Zusammenfassung
Die weite Verbreitung kardiovaskulärer Erkrankungen, höhere Lebenserwartung und Zunahme immer komplexerer operativer Eingriffe bei alten und/oder multimorbiden Patienten konfrontieren den Anästhesisten mit der Forderung, diesen Gegebenheiten im perioperativen anästhesiologischen Management Rechnung zu tragen. Die kardiale Morbidität ist trotz aller Fortschritte der operativen Medizin führende Todesursache nach Narkose und Operation. Neuere Arbeiten über kardiovaskuläre Risikopatienten und stille Myokardischämien modifizieren unsere traditionelle Vorstellung über die koronare Herzkrankheit dahingehend, nicht nur den symptomatischen Patienten, sondern auch den asymptomatisch, anhand klar formulierter Kriterien definierten Patienten mit Risikofaktoren in das Kollektiv koronarer Problempatienten einzufügen.
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Literatur
Aroesty JM, McKay RG, Heller GV, Royal HD, Als AD, Grossman W (1985) Simultaneous assessment of left ventricular systolic and diastolic dysfunction during pacing-induced ischemia. Circulation 71:889–900
Bär FW, Brugada P, Dassen W et al (1984) Prognostic value of Q waves, R/S ration, loss of R wave voltage, ST-T segment abnormalities, electrical axis, low voltage and notching: Correlation of electrocardiogramm and left ventriculogramm. J Am Coll Cardiol 4:17–27
Bellows WH, Bode RH, Levy JH et al (1984) Noninvasive detection of periinduction ischemic ventricular dysfunction by cardiokymography in humans: Preliminary experience. Anesthesiology 60: 155–158
Bethge KP, Gascha BD (1992) Langzeitelektrokardiographie. Springer, Berlin Heidelberg New York
Blackburn H, Katigbak R (1964) What electrocardiographic leads to take after exercise? Am Heart J 67:184–185
Bourdillon PD, Lorell BH, Mirsky L, Paulus WJ, Wynne J, Grossman W (1983) Increased regional myocardial stiffness of the left ventricle during pacing-induced angina in man. Circulation 67:316–323
Bowman LK, Cleman M W, Cabin HS, Zaret BL, Jaffe CC (1988) Dynamics of early and late left ventricular filling determined by Doppler two-dimensional echocardiography during percutaneous transluminal coronary angioplasty. Am J Cardiol 61:541–545
Buffington CW, Coyle RJ (1991) Altered load dependence of postischemic myocardium. Anesthesiology 75:464–474
Cahalan MK (1991) Detection of intraoperative myocardial ischemia with two-dimensional transesophageal Echocardiography. In: De Bruijn NP, Clements FM (eds) Intraoperative use of echocardiography. Lippincott, New York London Hagerstown, pp 45–58
Chaitman BR, Hanson JS (1981) Comparative sensitivity and specificity of exercise electrocardiographic lead systems. Am J Cardiol 47:1335–1348
Chang J, Atwood JE, Froelicher V (1994) Prognostic impact of myocardial ischemia. JACC 23; 1:225–228
Chatterjee K (1989) Ischemia-silent ofmanifest: Does ist matter? JACC 13;7:1503–1505
Clements FM, De Bruijn NP (1987) Perioperative evaluation of regional wall motion by transoesophageal two-dimensional echocardiography. Anesth Analg 656:249–261
Clements FM, De Bruijn NP (1991) Transoesophageal echocardiography. Little Brown, Boston Toronto London, pp 82–95
Clements FM, DeBruijn NP (1990) Electrocardiography: monitoring for ischemia. In: Lake CL (ed) Clinical montioring. Saunders, Philadelphia London Toronto
Clements FM, McCann RL, Levin RL (1988) Continuous ST segment analysis for the detection of perioperative myocardial ischemia. Crit Care Med 7:710–711
Cohn PF (1980) Silent myocardial ischemia in patients with a defective anginal warning system. Am J Cardiol 45:697–702
Cohn PF (1986) Total ischemic burden: definition, mechanisms, and therapeutic implications. Am J Med [Suppl 4A] 81:2–6
De Hert SG, Moens MM, Vermeyen KM, Hageman MP (1993) Use of the rightsided precordial lead V4R in the detection of intraoperative myocardial ischemia. J Cardiothorac Vasc Anesth 7; 6:659–667
Deedwania PC, Carbajal EV (1992) Ambulatory electrocardiography evalution of asymptomatic, unstable, and stable coronary artery disease patients for myocardial ischemia. In: Kennedy HL (ed) Cardiology clinics, vol 3. Saunders, Philadelphia London Toronto, pp 417–430
