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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 
  1. Lohnstein M, Eras J, Hammerbacher C. Der Prüfungsguide Allgemeinmedizin - Aktualisierte und erweiterte 3. Auflage. Augsburg: Wißner-Verlag, 2018.
  2. Thygesen K, Alpert J, Jaffe A, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J 2019; 40: 237-269. doi:10.1093/eurheartj/ehy462 DOI  
  3. Anderson L, Morrow D. Acute Myocardial Infarction. N Engl J Med 2017; 376: 2053-2064. doi:10.1056/NEJMra1606915 DOI  
  4. Bansilal S, Castellano J, Fuster V. Global burden of CVD: focus on secondary prevention of cardiovascular disease. Int J Cardiol 2015; 201: S1-S7. doi:10.1016/S0167-5273(15)31026-3 DOI  
  5. Zafari A. Acute Myocardial Infarction. Medscape. Updated February 11, 2018. Zugriff 23.06.18 emedicine.medscape.com  
  6. Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale VersorgungsLeitlinie Chronische KHK - Langfassung, 5. Aufl. 2019. www.awmf.org  
  7. Meisinger C, Peters A, Linseisen J. Vom MONICA-Projekt über KORA zur NAKO-Studie: Vom praktischen Nutzen von Bevölkerungsstudien in der Region Augsburg. Gesundheitswesen 2016; 78: 84-90. doi:10.1055/s-0041-110916 DOI  
  8. Deutsche Herzstiftung. Deutscher Herzbericht 2017. www.herzstiftung.de  
  9. Gößwald A, Schienkiewitz A, Nowossadeck A, et al. Prävalenz von Herzinfarkt und koronarer Herzkrankheit bei Erwachsenen im Alter von 40 bis 79 Jahren in Deutschland. Bundesgesundheitsbl 2013; 56: 650–655. doi:10.1007/s00103-013-1666-9 DOI  
  10. Falk E, Shah P, Fuster V. Coronary Plaque Disruption. Circulation 1995; 92: 657-671. doi:10.1161/01.CIR.92.3.657 DOI  
  11. Shibata T, Kawakami S, Noguchi T, et al. Prevalence, Clinical Features, and Prognosis of Acute Myocardial Infarction Due to Coronary Artery Embolism. Circulation 2015; 132: 241-250. doi:10.1161/CIRCULATIONAHA.114.015134 DOI  
  12. Ertan C, Özpelit M, limon Ö, et al. Vasospastic myocardial infarction: An even rarer occurrence of a rare entity. World J Emerg Med 2017; 8: 68-70. pubmed.ncbi.nlm.nih.gov  
  13. Heusch G, Gersh B. The pathophysiology of acute myocardial infarction and strategies of protection beyond reperfusion: a continual challenge. Eur Heart J 2017; 38: 774–784. doi:10.1093/eurheartj/ehw224 DOI  
  14. Yusuf S, Hawken S, Ôunpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364: 937-52. doi:10.1016/S0140-6736(04)17018-9 DOI  
  15. Dhingra R, Vasan R. Age as a Cardiovascular Risk Factor. Med Clin North Am 2012; 96: 87-91. www.ncbi.nlm.nih.gov  
  16. Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). Risikoberatung zur kardiovaskulären Prävention. AWMF-Nr. 053-024. Stand 2016. www.awmf.org  
  17. Anand S, Islam S, Rosengren A, et al. Risk factors for myocardial infarction in women and men: insights from the INTERHEART study. Eur Heart J 2008; 29: 932–940. doi:10.1093/eurheartj/ehn074 DOI  
  18. Roncaglioni M, Santoro L, D'Avanzo B, et al . Role of Family History in Patients With Myocardial Infarction. Circulation 1992; 85: 2065-2072. pmid:1591825 PubMed  
  19. Culic W. Acute risk factors for myocardial infarction. Int J Cardiol 2007; 117: 260-269. doi:10.1016/j.ijcard.2006.05.011 DOI  
  20. Lindhardsen J, Ahlehoff O, Gislason GH, et al. The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: a Danish nationwide cohort study. Ann Rheum Dis 2011; 70: 929-934. PubMed  
  21. Mehta NN, Yu Y, Pinnelas R, et al. Attributable risk estimate of severe psoriasis on major cardiovascular events. Am J Med 2011; 124: 775. www.ncbi.nlm.nih.gov  
  22. Olsen AM, Fosbøl EL, Lindhardsen J, et al. Long-term cardiovascular risk of NSAID use according to time passed after first-time myocardial infarction. A nationwide cohort study. Circulation 2012. www.ncbi.nlm.nih.gov  
  23. Trelle S, Reichenbach S, Wandel S et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ 2011:342:c7086. www.bmj.com  
  24. Hsia J, Larson JC, Ockene JK, et al. Resting heart rate as a low tech predictor of coronary events in women: prospective cohort study. BMJ 2009; 338: b219. www.ncbi.nlm.nih.gov  
  25. Kwong JC, Schwartz KL, Campitelli MA, et al. Acute myocardial infarction after laboratory-confirmed influenza infection. N Engl J Med 2018 Jan 25; 378(4): 345-353. pmid:29365305 PubMed  
