Diagnose und Therapie des kardiogenen Schocks im akuten Myokardinfarkt

Der kardiogene Schock ist weiterhin neben malignen Herzrhythmusstörungen die für die Prognose relevanteste Komplikation des akuten Myokardinfarkts mit einer Mortalität von 40 – 50%. Dieser Artikel soll das Thema von der Diagnose bereits in der prähospitalen Phase über die akute Triage bis zur Therapie beleuchten.

Kernaussagen

• Die Mortalität beim kardiogenen Schock liegt bei 40 – 50%. Rund 80% der kardiogenen Schocks basieren auf einem akuten Myokardinfarkt. Etwa 5 – 15% aller Myokardinfarkte entwickeln einen kardiogenen Schock.

• Die Verdachtsdiagnose „kardiogener Schock“ kann bereits beim ersten Patientenkontakt mittels EKG, Blutdruckmessung, Anamnese und klinischer Untersuchung gestellt werden.

• Bei Patienten mit infarktbedingtem kardiogenem Schock sollten unverzüglich eine invasive Koronardiagnostik mit anschließender Revaskularisation durchgeführt werden.

• Eine frühe Diagnose sowie ein zeitnaher Transport in ein Krankenhaus der maximalen Versorgung und eine frühe Revaskularisation mittels PCI oder ggf. CABG ist für die weitere Prognose des Patienten von entscheidender Bedeutung.

• Zur hämodynamischen Stabilisierung sind Dobutamin und Noradrenalin die Mittel der 1. Wahl. Die Dosierung sollte immer so niedrig wie möglich gewählt werden.

• Linksventrikuläre Unterstützungssysteme können im therapierefraktären kardiogenen Schock in Zentren implantiert werden. Implantationszeitpunkt, Art des Device und prognostischer Nutzen sind aktuell noch Untersuchungsschwerpunkte einiger Studien.

Schlüsselwörter

akuter Myokardinfarkt - kardiogener Schock - akutes Koronarsyndrom - Notfallmedizin

• Literatur

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