Was tun bei akutem Thoraxschmerz?

Abstract

Acute chest pain is one of the most important cardinal symptoms in medicine. There are several important differential diagnoses for chest pain. Therefore, a thorough history and physical examination, as well as the 12-lead ECG and laboratory tests are crucial. In clinical practice, it is useful to distinguish between cardiac chest pain and other forms of chest pain in order to treat patients appropriately and to exclude potentially life-threatening conditions.

Der akute Thoraxschmerz gehört zu den wichtigsten internistischen Leitsymptomen. Anamnese, Inspektion, körperliche Untersuchung, Basisdiagnostik mittels 12-Kanal-EKG und Laborchemie sind essenziell, um die vielfältigen möglichen Ursachen abzuklären. Bildgebung, verschiedene Scores und die Einteilung in kardiale und nicht kardiale Verdachtsdiagnosen helfen, unmittelbar lebensbedrohliche Krankheitsbilder schnell und sicher zu identifizieren.

Schlüsselwörter

akuter Brustschmerz - Diagnose - Myokardinfarkt - Lungenembolie - akutes Aortensyndrom

Key words

acute chest pain - diagnosis - myocardial infarction - pulmonary embolism - acute aortic syndrom

• Literatur

• 1 Bosner S, Becker A, Haasenritter J. et al. Chest pain in primary care: epidemiology and pre-work-up probabilities. Eur J Gen Pract 2009; 15: 141-146
• 2 Nilsson S, Scheike M, Engblom D. et al. Chest pain and ischaemic heart disease in primary care. Br J Gen Pract 2003; 53: 378-382
• 3 Battegay E, Siegenthaler W. Hrsg Siegenthalers Differenzialdiagnose: Innere Krankheiten – vom Symptom zur Diagnose. 20.. Aufl. Stuttgart: Thieme; 2012
• 4 Erbel R, Aboyans V, Boileau C. et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. Eur Heart J 2014; 35: 2873-2926
• 5 Bossone E, LaBounty TM, Eagle KA. Acute aortic syndromes: diagnosis and management, an update. Eur Heart J 2018; 39: 739-749d
• 6 Bruno RR, Donner-Banzhoff N, Sollner W. et al. The Interdisciplinary Management of Acute Chest Pain. Dtsch Arztebl Int 2015; 112: 768-779 , quiz 780
• 7 Wachter C, Markus B, Schieffer B. Cardiac causes of chest pain. Internist (Berl) 2017; 58: 8-21
• 8 Haasenritter J, Donner-Banzhoff N, Bosner S. Chest pain for coronary heart disease in general practice: clinical judgement and a clinical decision rule. Br J Gen Pract 2015; 65: e748-e753
• 9 Christ M, Popp S, Pohlmann H. et al. Implementation of high sensitivity cardiac troponin T measurement in the emergency department. Am J Med 2010; 123: 1134-1142
• 10 Ibanez B, James S, Agewall S. et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2018; 39: 119-177
• 11 Roffi M, Patrono C, Collet JP. et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2016; 37: 267-315
• 12 Thygesen K, Mair J, Giannitsis E. et al. How to use high-sensitivity cardiac troponins in acute cardiac care. Eur Heart J 2012; 33: 2252-2257
• 13 Konstantinides SV, Torbicki A, Agnelli G. et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014; 35: 3033-3069, 3069a-3069k
• 14 Le Gal G, Righini M, Roy PM. et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med 2006; 144: 165-171
• 15 Shen JH, Chen HL, Chen JR. et al. Comparison of the Wells score with the revised Geneva score for assessing suspected pulmonary embolism: a systematic review and meta-analysis. J Thromb Thrombolysis 2016; 41: 482-492
• 16 Wells PS, Anderson DR, Rodger M. et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thromb Haemost 2000; 83: 416-420
• 17 Tritschler T, Kraaijpoel N, Le Gal G. et al. Venous Thromboembolism: Advances in Diagnosis and Treatment. JAMA 2018; 320: 1583-1594
• 18 Sechtem U, Achenbach S, Friedrich M. et al. Non-invasive imaging in acute chest pain syndromes. Eur Heart J Cardiovasc Imaging 2012; 13: 69-78
• 19 Shah BN, Ahmadvazir S, Pabla JS. et al. The role of urgent transthoracic echocardiography in the evaluation of patients presenting with acute chest pain. Eur J Emerg Med 2012; 19: 277-283
• 20 Montalescot G, Sechtem U, Achenbach S. et al. 2013 ESC guidelines on the management of stable coronary artery disease. Eur Heart J 2013; 34: 2949-3003