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Das akute Koronarsyndrom

Instabile Angina pectoris—Herzinfarkt

Acute coronary syndrome: unstable angina and myocardial infarction

  • Schwerpunkt: Kardiovaskuläre Intensivmedizin
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Zusammenfassung

Das akute Koronarsyndrom umfasst die klinischen Entitäten der instabilen Angina pectoris, des nichttransmuralen Myokardinfarkts (NSTEMI) und des transmuralen Myokardinfarkts mit ST-Streckenhebungen (STEMI). Eine rasche und anhaltende Wiedereröffnung der Infarktarterie sowie die Verhinderung eines größeren Verlusts an Myokard sind die entscheidenden therapeutischen Zielgrößen. Die klinische Diagnosefindung erfolgt durch die Symptomatik, EKG-Veränderungen und den laborchemischen Nachweis von Troponinen im Serum. Letzterer ist bindend für die Diagnose des NSTEMI und STEMI. Die Methode der Wahl, soweit verfügbar, stellt die möglichst rasch einsetzende interventionelle Therapie der koronaren Herzerkrankung dar. Als Alternative oder auch als Überbrückung bietet sich nach Ausschluss von Kontraindikationen die systemische Thrombolyse an. Die medikamentöse Begleittherapie wird heute wesentlich durch Heparine, eine antithrombotische Therapie und durch die Gabe von CSE-Hemmern bestimmt. Zur Verhinderung des linksventrikulären Umbaus nach Infarkt finden ACE-Hemmer bzw. Angiotensin-2-Rezeptorantagonisten und β-Blocker frühzeitig Anwendung.

Abstract

The acute coronary syndrome comprises unstable angina, non-ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction. A successful and stable revascularisation of the infarct related vessel, and the prevention of the loss of myocardium are the main therapeutic targets, as cardiovascular mortality and long term quality of life are essentially determined by left ventricular function. The clinical diagnosis comprises clinical symptoms, ECG-changes, and cardiac troponins. Early percutaneous coronary intervention (PCI) has become the most common method of coronary revascularisation. If PCI is not available, systemic thrombolysis is an alternative after exclusion of contraindications. Parenteral anticoagulation with intravenous or subcutaneous heparines, antithrombotic therapy and HMG-CoA reductase inhibitors are the common secondary drug therapy. Moreover, to prevent left ventricular remodelling ACE-inhibitors, angiotension 2-receptor antagonists, and β-blocker are indicated.

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  1. Klinik für Kardiologie, Pneumologie und Angiologie, Medizinische Klinik und Poliklinik B, Heinrich-Heine-Universität Düsseldorf

    M. Kelm & B. E. Strauer

  2. Klinik für Kardiologie, Pneumologie und Angiologie, Medizinische Klinik und Poliklinik B, Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf

    M. Kelm

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Kelm, M., Strauer, B.E. Das akute Koronarsyndrom. Internist 46, 265–274 (2005). https://doi.org/10.1007/s00108-005-1357-1

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