Diagnose des akuten Koronarsyndroms

Zusammenfassung

Das akute Koronarsyndrom (ACS) stellt eine der häufigsten Differentialdiagnosen in der Notfallmedizin dar. Pathophysiologisch liegt dem ACS meist eine atherosklerotische Plaqueruptur ursächlich zugrunde. Der differentialdiagnostische Verdacht auf ein ACS ist im Wesentlichen durch das klinische Erscheinungsbild der thorakalen Beschwerden bestimmt. Die Diagnose wird erhärtet durch die Zusammenschau der Befunde von Elektrokardiogramm, Biomarkern und Bildgebung, bevor eine gezielte Therapie eingeleitet wird. In der Bildgebung und im Einsatz von Biomarkern wie den hochsensitiven und ultrasensitiven kardialen Troponintests haben sich in den letzten Jahren entscheidende Optimierungen ergeben, die eine frühzeitige, sensitive Diagnose des ACS erlauben und durch hohe negative prädiktive Werte gekennzeichnet sind. Strukturelle und personelle Voraussetzungen für eine optimale, leitliniengerechte Behandlung des Patienten mit Brustschmerz und dem Verdacht auf ein akutes Koronarsyndrom sind in einer Chest Pain Unit gegeben. Die Anzahl zertifizierter Brustschmerzkliniken nimmt in Deutschland stetig zu.

Abstract

The acute coronary syndrome (ACS) is one of the most frequent differential diagnoses in emergency medicine. The causal mechanism of the ACS most often is an atherosclerotic plaque rupture. The differential diagnosis of ACS is guided by the clinical symptom of chest discomfort. The diagnosis is based on the electrocardiographic, biomarker and imaging findings before targeted therapy can be initiated. Over the last years we have witnessed breakthroughs in imaging techniques and the application of biomarkers such as highly sensitive or ultrasensitive cardiac troponin assays. They permit an early and sensitive diagnosis of ACS. Furthermore, they exhibit a high negative predictive value for a safe rule-out. Trained personnel and optimized structures in chest pain units constitute optimal conditions for a guideline conform therapy of patients with ACS. The number of certified chest pain units in Germany has constantly been increasing.

Schlüsselwörter

Akutes Koronarsyndrom - Chest Pain Unit - Elektrokardiogramm - Bildgebung - Biomarker - Myokardinfarkt

Keywords

acute coronary syndrome - chest pain unit - electrocardiogram - imaging - biomarkers - myocardial infarction

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