Diedericks J, Leone BJ, Foex P (1989) Regional differences in left ventricular wall motion in the anesthetized dog. Anesthesiology 70:82–90
Epstein SE, Quyyumi AA, Bonow RO (1988) Myocardial ischemia — silent or symptomatic. N Engl J Med 16:1038–1043
Ellestad MH, Cooke DM Jr, Greenberg PS (1980) Stress testing: principles and practice. Davis, Philadelphia, pp 85
Fisch C (1984) Electrocardiography and echocardiography. In: Braunwald E (ed) Heart disease. A textbook of cardiovascular medicine. Saunders, Philadelphia London Toronto, pp 195–252
Forrester JS, Wyatt HL, Da Luz PL, Tyberg J V, Diamond G A, Swan H JC (1976) Funtional significance of regional ischemic contraction abnormalities. Circulation 54:64
Gardner CJ, Brown S, Hagen-Ansert S, Harrigan P, Kisslo J, Kisslo K, Kwan OL, Menapace F, Otto C, Pandian N, Pearlman AJ, Skelly A, Stevenson G (1992) Guidelines for cardiac sonographer education: report of the American Society of Echocardiography Sonographer Education and Training Committee. J Am Soc Echocardiogr 6:635–639
Griffin RM, Kaplan JA (1987) Intraoperative myocardial ischemia. In: Thys D, Kaplan DM (eds) The ECG in anesthesia and critical care. Churchill Livingstone, Edinburgh, London New York, pp 139–154
Gordon MA, Urban MK, O’Connor T, Barash PG (1991) Is the pressure rate quotient a predictor or indicator of myocardial ischemia as measured by ST segment changes in patients undergoing coronary artery bypass surgery? Anesthesiology 74:848–853
Häggmark S, Hohner P, Östman M et al (1989) Comparison of hemodynamic, electrocardiographic, mechanical and metabolic indicators of intraoperative myocardial ischemia in vascular surgical patients with coronary artery disease. Anesthesiology 70: 19–25
Hauser AM, Gangadharan V, Ramos RG et al (1985) Sequence of mechanical electrocardiographic and clinical effects of repeated coronary artery occlusion in human beings: Echocardiographic observations during coronary angioplasty. J Am Coll Cardiol 5: 193–197
Hecht HS, De Bord L, Sotomayor N, Shaw R, Ryan C (1994) Truly silent ischemia and the relationship of chest pain and ST segment changes to the amount of ischemic myocardium: evaluation by supine bicycle stress echocardiography. J Am Coll Cardiol 23; 2: 396–376
Heinecker R, Gonscha BD (1992) EKG in Praxis und Klinik. Thieme, Stuttgart New York, S 303–378
Hines RL (1987) Monitoring for right ventricular ischemia: is it necessary? J Cardiothorac Anesth 2:95–97
Hoeft A, Sonntag H, Stephan H, Kettler D (1991) Validation of myocardial oxygen demand indices in patients awake and during anesthesia. Anesthesiology 75:49–56
Hoeft A, Sonntag H, Stephan H (1991) Koronardurchblutung und myokardiale Sauerstoffbilanz in der Anästhesie. Anästhesiol Intensivmed Notfallmed Schmerzther 26:398–407
Hopf HB, Tarnow J (1992) Diagnostik der perioperativen Myokardischämie. Anästhesist 41:509–519
Iskandrian AS, Bemis CE, Hakki AH, Heo J, Kimbris D, Mintz GS (1986) Ventricular systolic and diastolic impairment during pacing-induced myocardial ischemia in coronary artery disease: simultaneous hemodynamic, electrocardiographic and radionuclid angiography evaluation. Am Heart J 112:382–391
Kaplan JA, Wells PH (1981) Early diagnosis of myocardial ischemia using the pulmonary arterial catheter. Anesth Analgl 60:789–793
Kennedy HL, Wiens RD (1989) Ambulatory (holter) electrocardiography and myocardial ischemia. Am Heart J 117:164–176
Klien HO, Tordjma T, Ninio R (1993) The early recognition of right ventricular infarction: diagnostic accuracy of the electrocardiographic V4R lead. Circulation 67: 558–565
Kleinman B, Henkin RE, Gilsson SN, El-Etr AA, Bakhos M, Sullivan HJ, Montoya A, Pifarre R (1986) Qualitative evalution of coronary flow during anesthetic induction using thallium-201 perfusion scans. Anesthesiology 64:157–164
Kloner RA, Parisi AF (1987) Acute myocardial infarction: Diagnostic and prognostic applications of two-dimensional echocardiography. Circulation 75:521–524
Knight A, Hollenberg M, London MJ, Tubau J, Verrier E, Browner W, Mangano DT (1988) Perioperative myocardial ischemia importance of the preoperative ischemic pattern. Anesthesiology 68:681–688
