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Tachykarde und bradykarde Rhythmusstörungen beim akuten Myokardinfarkt

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Book cover Notfallbehandlung des akuten Koronarsyndroms

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Zusammenfassung

Das Spektrum infarktassoziierter Arrhythmien ist weit und reicht von Sinusbradykardien und Sinustachykardien über supraventrikuläre und ventrikuläre Extrasystolen, Vorhofflimmern, Vorhofflattern bis hin zu malignen Arrhythmien wie Kammertachykardien, Kammerflimmern sowie schwerwiegenden Leitungsstörungen mit der Gefahr der Asystolie. Während ein Teil dieser Arrhythmien keinen prognostischen Einfluss hat und damit auch keiner spezifischen antiarrhythmischen Behandlung bedarf, erfordern bestimmte Arrhythmieformen eine rasche oder sofortige therapeutische Intervention. Grundsätzlich gilt, dass Rhythmusstörungen im Rahmen eines akuten Myokardinfarktes immer dann einer konsequenten Therapie bedürfen, wenn es infolge der Arrhythmie zu Hypotension oder zu einem erhöhten myokardialen Sauerstoffbedarfkommt oder das Auftreten maligner ventrikulärer Tachyarrhythmien droht [3]. Insbesondere in der frühen Phase des akuten Myokardinfarkt ist das Risiko lebensbedrohlicher Arrhythmien hoch [45]. Der richtigen Einschätzung, der Prävention und der Therapie von Arrhythmien kommt daher nicht nur im stationären Bereich, sondern auch in der Prähospitalphase eine wesentliche Bedeutung zu. In diesem Zusammenhang sei jedoch bereits an dieser Stelle darauf hingewiesen, dass es im Gegensatz zu dem im stationären Bereich nachgewiesenen Nutzen bestimmter Therapieformen - etwa dem Einsatz von Betablockern - bislang für die prähospitale Behandlung keine Studien und entsprechenden Therapierichtlinien gibt. Dieser Artikel befasst sich mit der klinischen Bedeutung und der Behandlung der verschiedenen Arrhythmieformen beim akuten Myokardinfarkt unter Berücksichtigung der prähospitalen Phase.

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Authors
  1. Steffen Behrens
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  2. Markus Zabel
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  3. Dirk Müller
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  4. Felix Lampe
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  5. Peter Gödde
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  6. Heinz-Peter Schultheiss
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Editors and Affiliations

  1. Klinikum Benjamin Franklin Med. Klinik II, Kardiopulmologie, Freie Universität Berlin, Hindenburgdamm 30, 12200, Berlin, Germany

    Hans-Richard Arntz

  2. Med. Klinik I, Krankenhaus Düren, Roonstr. 30, 52351, Düren, Germany

    Dietrich C. Gulba

  3. Med. Klinik II, Klinikum Lippe GmbH, Röntgenstr.18, 32756, Detmold, Germany

    Ulrich Tebbe

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Behrens, S., Zabel, M., Müller, D., Lampe, F., Gödde, P., Schultheiss, HP. (2002). Tachykarde und bradykarde Rhythmusstörungen beim akuten Myokardinfarkt. In: Arntz, HR., Gulba, D.C., Tebbe, U. (eds) Notfallbehandlung des akuten Koronarsyndroms. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-56220-4_13

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  • DOI: https://doi.org/10.1007/978-3-642-56220-4_13

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