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Myokardinfarkt und instabile Angina Pectoris

Diagnostik und Therapie

Myocardial infarct and unstable angina pectoris

Diagnostics and therapy

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Zusammenfassung

Unter dem Oberbegriff akutes Koronarsyndrom werden der ST-Hebungs-Myokardinfarkt, der Myokardinfarkt ohne ST-Hebungen und die instabile Angina Pectoris zusammengefasst. Charakterisiert wird das akute Koronarsyndrom durch den plötzlich einsetzenden Thoraxschmerz. In der Diagnostik kommt dem EKG und der Bestimmung von kardialen Markern zentrale Bedeutung zu. Eine umgehende invasive Diagnostik und interventionelle Therapie gilt beim ST-Hebungs-Infarkt als Therapie der ersten Wahl. Bei Patienten ohne ST-Hebungen sollte die Therapie risikoadaptiert durchgeführt werden. Während bei Patienten mit hohem Risiko (erhöhte Troponinwerte, klinische, hämodynamische oder rhythmische Instabilität, ST-Strecken-Senkungen im Ruhe-EKG, Diabetes mellitus) eine frühinvasive Therapie mit Angiographie inerhalb von 48 bis 72 Stunden indiziert ist, sollten Patienten mit niedrigem Risiko konservativ behandelt werden. Bei allen Patienten, bei denen eine interventionelle Therapie durchgeführt wird, ist in der Akutphase eine aggressive antiaggregatorische Therapie mit Acetylsalicylsäure, Clopidogrel, Heparin und einem Glykoprotein-IIb/IIIa-Hemmer indiziert. Für die Dauertherapie ist die Behandlung der kardiovaskulären Risikofaktoren besonders wichtig.

Abstract

Acute coronary syndromes include ST-elevation and non-ST elevation myocardial infarction, and unstable angina pectoris. These are characterised by the acute onset of chest pain. For the diagnostic work up in the acute phase, ECG and the assessment of cardiac markers play a central role. For patients with ST-elevation, primary interventional therapy is the first choice. For patients with an acute coronary syndrome without ST-elevation, a risk adapted therapeutic strategy should be chosen. High risk patients (elevated troponins, clinical, rhythmological and hemodynamic instability, ST-depression and diabetes mellitus) should be treated by an early invasive approach with angiography performed within 48–72 h. Low risk patients should be treated conservatively. For all patients who are treated interventionally, the administration of an aggressive antiaggregatory therapy including aspirin, clopidogrel, glycoprotein IIb/IIIa inhibitors and heparin is indicated in the acute phase. In the chronic phase, the treatment of cardiovascular risk factors is of paramount importance.

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  1. Abteilung für Kardiologie, Kerckhoff-Klinik, Benekestraße 2–8, 61231, Bad Nauheim, Deutschland

    M. Weber & C. Hamm

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  1. M. Weber
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  2. C. Hamm
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Correspondence to M. Weber.

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Weber, M., Hamm, C. Myokardinfarkt und instabile Angina Pectoris . Internist 48, 399–412 (2007). https://doi.org/10.1007/s00108-007-1802-4

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  • DOI: https://doi.org/10.1007/s00108-007-1802-4

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