkung der Akutletalität. Für Kalziumantagonisten gibt es kaum noch Indikationen; die intravenöse Magnesiumgabe und die Glukose-Insulin-Kalium-Infusion haben ihre Wirksamkeit bisher noch nicht überzeugend belegt. Bei Rechtsherzinfarkt und infarktbedingtem kardiogenem Schock reicht die nichtinterventionelle Standardtherapie nicht aus: hier ist zur Senkung der hohen Sterblichkeit die rasche Wiedereröffnung des verschlossenen Infarktgefäßes mit Wiederherstellung eines ausreichenden Koronarflusses — meist mittels Akut-PTCA — erforderlich.

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  1. Klinik und Poliklinik für Innere Medizin III, Klinikum Kröllwitz der Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, D-06097, Halle/Saale, Deutschland

    Dr. med. C. Kuhn & Prof. Dr. med. K. Werdan

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  1. Klinikum Benjamin Franklin, Medizinische Klinik II, Hindenburgdamm 30, D-12200, Berlin, Germany

    H.-R. Arntz

  2. Städtisches Krankenhaus Hildesheim Medizinische Klinik I, Akademisches Lehrkrankenhaus der Medizinischen Hochschule Hannover, Weinberg 1, D-31134, Hildesheim, Germany

    H.-P. Schuster

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Kuhn, C., Werdan, K. (2000). Akuter Myokardinfarkt: Nicht-interventionelle Standardtherapie in der ICU. In: Arntz, HR., Schuster, HP. (eds) Die Notfalltherapie bei akutem Myokardinfarkt. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-642-57713-0_9

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  • DOI: https://doi.org/10.1007/978-3-642-57713-0_9

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