Dtsch Med Wochenschr 2005; 130(12): 677-682
DOI: 10.1055/s-2005-865079
Übersichten
Kardiologie
© Georg Thieme Verlag Stuttgart · New York

Kardiologische Intensivmedizin - das akute Koronarsyndrom

Intensive care in cardiovascular medicine - acute coronary syndromeM. G. Hennersdorf1 , S. Steiner1 , M. Kelm1 , B.-E Strauer1
  • 1Klinik für Kardiologie, Pneumologie und Angiologie, Heinrich-Heine-Universität, Düsseldorf
Further Information

Publication History

eingereicht: 8.12.2004

akzeptiert: 9.3.2005

Publication Date:
18 March 2005 (online)

Die internistische Intensivmedizin wird in einem breiten Bereich durch kardiologische Krankheitsbilder mitbestimmt. Dadurch betroffen sind das akute Koronarsyndrom/ der akute Myokardinfarkt, schwerwiegende Arrhythmien, die akute und akut dekompensierte chronische Herzinsuffizienz, das akute Cor pulmonale/ die akute Lugenembolie, aber auch Mitreaktionen des Herz-Kreislauf-Systems im Rahmen von Systemerkankungen (Sepsis, die verschiedenen Schockformen). Für diesen Artikel wurden stellvertretend die Therapie des akuten Koronarsyndromes/ des akuten Herzinfarktes und schwerwiegender Arrhythmien ausgewählt. Das akute Koronarsyndrom nimmt eine wichtige Stellung ein. Bei steigender Prävalenz der koronaren Herzerkrankung stellen Patienten mit diesen Krankheitsbildern einen Großteil kardiologisch kranker Patienten in der Intensivmedizin dar. Das akute Koronarsysndrom umfasst die instabile Angina pectoris, den nicht-transmuralen und den transmuralen Myokardinfarkt. Die diagnostischen und therapeutischen Möglichkeiten dieser Entität sowie von supraventrikulären und ventrikulären Arrhythmien werden in diesem Artikel dargestellt und der aktuelle Stand vermittelt.

