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Kardiologie up2date 2014; 10(03): 195-209
DOI: 10.1055/s-0034-1390765
Thrombozyten und Gerinnungssystem bei kardiovaskulären Erkrankungen
© Georg Thieme Verlag KG Stuttgart · New York

Notfallbehandlung bei akutem Koronarsyndrom unter dem Blickwinkel der aktuellen STEMI-Leitlinien

Holger Thiele
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Publication History

Publication Date:
24 October 2014 (online)

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Notfallbehandlung bei akutem Koronarsyndrom unter dem Blickwinkel der aktuellen STEMI-LeitlinienNotfallmedizin up2date 2013; 8(04): 269-283
DOI: 10.1055/s-0033-1346882

Abstract

In the following review article a current update in the treatment of acute coronary syndromes is provided. It will cover the aspects of the universal definition of myocardial infarction, ECG diagnosis of ST-elevation myocardial infarction (STEMI), and the treatment of STEMI. In particular the actual European Society of Cardiology guidelines will be discussed.

Kernaussagen

  • Das akute Koronarsyndrom (ACS) setzt sich aus den Entitäten ST-Streckenhebungsinfarkt (STEMI), Nicht-ST-Streckenhebungsinfarkt (NSTEMI) und instabile Angina zusammen.

  • Neben der klinischen Symptomatik stellt ein 12-Kanal-EKG das wichtigste und schnellste diagnostische Kriterium für einen STEMI dar. Die sofortige Ableitung und korrekte Interpretation eines 12-Kanal-EKG ist durch den medizinischen Erstkontakt unumgänglich und sollte in weniger als 10 Minuten erfolgen.

  • Die Therapie beim ACS besteht aus einer symptomatischen und kausalen Therapie.

  • Aufgrund möglicher negativer Effekte sollte die Sauerstoffgabe nicht mehr routinemäßig erfolgen.

  • Die zeitnahe primäre PCI ist das bevorzugte Reperfusionsverfahren.

  • Die Fibrinolyse spielt bei guter Netzwerkbildung in Deutschland keine Rolle mehr.

  • Der Notarzt ist verantwortlich für die Einleitung einer Triage zur Reperfusionstherapie, und er hat die Entscheidung zur primären PCI und möglichst zur Umgehung von Nicht-PCI-Krankenhäusern zu fällen.

  • Zur kausalen Therapie gehört neben der zeitnahen Revaskularisation die Gabe von Antithrombinen und Thrombozytenaggregationshemmern.

  • Die Zeit spielt für die Reperfusionstherapie bei STEMI eine sehr wichtige Rolle.

 

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