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Koronarinsuffizienz und Herzinfarkt

  • H. Just
  • H. Jahrmärker
  • A. M. Zeiher

Zusammenfassung

Manifestationsformen der koronaren Herzkrankheit (KHK) sind:
  1. 1.

    Transitorische Myokardischämie mit oder ohne Angina pectoris in ihren verschiedenen Verlaufsformen, mit einem wahrscheinlich beträchtlichen Anteil teilweise oder ganz stummer Myokardischämien. Ursache sind signifikante (i. allg. über 75% Einengung) arteriosklerotische Koronarstenosen mit oder ohne, selten allein dominierender „vasomotorischer“ (spastischer) Komponente. Eine Angina pectoris stellt häufig die Primärmanifestation dar, kann aber ebenso im Verlauf der üübrigen Manifestationsformen auftreten und hat hier füür die Therapieindikation und die vorgeschaltete Diagnostik erhebliche Bedeutung.

     
  2. 2.

    Akuter Myokardinfarkt mit verschiedener Ausprägung und charakteristischen Komplikationen. Ursache ist in der Regel der thrombotische Verschluß einer stenosierten Koronararterie durch Ruptur von arteriosklerotischen Plaques, selten durch Koronarembolie oder Spasmus. Auch hier ist ein beträchtlicher Anteil stummer Infarzierungen anzunehmen (schmerzarm, wenig deutliche, atypische klinische Erscheinungen). Der Herzinfarkt kann die primäre Manifestationsform darstellen oder nach längerer oder kurzfristiger, zunehmender Angina pectoris auftreten.

     
  3. 3.

    Herzrhythmusstörungen und plötzlicher Herztod können als Primärmanifestation — also auch ohne symptomatische Vorkrankheit — oder bei und nach (1) und (2) auftreten. Herzinsuffizienz durch ischämische Myokardiopathie (arteriosklerostisches Narbenherz), Mitralinsuffizienz, Herzaneurysma treten vorwiegend als Sekundärmanifestation auf.

     

