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Dtsch Med Wochenschr 2005; 130(12): 677-682
DOI: 10.1055/s-2005-865079
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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
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Publication History

eingereicht: 8.12.2004

akzeptiert: 9.3.2005

Publication Date:
18 March 2005 (online)

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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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 10 Donaldson L, Grant L S, Naysmith N R. et al . Acute amiodarone-induced lung toxicity.  Intensive Care Med. 1998;  24 626-630
    Search in Google Scholar
  • 11 Erbel R, Heusch G. Spontaneous and iatrogenic microembolization. A new concept for the pathogenesis of coronary artery disease.  Herz. 1999;  24 493-495
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 19 Hennersdorf M G, Evers S, Perings C. et al . Antiarrhythmische Therapie von Vorhofflimmern.  Herzschr Electrophysiol. 2001;  12 86-94
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 21 Kelm M, Strauer B E. Akuter Myokardinfarkt - primäre Angioplastie oder Thrombolyse?.  Internist. 2000;  41 1331-1343
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 31 Podrid P J. Amiodarone: Reevaluation of an old drug.  Ann Intern Med. 1995;  122 689-700
    Search in Google Scholar
  • 32 Prystowsky E N. Management of atrial fibrillation: Therapeutical options and clinical decisions.  Am J Cardiol. 2000;  85 3D-11D
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 35 Schrör K. Endotheliale Faktoren und Thrombozytenfunktion.  Z Kardiol. 1991;  80 3-6
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 38 Stambler B S. Ibutilide.  Cardiac Electrophysiology Review. 1998;  2 173-175
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 42 Topol E J, Yadav J S. Recognition of the importance of embolization in atherosclerotic vascular disease.  Circulation. 2000;  101 570-580
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar

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