Zusammenfassung
Manifestationsformen der koronaren Herzkrankheit (KHK) sind:
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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.
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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.
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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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Just, H., Jahrmärker, H., Zeiher, A.M. (1995). Koronarinsuffizienz und Herzinfarkt. In: Paumgartner, G., Riecker, G. (eds) Therapie innerer Krankheiten. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-10479-8_5
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