Perioperativer Myokardinfarkt

Kernaussagen

• Kardiovaskuläre Komplikationen bedeuten bei Operationen ein großes Risiko für den Patienten. Insbesondere der perioperative Myokardinfarkt (POMI) ist mit einer hohen Mortalität verbunden, da er häufig kaum klinisch fassbare Symptome bietet und daher erst spät erkannt und behandelt wird.

• Typische Auslöser eines POMI sind eine Plaqueruptur mit nachfolgendem Koronargefäßverschluss oder ein Missverhältnis zwischen Sauerstoffangebot und Sauerstoffbedarf durch den operativen Stress und/oder hypoxische Phasen unterschiedlicher Genese.

• Wichtig ist die präoperative Risikoeinschätzung, um perioperativ gefährdende Situationen zu vermeiden und die wenigen klinisch fassbaren Zeichen einer Myokardischämie zu identifizieren.

• Beim klinischen Verdacht auf einen POMI sind eine umgehende Diagnostik mit EKG und Troponinbestimmung sowie eine Therapie in enger interdisziplinärer Absprache erforderlich.

• Bei einem STEMI oder einem NSTEMI mit hämodynamischer Instabilität ist eine Katheterintervention mit Reperfusionsmöglichkeit anzustreben, beim NSTEMI ohne hämodynamische Instabilität steht die konservative Therapie im Vordergrund.

• Literatur

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