Zusammenfassung
Das akute Koronarsyndrom, definiert als ST-Streckenhebungsinfarkt, Nicht-ST-Streckenhebungsinfarkt
und instabile Angina pectoris, ist die häufigste Einsatzindikation für den Notarzt.
Definitionsgemäß ist neben der Berücksichtigung der klinischen Beschwerden das Zwölf-Kanal-EKG
Schlüsselinstrument zur Diagnostik. Um einen optimalen Therapieweg zu wählen, muss
der Notarzt über die lokale Infrastruktur der Versorgungsmöglichkeiten (Verfügbarkeit
der Akutintervention, Zeit bis zur Durchführung einer eventuellen Intervention) informiert
sein. Bei ST-Streckenhebungsinfarkt kommt die prähospitale Lyse vor allem bei Patienten
mit kurzer Symptomdauer in Betracht, bei Kontraindikationen zur Lyse und sicher kurzfristig
erreichbarer Intervention ist die perkutane Intervention vorzuziehen. Auch die Kombination
beider Verfahren („facilitated PCI”) ist möglich. Bei Patienten ohne ST-Streckenhebung
ist die Nachbeobachtung über mehrere Stunden zur endgültigen Beurteilung regelhaft
notwendig. Vor dem Hintergrund der aktuell gültigen Leitlinien sollten zudem Netzwerkstrukturen
gebildet werden, in denen alle Beteiligten zusammenarbeiten.
Summary
Acute coronary syndrome, defined as an ST-elevation myocardial infarction, non-ST-elevation
myocardial infarction and unstable angina is the most common reason for calling in
the emergency physician. In accordance with the definition, apart from the clinical
symptomatology, the twelve-channel ECG is a key diagnostic instrument. In order to
provide optimal primary care, the emergency physician must be aware of the local infrastructure
of the emergency care services (availability of acute intervention facilities, transport
time lapse to required interventions). In the case of ST-elevation myocardial infarction
the prehospital thrombolysis must be considered in particular in patients with an
only short history of symptoms; in the event of a contraindication to thrombolysis
and when rapid transportation to interventional treatment is certain, PCI is to be
preferred. The combination of both approaches (facilitated PCI) is also possible.
In patients with no ST elevation, close observation of the patients over several hours
to establish a final diagnosis is regularly necessary. In addition, against the background
of currently valid guidelines network structures securing the cooperation of all relevant
care-providers should be put in place.
Key Words
acute coronary syndrome - prehospital care - twelve-channel ECG - thrombolysis - percutaneous
coronary intervention (PCI) - facilitated PCI
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Anschrift des Verfassers
Prof. Dr. Hans-Richard Arntz
Medizinische Klinik II
Charité, Campus Benjamin Franklin
Hindenburgdamm 30
12200 Berlin
