Zusammenfassung.
Ein 41jähriger Mann erlitt bei einem Verkehrsunfall ein schweres Polytrauma und einen ausgedehnten traumatischen Myokardinfarkt mit kardiogenem Schock. Aufgrund der Begleitverletzungen war eine thrombolytische Therapie oder eine aortokoronare Bypass-Operation kontraindiziert. Der Versuch einer frühzeitigen koronaren Rekanalisierung mittels perkutaner transluminaler koronarer Angioplastie (PTCA) mißlang aufgrund einer Dissektion der Koronararterie. In der Akutphase war eine operative Versorgung der schweren intraabdominalen und knöchernen Schädelverletzungen notwendig. Der Einsatz einer intraaortalen Gegenpulsation erwies sich als effektiv zur Stabilisierung des Kreislaufs. Die Falldarstellung dokumentiert die Möglichkeiten und den Stellenwert einer koordinierten und gleichrangigen Therapie von myokardialer Ischämie und schweren Begleitverletzungen bei traumatischem Myokardinfarkt.
A 41-year-old man suffered severe polytrauma and developed a traumatic myocardial infarction with cardiogenic shock. Thrombolysis as well as coronary bypass grafting was contraindicated due to accompanying injuries. An attempted early coronary revascularization by percutaneous transluminal coronary angioplasty (PTCA) failed due to dissection of the left interventricular coronary artery. Treatment of cardiac insufficiency was complicated by intraabdominal haemorrhage enforcing emergency laparotomy. Intraaortic balloon counterpulsation proved to be efficient in supporting circulation in these circumstances. The case report documents the practicability and importance of treating both myocardial ischaemia and attending injuries in an equivalent and coordinated manner in traumatic myocardial infarction.
Schlüsselwörter:
Traumatischer Myokardinfarkt - kardiogener Schock - Polytrauma
Key words:
Traumatic myocardial infarction - Cardiogenic shock - Polytrauma
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Dr. Prof. Dr. med. T. Hachenberg
Klinik und Poliklinik für Anästhesiologie und Intensivmedizin Ernst-Moritz-Arndt-Universität
Friedrich-Loeffler-Str. 23b
17489 Greifswald
Email: hachenbe@mail.uni-greifswald.de
