Abstract
Prehospital diagnosis and first line therapy of acute chest pain are among the most frequently encountered challenges for general practitioners and emergency physicians. Acute myocardial infarction or acute coronary syndromes in general are present in about a third of patients complaining of acute chest pain. The basis of first line therapy is the understanding of the pathophysiology of myocardial ischemia, the clinical symptoms, the diagnostic tools and the preclinically available therapeutic options. Time is the most critical factor in myocardial ischemia and subsequent infarction with irreversible injury of subendocardial cells starting within 30–60 minutes of total myocardial ischemia and with transmural infarction becoming complete in 3 to 6 hours. With 30% of patients dying within the first hour of ischemia mostly due to ventricular arrhyhtmias every effort needs to be made to shorten the delay between symptom onset and start of reperfusion therapy. The present overview concentrates on the armamentarium of preclincial diagnosis and the options of first line therapy of myocardial infarction with the aim of a short transport time to the hospital and therefore a short delay to more specific therapies like thrombolysis or PTCA.
Zusammenfassung
Die präklinische Notfallbehandlung des akuten Thoraxschmerzes zählt zu den häufigsten Einsätzen des Notarztes, wo- bei bei ca. einem Drittel der Patienten ein akuter Myokardinfarkt oder im weiteren Sinne ein akutes Koronarsyndrom vorliegt. Zur akuten Behandlung bedarf es einer klaren Vorstellung von der Pathogenese, der klinischen Symptomatik, der möglichen Akutdiagnostik und den therapeutischen Optionen. Dabei spielt der Faktor Zeit die entscheidenden Rolle! Aufgrund der geringen Ischämietoleranz des Myokards bestimmt die Zeit zwischen Symptombeginn und Wiedereröffnung des Infarktgefäßes einerseits den Erfolg der Reperfusionstherapie und andererseits sterben in der ersten Infarktstunde schon ca. 30% der Patienten vorrangig durch auftretenden ventrikuläre Herzrhythmusstörungen. In der vorliegenden Übersicht wird auf die akute präklinische Diagnostik und mögliche Therapie ausführlich eingegangen, mit dem Ziel der sofortigen Einleitung einer spezifischen Therapie, der sicheren Überwachung und des sicheren Transportes des Patienten in die Klinik.
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Sorges, E., Carlsson, J., Miketic, S., Kirchner, A., Tebbe, U. (2000). Sofortdiagnose und Soforttherapie durch den zuerst eintreffenden Arzt. In: Arntz, HR., Schuster, HP. (eds) Die Notfalltherapie bei akutem Myokardinfarkt. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-642-57713-0_5
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DOI: https://doi.org/10.1007/978-3-642-57713-0_5
Publisher Name: Steinkopff, Heidelberg
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