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Notfallmedizin up2date 2011; 6(4): 257-269
DOI: 10.1055/s-0031-1280250
Spezielle Notfallmedizin
Georg Thieme Verlag KG Stuttgart · New York

Diagnose und Therapie des kardiogenen Schockes im akuten Myokardinfarkt

Georg Fürnau
,
Holger Thiele
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Publication History

Publication Date:
21 October 2011 (online)

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Einleitung

Abkürzungen

CABG aortokoronare Bypassoperation

CI Cardiac Index, Herzindex = HZV/Körperoberfläche

CPI Cardiac Power Index: (CPI [W/m2] = CI × MAD × 0,0022)

ECMO extrakorporale Membranoxygenierung

eNOS endotheliale Stickstoffmonoxidsynthasen

HZV Herzzeitvolumen

IABP intraaortale Ballongegenpulsation

iNOS induzierbare Stickstoffmonoxidsynthasen

LVAD linksventrikuläres Unterstützungssystem

MAD arterieller Mitteldruck

NO Stickstoffmonoxid

PCI perkutane Koronarintervention

PCWP pulmonalkapillärer Verschlussdruck

SIRS Systemic Inflammation Response Syndrome

Die Therapie des akuten Myokardinfarkts hat sich in den vergangenen Jahren durch die Weiterentwicklung der interventionellen Therapie und die Verbesserung der adjunktiven medikamentösen Therapie wie zum Beispiel durch Glykoproteinrezeptor-Antagonisten sukzessive verbessert. So konnte die Krankenhaus-Mortalität des akuten Myokardinfarkts von 30 auf 5 % gesenkt werden [1], [2], [3]. In 5–15 % der Fälle mit akutem Myokardinfarkt, je nach gewählter Definition, kommt es jedoch zum Auftreten eines kardiogenen Schockes [1], [2], [4]. Dies ist für die Prognose des Patienten von entscheidender Bedeutung, da in der Literatur die Sterblichkeit des kardiogenen Schockes mit bis zu 50 % beschrieben ist [2], [5], [6], [7].

Die Ausbildung eines kardiogenen Schockes ist die häufigste Todesursache und somit die bedeutendste Komplikation im akuten Myokardinfarkt.

Von immenser Bedeutung ist es, die Entwicklung eines kardiogenen Schockes möglichst früh, im besten Fall schon präklinisch, zu erkennen und den Patienten einer adäquaten Therapie zuzuführen. Aktuell wurde im Jahr 2010 eine neue S3-Leitlinie für Deutschland und Österreich herausgegeben, in der auch dieser Punkt Beachtung findet [8]. Diese Übersichtsarbeit soll Ihnen nun den aktuellen Stand in Diagnostik und Therapie des kardiogenen Schockes im akuten Myokardinfarkt näherbringen, aber auch die Pathophysiologie im kardiogenen Schock beleuchten.

 

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