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Herzinfarkt

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Definition:
Nachweis einer Myokardnekrose bei klinischem Bild einer akuten myokardialen Ischämie.
Häufigkeit:
Hospitalisierungsrate wegen Herzinfarkt ca. 360/100.000 Männer und ca. 180/100.000 Frauen in Deutschland (2015). Die Häufigkeit geht weiter zurück.
Symptome:
Andauernder Brustschmerz, thorakales Engegefühl, Atemnot, Angst, Übelkeit.
Befunde:
Keine spezifischen klinischen Befunde; evtl. Blässe, Kaltschweißigkeit, Tachypnoe. Blutdruck und Puls können normal, erhöht oder erniedrigt sein.
Diagnostik:
Die Diagnose wird im Allgemeinen gestellt auf der Basis von Vortest-Wahrscheinlichkeit, Symptomen, Troponin-Test. Das EKG erlaubt, zwischen Infarkt mit (STEMI) und ohne ST-Hebung (NSTEMI) zu differenzieren.
Therapie:
Bei akutem Koronarsyndrom schnellstmögliche primäre PCI, bei nicht vermeidbarer Zeitverzögerung > 120 min Thrombolyse. Duale Plättchenhemmung und Behandlung der Risikofaktoren.
  • Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale VersorgungsLeitlinie Chronische KHK – Langfassung. S3, Stand 2019. www.awmf.org 
  • Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). Brustschmerz. AWMF-Nr. 053-023. S3, Stand 2011. www.awmf.org 
  • Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). Neue Thrombozyten-Aggregationshemmer, Einsatz in der Hausarztpraxis. DEGAM-Leitlinie Nr. 16. AWMF-Leitlinie Nr. 053-041. S2e, Stand 2019. www.awmf.org 
  • Deutsche Gesellschaft für Allgemeinmedizin. Hausärztliche Risikoberatung zur kardiovaskulären Prävention. AWMF-Leitlinie Nr. 053-024. S3, Stand 2017. www.awmf.org 
  • Deutsche Gesellschaft für Prävention und Rehabilitation von Herz-Kreislauferkrankungen (DGPR). Kardiologische Rehabilitation im deutschsprachigen Raum Europas Deutschland, Österreich, Schweiz (D, A, CH). AWMF-Leitlinie Nr. 133-001. S3, Stand 2020. www.awmf.org 
  • European Society of Cardiology. Fourth Universal Definition of Myocardial Infarction. Stand 2018. www.escardio.org 
  • European Society of Cardiology. Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Stand 2017. www.escardio.org 
  • European Society of Cardiology. Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Stand 2020. www.escardio.org 
  • European Society of Cardiology. Focused update on dual antiplatelet therapy in coronary artery disease developed. Stand 2017. www.escardio.org 
  • European Society of Cardiology. Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Stand 2015. www.escardio.org 
  • European Society of Cardiology. Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Stand 2020. www.escardio.org 
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  • Michael Handke, Prof. Dr. med., Facharzt für Innere Medizin, Kardiologie und Intensivmedizin, Freiburg i. Br.
  • Günther Egidi, Dr. med., Facharzt für Allgemeinmedizin, Bremen (Review)