  26. McSweeney JC, Cody M, Sullivan P, et al. Women's early warning symptoms of acute myocardial infarction. Circulation 2003; 108: 2619-23. www.ncbi.nlm.nih.gov  
  27. Khan N, Daskalopoulou S, Karp I, et al. Sex differences in prodromal symptoms in acute coronary syndrome in patients aged 55 years or younger. Heart 2017; 103: 863-869. doi:10.1136/heartjnl-2016-309945 DOI  
  28. Milner KA, Vaccarino V, Arnold AL, et al. Gender and age differences in chief complaints of acute myocardial infarction.. Am J Cardiol 2004; 93: 606-8. www.sciencedirect.com  
  29. Dezman Z, Mattu A, Body R, et al. Utility of the History and Physical Examination in the Detection of Acute Coronary Syndromes in Emergency Department Patients. West J Emerg Med 2017; 18: 752-760. www.ncbi.nlm.nih.gov  
  30. Roffi M, Patrono C, Collet J, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2016; 37: 267–315. doi:10.1093/eurheartj/ehv320 DOI  
  31. Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). Brustschmerz. AWMF-Leitlinie 053-023. S3, Stand 2011. www.awmf.org  
  32. Collet J, Thiele H, Barbato E, et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presentingwithoutpersistentST-segment elevation. Eur Heart J 2020; 00: 1-79. doi:10.1093/eurheartj/ehaa575 DOI  
  33. Ammann P, Pfisterer M, Fehr T, Rickli H. Raised cardiac troponins. BMJ 2004; 328: 1028-9. PubMed  
  34. Maffei E, Seitun S, Martini C, et al. CT coronary angiography and exercise ECG in a population with chest pain and low-to-intermediate pre-test likelihood of coronary artery disease. Heart 2010; 96: 1973-9 PubMed  
  35. Deutsche Gesellschaft für Allgemeinmedizin (DEGAM). Neue Thrombozyten-Aggregationshemmer, Einsatz in der Hausarztpraxis. DEGAM-Leitlinie Nr. 16. AWMF-Nr. 053-041. Stand 2019. www.degam.de  
  36. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2018; 39: 119-177. doi:10.1093/eurheartj/ehx393 DOI  
  37. Valgimigli M, Bueno H, Byrne R, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur Heart J 2018; 39: 213–254. doi:10.1093/eurheartj/ehx419 DOI  
  38. Bønaa et al. Drug-Eluting or Bare-Metal Stents for Coronary Artery Disease. N Engl J Med 2016;375:1242-52. www.ncbi.nlm.nih.gov  
  39. Sepehrvand N, James SK, Stub D, et al. Effects of supplemental oxygen therapy in patients with suspected acute myocardial infarction: a meta-analysis of randomised clinical trials. Heart 2018 Mar 29. pmid:29599378 PubMed  
  40. Cabello JB, Burls A, Emparanza JI, Bayliss SE, Quinn T. Oxygen therapy for acute myocardial infarction. Cochrane Database of Systematic Reviews Issue 12. pubmed.ncbi.nlm.nih.gov  
  41. Eikelboom JW, Anand SS, Malmberg K, Weitz JI, Ginsberg JS, Yusuf S. Unfractioned heparin and low-molecular-weight heparin in acute coronary syndrome without ST elevation: a mata analysis. Lancet 2000; 355: 1936-42. PubMed  
  42. Schüpke S, Neumann FJ, Menichelli M et al for the ISAR-REACT 5 trial investigators. Ticagrelor or Prasugrel in patients with acute coronary syndromes. N Engl J Med. 2019 Oct 17;381(16):1524-1534. www.ncbi.nlm.nih.gov  
  43. Kontos M, Diercks D, Ho P, et al. Treatment and outcomes in patients with myocardial infarction treated with acute β-blocker therapy: results from the American College of Cardiology's NCDR(®). Am Heart J 2011; 161: 864-870. doi:10.1016/j.ahj.2011.01.006 DOI  
  44. Bangalore S, Makani H, Radford M, et al. Clinical Outcomes with beta-Blockers for Myocardial Infarction: A Meta-analysis of Randomized Trials. Am J Med. 2014 Oct;127(10):939-53. PubMed  
  45. Schwarzt G, Olsson A, Ezekowitz M, et al. Effects of Atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIACL study. JAMA 2001;285:1711-1718. www.ncbi.nlm.nih.gov  
  46. Baigent C, Blackwell L, Emberson J, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials. Lancet 2010; 376: 1670-1681. www.ncbi.nlm.nih.gov  
  47. Zijlstra F, Hoorntje J, de Boer M, et al. Long-Term Benefit of Primary Angioplasty as Compared with Thrombolytic Therapy for Acute Myocardial Infarction. New Engl J Med 1999; 341: 1413-1419. doi:10.1056/NEJM199911043411901 DOI  
  48. Keeley E, Boura J, Grines C. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 2003; 361: 13-20. doi:10.1016/S0140-6736(03)12113-7 DOI  