Literatur

  • 1 Antoniucci D, Santoro G M, Bolognese L. et al . A clinical trial comparing primary stenting of the infarct-related artery with optimal angioplasty for acute myocardial infarction. Results from the Florence randomized elective stenting in acute coronary occlusions (FRESCO) trial.  J Am Coll Cardiol. 1998;  31 1234-1239
  • 2 Bertrand M E, Simoons M, Fox K A. et al . Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. The Task Force on the Management of Acute Coronary Syndromes of the European Society of Cardiology.  Eur Heart J. 2000;  23 1809-1840
  • 3 Brener S J, Barr L A, Burchenal J EB. et al . Randomized, placebo-controlled trial of platelet glycoprotein IIb/IIIa blockade with primary angioplasty for acute myocardial infarction.  Circulation. 1998;  98 734-741
  • 4 Cannon C P, Weintraub W S, Demopoulos L A. et al . Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the Glycoprotein IIb/IIIa inhibitor tirofiban.  N Engl J Med. 2001;  344 1879-1887
  • 5 Coyne K S, Lundergan C F, Boyle D. et al . Relationship of infarct artery patency and left ventricular ejection fraction to health-related quality of life aftr myocardial infarction.  Circulation. 2000;  102 1245-1251
  • 6 Cura F A, Bhatt D L, Lincoff A M. et al . Pronounced benefit of coronary stenting and adjunctive platelet glycoprotein IIb/IIIa inhibition in complex atherosclerosis lesions.  Circulation. 2000;  102 28-34
  • 7 Davies M J, Thomas A C. Plaque fissuring - the cause of acute myocardial infarction, sudden ischaemic death, and crescendo angina.  Br Heart J. 1985;  53 363-373
  • 8 Desai A D, Chun S, Sung R J. The role of intravenous amiodarone in the management of cardiac arrhythmias.  Ann Intern Med. 1997;  127 294-303
  • 9 Domanovits H, Schillinger M, Thoennissen J. et al . Termination of recent-onset atrial fibrillation/flutter in the emergency department: a sequential approach with intravenous ibutilide and external electrical cardioversion.  Resuscitation. 2000;  45 181-187
  • 10 Donaldson L, Grant L S, Naysmith N R. et al . Acute amiodarone-induced lung toxicity.  Intensive Care Med. 1998;  24 626-630
  • 11 Erbel R, Heusch G. Spontaneous and iatrogenic microembolization. A new concept for the pathogenesis of coronary artery disease.  Herz. 1999;  24 493-495
  • 12 Wallentin L. FRISC Study Group . Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC II prospective randomised multicentre study.  Lancet. 1999;  354 708-715
  • 13 Gawaz M, Neumann F -J, Ott I. et al . Platelet Function in Acute Myocardial Infarction Treated With Direct Angioplasty.  Circulation. 1996;  93 229-237
  • 14 Grines C L, Cox D A, Stone G W. et al . Coronary Angioplasty With or Without Stent Implantation For Acute Myocardial Infarction.  N Engl J Med. 1999;  341 1949-1956
  • 15 Topol E J, Califf R M. et al. GUSTO . A comparison of recombinant hirudin with heparin for the treatment of acute coronary syndromes.  N Engl J Med. 1996;  335 775-782
  • 16 Hamm C W, Arntz H R, Bode C. et al . Leitlinien: Akutes Koronarsyndrom (ACS). Teil 1: ACS ohne persistierende ST-Hebung.  Z Kardiol. 2004;  93 72-90
  • 17 Hamm C W, Arntz H R, Bode C. et al . Leitlinien: Akutes Koronarsyndrom (ACS). Teil 2: Akutes Koronarsyndrom mit ST-Hebung.  Zeitschrift für Kardiologie. 2004;  93 324-341
  • 18 Hamm C W, Heeschen C, Goldmann B. et al . Benefit of abciximab in patients with refractory unstable angina in relation to serum troponin T levels.  N Engl J Med. 1999;  340 1623-1629
  • 19 Hennersdorf M G, Evers S, Perings C. et al . Antiarrhythmische Therapie von Vorhofflimmern.  Herzschr Electrophysiol. 2001;  12 86-94
  • 20 Hennersdorf M G, Perings S M, Zuhlke C. et al . Conversion of recent-onset atrial fibrillation or flutter with ibutilide after amiodarone has failed.  Intensive Care Med. 2002;  28 925-929
  • 21 Kelm M, Strauer B E. Akuter Myokardinfarkt - primäre Angioplastie oder Thrombolyse?.  Internist. 2000;  41 1331-1343
  • 22 Knotzer H, Mayr A, Ulmer H. et al . Tachyarrhythmias in a surgical intensive care unit: a case-controlled epidemiologic study.  Intensive Care Med. 2000;  26 908-914
  • 23 Kudenchuk P J, Cobb L A, Copass M K. et al . Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation.  N Engl J Med. 1999;  341 871-878
  • 24 Landau C, Glamann D B, Willard J E. et al . Coronary angioplasty in the patient with acute myocardial infarction.  Am J Med. 1994;  96 536-543
  • 25 Lieu T A, Gurley R J, Lundstrom R J. et al . Primary angioplasty and thrombolysis for acute myocardial infarction: an evidence summary.  J Am Coll Cardiol. 1996;  27 737-750
  • 26 Lincoff A M, Tcheng J E, Califf R M. et al . Sustained suppresion of ischemic complications of coronary intervention by platelet GP IIb/IIIa blockade with abciximab-One-year outcome in the EPILOG trial.  Circulation. 1999;  99 1951-1958
