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Notfallmedizin up2date 2011; 6(1): 65-80
DOI: 10.1055/s-0030-1270838
Reanimation

© Georg Thieme Verlag KG Stuttgart · New York

Notfallbehandlung bei akutem Koronarsyndrom nach aktuellen Leitlinien

Hans-Richard Arntz, Holger Thiele
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Publication Date:
21 March 2011 (online)

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Kernaussagen

Akutes Koronarsyndrom

  • Das akute Koronarsyndrom setzt sich aus den Entitäten STEMI, NSTEMI und instabile Angina zusammen.

  • Neben der klinischen Symptomatik stellt ein 12-Kanal-EKG das wichtigste und schnellste diagnostische Kriterium für einen akuten STEMI dar. Die sofortige Ableitung und korrekte Interpretation eines 12-Kanal-EKGs durch den medizinischen Erstkontakt ist unumgänglich.

  • Beim NSTEMI zeigt das EKG variable oder keine Veränderungen. Die Diagnose wird durch zusätzliche Laborparameter gestellt, die Ausdruck einer myokardialen Nekrose sind, deren Bestimmung im Rettungsdienst aber keine Rolle spielt.

  • Die Therapie beim akuten Koronarsyndrom besteht aus einer symptomatischen und einer kausalen Therapie.

  • Die symptomatische Therapie beinhaltet die Gabe von Nitroglyzerin und eventuell einem Opiat. Aufgrund möglicher negativer Effekte sollte die Sauerstoffgabe nicht mehr routinemäßig erfolgen.

  • Zur kausalen Therapie gehört die Gabe von Antithrombinen und Thrombozytenaggregationshemmern.

  • Weiterhin obliegt dem Notarzt bei der Diagnose STEMI die Einleitung einer Triage zur Reperfusionstherapie. Der Notarzt hat folgende Entscheidungen zu treffen:

    • primäre PCI oder (prä-)hospitale Lyse?

    • bei Entscheidung zur primären PCI: Umgehung von Nicht-PCI-Krankenhäusern?

    • Wahl des Reperfusionsverfahrens bei überlebtem plötzlichen Herzstillstand

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

  • Bei der Entscheidung für eine Lyse, die nur bei nicht optimalen Bedingungen für eine primäre PCI zu erwägen ist, spielen eine Rescue-PCI oder pharmakoinvasives Vorgehen eine wichtige Rolle in Abhängigkeit vom Lyseerfolg.

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Prof. Dr. med. Hans-Richard Arntz

Universitätsklinikum Benjamin Franklin

Hindenburgdamm 30

12200 Berlin

Phone: 030/84 45 46 79

Fax: 030/84 45 26 40

Email: hans-richard.arntz@charite.de

Prof. Dr. med. Holger Thiele

Universität Leipzig – Herzzentrum
Klinik für Innere Medizin/Kardiologie

Strümpellstraße 39

04289 Leipzig

Phone: 03 41/8 65-14 26/14 28

Fax: 03 41/8 65-14 61

Email: thielh@medizin.uni-leipzig.de