Knoebel SB, Crawford MH, Dunn Ml, Fisch C, Forrester JS, Hutter AM, Kennedy HL, Lux RL, Sheffied LT, DeSanctis RW, Dodge HT, Reeves, TJ, Weinberg SL (1989) Guidelines for ambulatory electrocardiography. Circulation 79:206–215
Knoebel SB, Williams SV, Achord JL, Reynolds WA, Fisch Ch, Friesinger GÇ, Klocke FJ, Akthtar M, Ryan TJ, Schlant RC (1993) Clinical competence in ambulatory electrocardiography. A statement for physicians from the AHA/ACC/ACP Task Force in Clinical Privileges in Cardiology. Circulation 88; 1:337–341
Kotrly KJ, Kotter GS, Mortara D, Kampine JP (1984) Intraoperative detection of; myocardial ischemia with ST segment trend monitoring system, Anesth Analg 63: 343–345
Kotter GS, Kotrly KJ, Kalbfleisch JH, Vucins EJ, Kampine JP (1987) Myocardial ischemia during cardiovascular surgery as detected by ST segment trend monitoring system. J Cardiothorac Anesth 1:190–199
Landesberg G, Luria MH, Cotev S, Eidelman LA, Anner H, Mosseri M, Schechter D, Assaf J, Erel J, Berlatzky Y (1993) Importance of long-duration postoperative ST segment depression in cardiac morbidity after vascular surgery. Lancet 341; 20:715–719
Leung JM, Mangano DT (1993) Myocardial ischemia. In: Saidman LJ, Smith NT (eds) Monitoring in anesthesia, 3rd edn. Butterworth-Heinemann, Boston London Singapore, pp 145–155
Leung JM, O’Kelly B, Browner WS, Tubau J, Hollenberg M, Mangano DT (1989) Prognostic importance of postbypass regional wall-motion abnormalities in patients undergoing coronary artery bypass graft surgery. Anesthesiology 71:16–25
Leung JM, O’Kelly BF, Mangano DT (1990) Relationship of regional wall motion abnormalities to hemodynamic indices of myocardial oxygen supply and demand in patients undergoing CABG surgery. Anesthesiology 73:802–814
Liebermann RW, Orkin FK, Jobes DR, Schwartz AJ (1983) Hemodynamic predictors of myocardial ischemia during halothane anesthesia for coronary artery revascularization. Anesthesiology 59:36–41
London MJ, Hollenberg M, Wong MG, Levenson L, Tubau JF, Browner W, Mangano DT (1988) Intraoperative myocardial ischemia: localization by continuous 12-leald electrocardiography. Anesthesiology 69:232–241
London MJ, Tubau JF, Wong MG et al (1990) The „natural history” of segmental wall motion abnormalities in patients undergoing noncardiac surgery. Anesthesiology 73: 644–655
Lowenstein (1991) Acute ventricular wall motion heterogeneity. A valuable but imperfect index of myocardial ischemia. Anesthesiology 75:385–387
Mangano DT (1993) Perioperative cardiac morbidity: concepts and controversies. ASA Refresh Course Lect 131:1–5
Mangano DT, Browner WS, Hollenberg M, London MJ, Tubau JF, Tateo IM (1990) Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. N Engl J Med 323; 26:1781–1787
Mangano DT, Hollenberg M, Fegert G, Meyer ML, London MJ, Tubau JF (1991) Perioperative myocardial ischemia in patients undergoing noncardiac surgery-I: Incidence and severity during the 4 day perioperative period. JACC 4:843–850
Mangano DT, Wong MG, London MJ, Tubau JF, Rapp JA (1991) Perioperative myocardial ischemia in patients undergoing noncardiac surgery-II: Incidence and severity during the 1st week after surgery. JACC 4:851–857
Marsch SCU, Schaefer HG, Skarvan K, Castelli I, Scheidegger D (1992) Perioperative myocardial ischemia in patients undergoing elective hip arthroplasty during lumbar regional anesthesia. Anesthesiology 76:518–527
Metzler H, Mahla E, Rotman B, Rehak P, Potisk S, List WF (1991) Postoperative myocardial ischemia in patients with recent myocardial infarction. Br J Anaesth 67: 317–319
Miller TD, Christian TF, Taliercio CP, Zinsmeister AR, Gibbons RJ (1994) Severe exercise-induced ischemia does not identify high risk patients with normal left ventricular function and one-or two-vessel corornary artery disease. J Am Coll Cardiol 23:219–224
Miranda CP, Lehmann KG, Lachterman B, Coodley EM, Froelicher VF (1991) Comparison of silent and symptomatic ischemia during excercise testing in men. Ann Intern Med 114:649–656
Mirvis DM, Berson AS, Goldberger AL, Green LS, Heger JJ, Hinohara T, Insel J, Krucoff MW, Moncrief A, Selvester RH, Wagner GS (1989) Instrumentation and practice standards for electrocardiographic monitoring in special care units. Circulation 79: 464–471