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Literatur

  1. 1.
    Alderman EL, Fisher LD, Litwin P, Kaiser GC, Myers WO, Mynard C, Levine F, Schloss M (1983) Results of coronary artery surgery in patients with poor left ventricular function (CASS), Circulation 67:785–795CrossRefGoogle Scholar
  2. 2.
    Bussmann WD, Passek D, Seidel W, Kaltenbach M (1981) Reduction of CK and CK-MB indices of infarct size by intravenous nitroglycerin. Circulation 63: 615–622PubMedCrossRefGoogle Scholar
  3. 3.
    Cairns JA, Gent M, Singer J, Finnie K, Frogatt GM, Holder DA, Jablonsky G, Kestuk WJ, Melendez LJ, Myers MG, Sacket DL, Sealey BJ, Tanser PH (1985) Aspirin, Sulfinpyrazone, or both in unstable angina. N Engl J Med 313:1369–1375PubMedCrossRefGoogle Scholar
  4. 4.
    CASS Principal Investigators and their Associates (1983) Coronary artery surgery study (CASS): a randomized trial of coronary artery bypass surgery. Circulation 68: 939–950CrossRefGoogle Scholar
  5. 5.
    CAST Study (1989) The Cardiac arrhythmia suppression trial investigators. Effect of flecainide and encainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med 321: 406–412CrossRefGoogle Scholar
  6. 6.
    DeBusk RF, Blomquist CG, Kouchoukos NT et al. (1986) Identification and treatment of low risk patients after acute myocardial infarction and coronary bypass graft surgery. N Engl J Med 314:161–166PubMedCrossRefGoogle Scholar
  7. 7.
    European Coronary Surgery Study Group (1982) Prospective randomized study of coronary artery bypass surgery in stable angina pectoris: a progress report on survival. Circulation 65 [Suppl II]: 67–71CrossRefGoogle Scholar
  8. 8.
    European Myocardial Infarction Project Group (EMIP) (1993) Prehospital thrombolytic therapy in patients with suspected acute myocardial infarction. N Engl J Med 329: 383–389CrossRefGoogle Scholar
  9. 9.
    Fuster V, Cohen M, Halperin J (1989) Aspirin in the prevention of coronary disease. N Engl J Med 321:183–185PubMedCrossRefGoogle Scholar
  10. 10.
    Gibson RS, Boden WE, Theroux P et al. (1986) Diltiazem and reinfarction in patients with non-Q-wave myocardial infarction. N Engl J Med 315: 423–429PubMedCrossRefGoogle Scholar
  11. 11.
    GISSI Study Group (1986) Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet I:397–402Google Scholar
  12. 12.
    GISSI Study Group (1987) Long-term effects of intravenous thrombolysis in acute myocardial infarction: Final report of the GISI study. Lancet II: 871–874Google Scholar
  13. 13.
    Gissi 2 Study Group (1990) Randomized trial of thrombolysis with streptokinase or rt-PA in acute myocardial infarction. Effect on Mortality. Lancet II: 235Google Scholar
  14. 14.
    Grines CL, Browne KF, Marco J et al. (1993) A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. N Engl J Med 328: 673–679PubMedCrossRefGoogle Scholar
  15. 15.
    Guidelines A (1990) for the early management of patients with acute myocardial infarction. ACC/AHA Task force report. J Am Coll Cardial 16: 249–292CrossRefGoogle Scholar
  16. 16.
    GUSTO Investigators (1993) An international randomized trial omparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 329: 673–682CrossRefGoogle Scholar
  17. 17.
    Held PH., Yusuf S, Furberg CD (1989) Calcium channel blockers in acute myocardial infarction and unstable angina: An overview. Br Med J 299:1187–1192CrossRefGoogle Scholar
  18. 18.
    ISIS-2 (Second International Study of Infarct Survival) InstitutionalAuthorNameorative Group (1988) Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17187 cases of suspected acute myocardial infarction: ISIS2. Lancet I:349–360Google Scholar
  19. 19.
    Kaplan NM (1991) Cardiovascular risk reduction: the role of antihypertensive treatment. Am J Med 90:198–235Google Scholar
  20. 20.
    LaRosa JC, Dunninghake D, Bush D et al. (1990) The cholesterol facts. A summary of the evidence relating dietary fats, serum cholesterol and coronary heart disease. A joint statement of the American Heart Association and the National Heart, Lung and Blood Institute, Circulation 81: 1721–1733PubMedCrossRefGoogle Scholar
  21. 21.
    Lewis HD, Davies JW, Archibald DG et al. (1983) Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. N Engl J Med 309: 396–403PubMedCrossRefGoogle Scholar
  22. 22.
    Lichtlen P, Hugenholtz PG, Rafflenbeul W et al. (1990) Retardation of angiographic progression of coronary artery disease by nifedipine. Lancet II 335:1109–1113CrossRefGoogle Scholar
  23. 23.
    Murphy MJ, Hultgren HN, Detre K, Thomsen I, Takoro T (1977) Treatment of chronic stable angina. A preliminary report of survival data of the randomized Veterans administration cooperative study. N Engl J Med 297: 621–627PubMedCrossRefGoogle Scholar
  24. 24.
    Norwegian Multicenter Study Group (1981) Timolol induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. N Engl J Med 304: 801–807CrossRefGoogle Scholar
  25. 25.
    Parisis AF, Folland ED, Hartigan P (1992) A comparison of angioplasty with medical therapy in the treatment of single-vessel coronary artery disease. N Engl J Med 326: 10–16CrossRefGoogle Scholar
  26. 26.
    Pfeffer MA, Lamas GA, Vaughan DE et al. (1988) Effect of captopril on progressive ventricular dilatation after anterior myocardial infarction. N Engl J Med 319: 80–86PubMedCrossRefGoogle Scholar
  27. 27.
    Pfeffer MA, Braunwald E, Moye LA et al. (1992) Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction — results of the Survival and Ventricular Enlargement Trial (SAVE). N Engl J Med 327: 669–677PubMedCrossRefGoogle Scholar
  28. 28.
    Pölnitz A von, Backa D, Bauriedel G, Nerlich A, Höfling B (1991) Coronary directional atherectomy: Rescue for failed Balloon Angioplasty and Treatment of Complicated Lesions. J Interv Cardiol 4/1:5–11CrossRefGoogle Scholar
  29. 29.
    Ruberman W, Weinblatt E, Goldberg JD, Chaudhary BS (1984) Psychosocial influences on mortality after myocardial infarction. N Engl J Med 3n:552–559CrossRefGoogle Scholar
  30. 30.
    Sharpe N, Murphy J, Smith H et al. (1988) Treatment of patients with symptomless left ventricular dysfunction after myocardial infarction. Lancet I: 255–259CrossRefGoogle Scholar
  31. 31.
    Silber S, Vogler A, Theisen K (1986) Equal anti-ischemic effect of Isosorbitdinitrate plus Verapamil and Isosorbitdinitrate plus Propranolol. Z Kardiol 75 [Suppl 3]:100–105PubMedGoogle Scholar
  32. 32.
    Sleight P (1990) Do we need to intervene after thrombolysis in acute myocardial infarction? Circulation 81:1707–1709PubMedCrossRefGoogle Scholar
  33. 33.
    The TIMI Study Group (1985) The thrombolysis in myocardial infarction (TIMI) trial. N Engl J Med 310: 932–936Google Scholar
  34. 34.
    The TIMI II-A study group: Rogers WJ, Baim DS, Gore JM, Brown BG, Robert SR, Williams DO, Chesebro JH, Babb JD, Sheehan FH, Wackers FJTh, Zaret BL, Robertson TL, Passamani ER, Ross R, Knatterud GL, and Braunwald E, for the TIMI II-A Investigators (1990) Comparison of immediate invasive, delayed invasive, and conservative strategies after tissue-type plasminogen activator: Results of the Thrombolysis in Myocardial Infarction (TIMI) Phase II-A Trial. Circulation 81:1457–1476PubMedCrossRefGoogle Scholar
  35. 35.
    The Veterans Administration Coronary Artery Bypass Cooperative Study Group (1984) Eleven-year survival in the veterans administration randomized trial of coronary bypass surgery for stable angina. N Engl J Med 311: 1333–1339CrossRefGoogle Scholar
  36. 36.
    Topol EJ, Califf RM, George BS, Kereiakes DJ, Abbottsmith CW, Candela RJ, Lee KL, Pitt B, Stack RS, O’Neill WW, and the Thrombolysis and Angioplasty in Myocardial Infarction Study Group (1987) A randomized trial of immediate versus delayed elective angioplasty after intravenous tissue plasminogen activator in acute myocardial infarction. N Engl J Med 317:581–588PubMedCrossRefGoogle Scholar
  37. 37.
    Topol EJ (1991) Promises and pitfalls of new devices for coronary artery disease. Circulation 83: 689–694PubMedCrossRefGoogle Scholar
  38. 38.
    Yusuf S, Peto R., Lewis J, Collins R, Sleight P (1985) Beta blockade during and after myocardial infarction: An overview of the randomized trials. Progr Cardiovasc Dis 37: 335–371CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1995

Authors and Affiliations

  • H. Just
  • H. Jahrmärker
  • A. M. Zeiher

There are no affiliations available

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