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Der Klinikarzt 2018; 47(04): 134-139
DOI: 10.1055/a-0598-9690
Schwerpunkt
© Georg Thieme Verlag Stuttgart · New York

Kardiale Biomarker und EKG-Veränderungen beim Schlaganfall

Fallstricke in der Interpretation
Regina von Rennenberg
1   Klinik für Neurologie, Charité-Universitätsmedizin Berlin, Berlin
,
Jan F. Scheitz
1   Klinik für Neurologie, Charité-Universitätsmedizin Berlin, Berlin
2   Center for Stroke Research, Charité-Universitätsmedizin Berlin, Berlin
5   Berlin Institute of Health, Berlin
,
Matthias Endres
1   Klinik für Neurologie, Charité-Universitätsmedizin Berlin, Berlin
2   Center for Stroke Research, Charité-Universitätsmedizin Berlin, Berlin
3   Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Berlin
4   Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin
5   Berlin Institute of Health, Berlin
,
Christian Nolte
1   Klinik für Neurologie, Charité-Universitätsmedizin Berlin, Berlin
2   Center for Stroke Research, Charité-Universitätsmedizin Berlin, Berlin
5   Berlin Institute of Health, Berlin
› Author Affiliations
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Publication History

Publication Date:
09 May 2018 (online)

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Zusammenfassung

Kardiale Komplikationen treten bei akuten Schlaganfallpatienten häufig auf und sind eine der Haupttodesursachen nach einem Schlaganfall. Gleichzeitig sind kardiale Erkrankungen häufig Ursache für die Entstehung von Schlaganfällen. Kardiovaskuläre und zerebrovaskuläre Erkrankungen teilen viele gemeinsame Risikofaktoren, sodass nicht selten zusätzlich zum Schlaganfall auch eine KHK vorliegt. Das kontinuierliche EKG-Monitoring stellt einen wichtigen Baustein in der diagnostischen Abklärung beim Schlaganfall dar und die Leitlinien der American Heart Association (AHA) empfehlen Troponin bei Schlaganfallpatienten zu bestimmen. Häufig finden sich nach Schlaganfall EKG-Veränderungen sowie eine Erhöhung von Troponin. Beides ist mit einer schlechten Prognose assoziiert. Es gibt jedoch wenig konkrete Empfehlungen zum Umgang mit pathologischen EKG- und Laborbefunden im Alltag. Im klinischen Alltag gestaltet sich die Differenzialdiagnose von kardialen Erkrankungen bei Schlaganfallpatienten aber häufig schwierig: Kardiale Erkrankungen präsentieren sich bei Schlaganfallpatienten vielfach mit atypischen Symptomen. Bei Schlaganfallpatienten können EKG-Veränderungen oder eine Erhöhung kardialer Biomarker vorkommen, ohne dass dem eine akute koronare Ischämie zugrunde liegt. Stattdessen können sowohl chronische kardiale als auch nicht-kardiale Erkrankungen die Ursache für die Erhöhung kardialer Biomarker oder EKG-Veränderungen sein. Daneben kommt es bei einigen Schlaganfallpatienten zu einer neurogenen Myokardschädigung im Sinne einer stressinduzierten Kardiomyopathie.

Dieser Artikel soll einen Überblick über die klinische Relevanz und Interpretationsmöglichkeiten häufiger EKG-Veränderungen und kardialer Biomarker bei Patienten mit akuter zerebraler Ischämie liefern.

 

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