  • 27 Martínez-Marcos F J, García-Garmendia J L, Ortega-Carpio A. et al . Comparison of intravenous flecaninde, propafenone, and amiodarone for conversion of acute atrial fibrillation to sinus rhythm.  Am J Cardiol. 2000;  86 950-953
  • 28 Neumann F -J, Blasini R, Schmitt C. et al . Effect of glycoprotein IIb/IIIa receptor blockade on recovery of coronary flow and left ventricular function after the placement of coronary-artery stents in acute myocardial infarction.  Circulation. 1998;  98 2695-2701
  • 29 Ohman E M, Califf R M, Topol E J. The TAMI Study Group . Consequences of reocclusion after successful reperfusion therapy in acute MI.  Circulation. 1990;  82 781-791
  • 30 Peter K, Kohler B, Straub A. et al . Flow cytometric monitoring of glyycoprotein IIb/IIIa blockade and platelet function in patients with acute myocardial infarction receiving reteplase, abciximab, and ticlopidine - Continuous platelet inhibition by the combination of abciximab and ticlopidine.  Circulation. 2000;  102 1490-1496
  • 31 Podrid P J. Amiodarone: Reevaluation of an old drug.  Ann Intern Med. 1995;  122 689-700
  • 32 Prystowsky E N. Management of atrial fibrillation: Therapeutical options and clinical decisions.  Am J Cardiol. 2000;  85 3D-11D
  • 33 Reinelt P, Karth G D, Geppert A. et al . Incidence and type of cardiac arrhythmias in critically ill patients: a single center experience in a medical-cardiological ICU.  Intensive Care Med. 2001;  27 1466-1473
  • 34 Schömig A, Neumann F -J, Kastrati A. et al . A randomized comparison of antiplatelet and anticoagulant therapy after the placemant of coronary-artery stents.  N Engl J Med. 1996;  334 1084-1089
  • 35 Schrör K. Endotheliale Faktoren und Thrombozytenfunktion.  Z Kardiol. 1991;  80 3-6
  • 36 Seguin P, Signouret T, Laviolle B. et al . Incidence and risk factors of atrial fibrillation in a surgical intensive care unit.  Crit Care Med. 2004;  32 722-726
  • 37 Society of Cardiology . Myocardial infarction redefined - a consensus document of the joint european society of cardiology/american college of cardiology committee for the redefinition of myocardial infarction.  J Am Coll Cardiol. 2000;  36 959-970
  • 38 Stambler B S. Ibutilide.  Cardiac Electrophysiology Review. 1998;  2 173-175
  • 39 Suryapranata H, van’t Hof A W, Hoorntje J C. et al . Randomized comparison of coronary stenting with bolloon angioplasty in selected patients with acute myochardian infarction.  Circulation. 1998;  97 2502-2505
  • 40 Suttorp M J, Kingma J H, Lie-A-Huen L. Intravenous flecainide versus verapamil for acute conversion of paroxysmal atrial fibrillation or flutter to sinus rhythm.  Am J Cardiol. 1989;  63 693-696
  • 41 Topol E J, Holmes D R, Rogers W J. Coronary angiography after thrombolytic therapy for acute myocardial infarction.  Ann Intern Med. 1991;  114 877-885
  • 42 Topol E J, Yadav J S. Recognition of the importance of embolization in atherosclerotic vascular disease.  Circulation. 2000;  101 570-580
  • 43 Volgman A S, Carberry P A, Stambler B S. Conversion efficacy and safety of intravenous ibutilide compared with intravenous procainamide in patients with atrial flutter or fibrillation.  J Am Coll Cardiol. 1998;  31 1414-1419
  • 44 Vos M A, Golitysn S R, Stangl K. et al . Superiority of ibutilide (a new class III agent) over dl-sotalol in converting atrial flutter and atrial fibrillation.  Heart. 1998;  79 568-575
  • 45 Weaver W D, Simes R J, Betriu A. et al . Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction. A quantitative review.  JAMA. 1997;  278 2093-2098
  • 46 Wu K C, Zerhouni E A, Judd R M. et al . Prognostic significance of microvascular obstruction by magnetic resonance imaging in patients with acute myocardial infarction.  Circulation. 1998;  97 765-772
  • 47 Zeltser D, Justo D, Halkin A. et al . Drug-induced atrioventricular block: prognosis after discontinuation of the culprit drug.  J Am Coll Cardiol. 2004;  44 105-108
  • 48 Zijlstra F, Hoorntje J CA, De Boer M J. et al . Long-term benefit of primary angioplasty as compared with thromobolytic therapy for acute myocardial infarction.  N Engl J Med. 1999;  341 1413-1419
  • 49 Schneider H, Weber F, Paranskaja L, Holzhausen C, Petzsch M, Severin R, Nienaber C A. Leitlinienkonforme interventionelle Therapie des akuten ST-Hebungsinfarkt in ländlichen Gebieten durch Netzwerkbildung.  Dtsch Med Wochenschr. 2004;  129 2162-2166

Priv.-Doz. Dr. med. Marcus G. Hennersdorf

Medizinische Kinik und Poliklinik B, Klinik für Kardiologie, Pneumologie und Angiologie, Heinrich-Heine-Universität

Moorenstraße 5

40225 Düsseldorf

Phone: 0211/8118800

Fax: 0211/8119520

Email: hennersdorf@med.uni-duesseldorf.de

    >