Diagnose und Triage

Zusammenfassung

Der Begriff akutes Koronarsyndrom (ACS) umfasst ein weites Spektrum. Patienten mit der Arbeitsdiagnose ACS können final an einem akuten Myokardinfarkt (AMI) leiden – wobei wir zwischen Nicht-ST-Strecken-Hebungsinfarkt (NSTEMI) und ST-Strecken-Hebungsinfarkt (STEMI) unterscheiden – oder auch eine instabile Angina aufweisen. Die Anamnese, klinische Untersuchung, Veränderungen im 12-Kanal-EKG und die Bestimmung der Konzentration von kardialem hochsensitivem Troponin (hs-cTn) helfen dabei, ausgehend von der Arbeitshypothese akutes Koronarsyndrom eine definitive Diagnose stellen zu können.

Die Bandbreite der klinischen Präsentation von Patienten mit ACS ist groß und reicht von symptomfreien Patienten über Patienten mit anhaltenden Brustschmerzen bis zu Patienten mit Herzstillstand, elektrischer/hämodynamischer Instabilität oder kardiogenem Schock (CS). Zum initialen Management werden die Patienten mit ACS typischerweise anhand der EKG-Veränderungen klassifiziert. Im Weiteren kann eine Unterteilung basierend auf etwaigen laborchemischen Erhöhung von hs-cTn getroffen werden. Die diagnostischen Tools (Veränderungen des EKGs und hs-cTn) sind für die initiale Triage sowie Diagnosestellung essenziell, um eine Risikostratifizierung für den individuellen Patienten durchzuführen und die initiale therapeutische Strategie festzulegen.

Nach dem akuten Management und der Stabilisierung des Patienten ist die weiterführende therapeutische Strategie einheitlicher für alle ACS-Patienten und weist keine so diversifizierten Therapieschemata wie das initiale Management auf.

Abstract

Acute coronary syndromes (ACS) encompass a wide spectrum of conditions. Patients presenting with suspected ACS may eventually receive a diagnosis of acute myocardial infarction (AMI), including the categories of ST-segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI) or unstable angina (UA). Clinical presentation, changes on 12-lead electrocardiogram and concentrations of high sensitivity cardiac troponin (hs-cTn) will help to navigate from a working diagnosis of ACS to a final diagnosis.

ACS are associated with a broad range of clinical presentations, from patients who are symptom free at presentation to patients with ongoing chest discomfort/symptoms and patients with cardiac arrest, electrical/hemodynamic instability, or cardiogenic shock (CS). Patients presenting with suspected ACS are typically classified based on ECG at presentation for the purposes of initial management. After this, patients can be further classified based on the presence or absence of hs-cTn elevation. These features (ECG and hs-cTn changes) are important in the initial triage and diagnosis of patients with ACS, helping to risk stratify patients and guide the initial management strategy. However, after the acute management and stabilization phase, most aspects of the subsequent management strategy are common to all ACS patients (regardless of the initial ECG pattern or the presence/absence of hs-cTn elevation at presentation) and can therefore be considered under a common pathway.

Was ist wichtig?

Patienten mit der Verdachtsdiagnose akutes Koronarsyndrom (ACS) weisen eine große Bandbreite an Symptomen und Zustandsbildern auf, wobei uns 3 diagnostische Werkzeuge bei der Festlegung der definitiven Diagnose helfen können/sollten [1]:

• klinische Präsentation und klinische Untersuchung,

• Elektrokardiogramm (EKG),

• hochsensitives kardiales Troponin (hs-cTn).

Schlüsselwörter

Myokardinfarkt - STEMI - NSTE-ACS - NSTEMI - akutes Koronarsyndrom - instabile Angina

Keywords

myocardial infarction - STEMI - NSTE-ACS - NSTEMI - acute coronary syndrome - unstable angina

Publication History

Article published online:
05 April 2024

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