Diagnose des akuten Koronarsyndroms

Das akute Koronarsyndrom ist in vielen Fällen die erste klinische Manifestation der zugrunde liegenden Atherosklerose und stellt häufig eine Notfallsituation dar. In kurzer Zeit müssen die Ursache und ggf. mögliche Differenzialdiagnosen erkannt und zügig gehandelt werden. Die richtige Interpretation von Anzeichen und Symptomen und die entsprechende Auswahl der diagnostischen Methode sind die Basis für die weitere Therapie.

Abstract

Acute coronary syndrome is one of the most important differential diagnostic considerations in emergency medicine. It describes the constellation of newly occurring clinical symptoms, often accompanied by typical 12-lead ECG changes and the release of cardiac troponins. The spectrum includes unstable angina pectoris, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). It is important to consistently carry out the diagnostic steps that are crucial for further therapeutic procedures to avoid delaying life-saving invasive coronary diagnostics, without losing sight of the diverse, sometimes time-critical differential diagnoses. Anamnesis and clinical examination form the basis of the further procedure. Further developments of biomarker assays with personalized limit values, new imaging modalities with ever higher resolution and faster imaging methods as well as advances in automated ECG analysis with integration of all findings through artificial intelligence will continue to offer many optimization options in the future diagnosis of acute coronary syndrome.

Kernaussagen

• Das akute Koronarsyndrom umfasst das Spektrum von der instabilen Angina pectoris, über den NSTEMI, bis hin zum STEMI.

• Bei klinischem Verdacht sollte der Fokus der Ersteinschätzung auf EKG-Veränderungen, Klinik und Vitalzeichen gelegt werden.

• Die Unterscheidung in die Arbeitsdiagnosen STEMI und NSTE-ACS mittels 12-Kanal-EKG legt das weitere Prozedere im Diagnostik-/Therapie-Algorithmus fest.

• Patient*innen mit der Arbeitsdiagnose STEMI müssen einer unmittelbaren Reperfusionstherapie zugeführt werden.

• Bei Fehlen ischämietypischer EKG-Veränderungen erlaubt die sequenzielle hs-cTn-Bestimmung die Unterscheidung zwischen der instabilen Angina pectoris und dem NSTEMI.

• Neben dem klassischen Typ-1-Myokardinfarkt durch eine Plaqueruptur können viele Erkrankungen zu einer myokardialen Minderperfusion i.S. eines Myokardinfarkts Typ 2 führen.

• Neben dem akuten Koronarsyndrom existieren vielfältige, mitunter ebenfalls lebensgefährliche und zeitkritische Differenzialdiagnosen.

• Bei instabiler Angina pectoris oder grenzwertigen hs-cTn-Befunden kann die nicht invasive Ischämiediagnostik einer invasiven Diagnostik vorgezogen werden.

• Der technische Fortschritt in der Bildgebung, der Einsatz von KI und die Personalisierung der Laborgrenzwerte bieten weiterhin viel Optimierungspotenzial.

Schlüsselwörter

akutes Koronarsyndrom - Diagnose - Notfall - Bildgebung - kardiale Biomarker

Keywords

acute coronary syndrome - diagnosis - emergency - imaging - cardial biomarkers

Publication History

Article published online:
15 April 2024

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