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Dtsch Med Wochenschr 2019; 144(12): 831-834
DOI: 10.1055/a-0848-9705
Kasuistik
© Georg Thieme Verlag KG Stuttgart · New York

Seltene Ursache eines akuten Koronararterienverschlusses mit ST-Hebungsinfarkt der Hinterwand und präklinischer Reanimation

A Rare Cause of Acute Coronary Occlusion with Inferior ST-Elevation Myocardial Infarction and Out of Hospital Cardiac Arrest
Tomislav Miljak
  Klinik für Innere Medizin II (Kardiologie), Klinikum Sindelfingen-Böblingen
,
Kristina Lohrengel
  Klinik für Innere Medizin II (Kardiologie), Klinikum Sindelfingen-Böblingen
,
Wolfgang Rupp
  Klinik für Innere Medizin II (Kardiologie), Klinikum Sindelfingen-Böblingen
› Author Affiliations
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Publication History

Publication Date:
18 June 2019 (online)

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Zusammenfassung

Anamnese Die 59-jährige Patientin wurde bei Kammerflimmern präklinisch reanimiert. Nach Wiederherstellung des Spontankreislaufs zeigte das vom Notarzt noch vor Ort abgeleitete EKG einen akuten ST-Hebungsinfarkt der Hinterwand.

Untersuchungen und Diagnose In der Akutkoronarangiografie war das rechte Kranzgefäß vollständig verschlossen. Nach intrakoronarer Gabe von Nitroglyzerin kam es zu einer kompletten Reperfusion ohne relevante Stenose.

Therapie und Verlauf Auf die Implantation eines Koronarstents wurde verzichtet. Nach kontrollierter Hypothermie und 68-stündiger Beatmung konnte die Patientin ohne persistierendes neurologisches Defizit extubiert werden. Am 6. Tag erfolgte die Implantation eines Defibrillators. 2 Wochen nach dem Ereignis wurde die Patientin in gutem Allgemeinzustand entlassen.

Folgerung Vor Ballondilatation und/oder Stentimplantation wird – auch bei akuten Koronarsyndromen – die routinemäßige intrakoronare Gabe von Nitroglyzerin empfohlen. Nach Koronarspasmus-bedingtem, überlebtem plötzlichem Herztod sollte wegen des hohen Rezidivrisikos eine Defibrillatorimplantation (AICD) erfolgen.

Abstract

History The 59-year old female was successfully resuscitated after out of hospital cardiac arrest due to ventricular fibrillation. The ECG after return of spontaneous circulation showed elevated ST-segments in the inferior leads.

Findings and Diagnosis Acute coronary angiography confirmed a complete occlusion of the right coronary artery without collateral flow. However, a few seconds after intracoronary administration of nitroglycerin complete reperfusion was achieved without persistent relevant stenosis.

Therapy and Course Stenting of the vessel was withheld. After controlled hypothermia and 68 h on respirator therapy the patient was extubated and showed no persistent neurological disorders. On day 6 she received an implantable cardioverter-defibrillator. Two weeks after the index event the patient could be discharged in good condition. Routine intracoronary administration of nitroglycerin before balloon dilatation or stenting is therefore highly recommended, also in the setting of acute coronary syndromes. Because of the high risk of recurrence, patients resuscitated from lethal cardiac arrhythmia, caused by coronary spasm should receive a cardioverter-defibrillator.

Schlüsselwörter

Koronarspasmen - STEMI - MINOCA - präklinischer plötzlicher Herztod

Key words

coronary spasm - STEMI - MINOCA - OHCA
 

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