  49. Armstrong PW, Gershlick AH, Goldstein P, et al. Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. N Engl J Med 2013. doi:10.1056/NEJMoa1301092 DOI  
  50. Cantor WJ, Fitchett D, Borgundvaag B, et al, for the TRANSFER-AMI Trial Investigators. Routine early angioplasty after fibrinolysis for acute myocardial infarction. N Eng J Med 2009; 360: 2705-18. www.nejm.org  
  51. McNamara RL, Wang Y, Herrin J, et al, for the NRMI Investigators. Effect of door-to-balloon time on mortality in patients with ST-segment elevation myocardial infarction. J Am Coll Cardiol 2006; 47: 2180-6. PubMed  
  52. De Luca G, Biondi-Zoccai G, Marino P. Transferring patients with ST-segment elevation myocardial infarction for mechanical reperfusion: a meta-regression analysis of randomized trials. Ann Emerg Med 2008; 52: 665-76. PubMed  
  53. Bavry A, Kumbhani D, Rassi A, et al. Benefit of early invasive therapy in acute coronary syndromes: a meta-analysis of contemporary randomized clinical trials. J Am Coll Cardiol 2006; 48: 1319-1325. doi:10.1016/j.jacc.2006.06.050 DOI  
  54. O'Donoghue M, Boden W, Braunwald E, et al. Early invasive vs conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction: a meta-analysis. JAMA 2008; 300: 71-80. doi:10.1001/jama.300.1.71 DOI  
  55. Fox K, Clayton T, damman P, et al. Long-term outcome of a routine versus selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome a meta-analysis of individual patient data. J Am Coll Cardiol 2010; 55: 2435-2445. doi:10.1016/j.jacc.2010.03.007 DOI  
  56. Valgimigli M, Gagnor A, Calabro P, et al. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet ; 385: 2465-76. doi:10.1016/S0140-6736(15)60292-6 DOI  
  57. Sørensen R, Hansen ML, Abildstrom SZ, et al. Risk of bleeding in patients with acute myocardial infarction treated with different combinations of aspirin, clopidogrel, and vitamin K antagonists in Denmark: a retrospective analysis of nationwide registry data. Lancet 2009; 374: 1967-74. PubMed  
  58. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2020; 00: 1-126. doi:10.1093/eurheartj/ehaa612 www.escardio.org  
  59. Choo EH, Chang K, Ahn Y, et al. Benefit of β-blocker treatment for patients with acute myocardial infarction and preserved systolic function after percutaneous coronary intervention. Heart 2013. doi:10.1136/heartjnl-2013-305137 DOI  
  60. Udell JA, Zawi R, Bhatt DL, et al. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a meta-analysis. JAMA 2013 Oct 23;310(16):1711-20. PubMed  
  61. Deutsche Gesellschaft für Prävention und Rehabilitation von Herz-Kreislauferkrankungen (DGPR). Kardiologische Rehabilitation im deutschsprachigen Raum Europas Deutschland, Österreich, Schweiz (D, A, CH). AWMF-Leitlinie 133-001. Stand 2020. www.awmf.org  
  62. Bäck M, Hansen T, Frederix I. European Society of Cardiology. Rehabilitation and exercise training recommendations. Stand 30.06.17. Zugriff 08.06.18 www.escardio.org  
  63. Heran BS, Chen JMH, Ebrahim S, Moxham T, Oldridge N, Rees K, Thompson DR, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD001800. DOI: 10.1002/14651858.CD001800.pub2. pubmed.ncbi.nlm.nih.gov  
  64. Vaccarino V, Parsons L, Peterson ED, et al. Sex differences in mortality after acute myocardial infarction. Arch Intern Med 2009; 169: 1767-74. PubMed  
  65. Chung S, Gedeborg R, Nicholas O, et al. Acute myocardial infarction: a comparison of short-term survival in national outcome registries in Sweden and the UK. Lancet 2014; 383: 1305–12. www.ncbi.nlm.nih.gov  
  66. Schmidt M, Szepligeti S, Horváth-Puhó E, et al. Long-Term Survival Among Patients With Myocardial Infarction Before Age 50 Compared With the General Population. Circ Cardiovasc Qual Outcomes 2016; 9: 523-531. doi:10.1161/CIRCOUTCOMES.115.002661 DOI  
  67. Chapman et al. Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome. JAMA 2017 Nov 21;318(19):1913-1924. www.ncbi.nlm.nih.gov  
  68. Johansson S, Annika Rosengren A, Young K, et al. Mortality and morbidity trends after the first year in survivors of acute myocardial infarction: a systematic review. BMC Cardiovasc Disord 2017; 17: 53. doi:10.1186/s12872-017-0482-9 DOI  
  • Michael Handke, Prof. Dr. med., Facharzt für Innere Medizin, Kardiologie und Intensivmedizin, Freiburg i. Br.
  • Günther Egidi, Dr. med., Facharzt für Allgemeinmedizin, Bremen (Review)