Management der perioperativen Myokardischämie

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• 作者：Dr. F. Stoll ; Prof. Dr. E. Giannitsis ; Prof. Dr. H. A. Katus…
• 关键词：SchlüsselwörterST ; Strecken ; Hebungs ; Myokardinfarkt ; Nicht ; ST ; Strecken ; Hebungs ; Myokardinfarkt ; Troponin ; Periphere arterielle Verschlusskrankheit ; Koronarangiographie
• 刊名：Der Kardiologe
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：11
• 期：1
• 页码：61-74
• 全文大小：
• 刊物主题：Internal Medicine; Cardiology; Pneumology/Respiratory System; Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：Springer Medizin
• ISSN：1864-9726
• 卷排序：11

文摘

Patients undergoing vascular surgery are often affected by a much higher cardiac risk profile. Cardiac events in peripheral arterial disease (PAD) patients occur not only more frequently than in non-PAD patients but are also associated with a poorer outcome. Despite a similar underlying pathogenesis, PAD patients receive less pharmaceutical treatment than patients with known coronary artery disease (CAD). If certain risk factors for CAD are present, preoperative cardiology diagnostic testing and if necessary therapy is recommended. When a perioperative myocardial infarction is suspected, an electrocardiogram (ECG) should immediately be carried out. In the case of ST segment elevation myocardial infarction, a percutaneous coronary intervention (PCI) is performed without waiting for the blood test results. If a non-ST segment elevation myocardial infarction is present, further evaluation includes (serial) blood tests for troponin, a cardiac biomarker. In addition to a type 1 myocardial infarction, which is caused by rupture of plaque, a type 2 myocardial infarction must also be taken into consideration, which can arise due to an imbalance between oxygen needs and increased consumption even in the absence of plaque rupture (e.g. in cases of significant coronary artery stenosis and coronary artery spasm). Coronary angiography is performed on an individual basis depending on the risk-benefit assessment. Medicinal therapy of myocardial infarction includes dual platelet inhibition and anticoagulation. Other potentially life-threatening diseases, such as pulmonary embolism and aortic dissection have to be taken into account as differential diagnoses in acute situations.