Näslund U, Häggmark S, Johansson G, Reiz S (1993) Quantification of myocardium at risk and detection of reperfusion by dyamic vectorcardiographie ST segment monitoring in a big occlusion-reperfusion model. Cardiovasc Res 27:2170–2178
Ouyang P, kGerstenblith G, kFurman WR, Golueke PJ, Gottlieb SO (1989) Frequency and significance of early postoperative silent myocardial ischemia in patients having peripheral vascular surgery. Am J Cardiol 15:1113–1116
Pandian NG, Skorton DJ, Collins SM, Falsetti HL, Burke ER, Kerber RE (1983) heterogeneity of left ventricular segmental wall thickening and excursion in twodimensional echocardiograms of normal human subjects. Am J Cardiol 51:1667–1673
Pearlman AS, Gardin JM, Martin RP, Parisi AF, Popp RL, Quinones MA, Stevenson JG, Schiller NB, Seward JB, Stewart WJ (1992) Guidelines for physican training in transesophageal echocardiogaraphy: recommendations of the American Society of Echocardiography Committee for Physician Training in Echocardiography. J Am Soc Echocardiogr 2:187–194
Pepine CJ (1990) Is silent ischemia a treatable risk factor in patients with angina pectoris? Circulation 82; 3:II135–II142
Probst S, Wiederspahn T, Dudziak R (1991) Automatisierte, kontinuierliche ST-Strecken-Analyse im EKG als Monitoring myokardialer Ischämien bei aortokoronarer Bypassoperation. Anaesthesist 40:380–385
Raby KE, Goldman L, Creager MA, Cook EF, Weisberg MC, Whittemore AD, Selwyn AP (1989) Correlation between preoperative ischemia and major cardiac events after peripheral vascular surgery. N Engl J Med 9:1296–1300
Rahimtoola SH, Loeb HS, Ehsani A, Sinno MZ, Chuquimia R, Lal R, Rosen KM, Gunnar RM (1972) Relationship of pulmonary artery to left ventricular diastolic pressures in acute myocardial infarction. Circulation 46:283–290
Rapp HJ, Gasteiger P, Ackern K van (1993) ST-Trend-Analyse. Anaesthesist 42: 652–656
Robertson D, Kostok WJ, Ahuja SP (1976) The localization ofcoronary artery stenosis by 12-lead ECG response to graded exercise test. Am Heart J 91:437–444
Roizen MF, Beaupre PN, Alpert RA et al (1984) Monitoring with two-dimensional transoesophageal echocardiography. Comparison of myocardial function in patients undergoing supreceliac, suprarenal-infraceliac, or infrarenal aortic occlusion. J Vasc Surg 1:300–305
Rotman B, Eber B, Duslag J, Fluch N, Weinrauch V, Klein W (1988) Comparison of different methods of ST measurement for evaluation of myodardial ischaemia in holter monitoring. Eur Heart J 9: 78–84
Saur P, Kettler D, Sonntag H (1991) Hämodynmaische Parameter zur Abschätzung des myokardialen Sauerstoffverbrauchs in der Anaesthesia. Anaesthesist 40:7–13
Seward JB, Khandheria BK, Oh JK, Abel, Hughes RW, Edwards WD, Nochols BA, Freeman WK, Tajik AJ (1988) Technique, anatomic correlations, implementation, and clinical applications. Mayo Clin Proc 63:649–680
Sheffield LT, Berson A, Bragg-Remschel D, Gillette PC, Hermes RE, Hinkle L, Kennedy H, Mirvis DM, Oliver Ch (1985) Recommendations for standards of instrumentation and practice in the use of ambulatory electrocardiography. Circulation 71:626A–636A
Slogoff S, Keats AS (1985) Does perioperative myocardial ischemia lead to postoperative myocardial infarction? Anesthesiology 62:107–114
Slogoff S, Keats AS (1988) Does chronic treatment with calcium entry blocking drugs reduce perioperative myocardial ischemia? Anesthesiology 68:676–680
Slogoff S, Keats AS, David Y, Igo SR (1990) Incidence of perioperative myocardial ischemia detected by different electrocardiographic systems. Anesthesiology 73: 1074–1081
Smith JS, Cahalan MK, Benefiel DJ, Byrd BF, Lurz FW, Shapiro WA, Roizen MF, Bouchard A, Schiller NB (1985) Intraoperative detection of myocardial ischemia in high-risk patients: electrocardiography versus two-dimensional transoesophageal echocardiography. Circulation 72; 5:1015–1021
Steinbrook RA, Goldman DB, Mark JB, Philip JH, Raemer DB (1991) How best to monitor-for detection of myocardial ischemia. Anesthesiology 74:1171–1172
Tarnow J, Markschies-Hormung A, Schulte-Sasse U (1986) Isoflurane improves the tolerance to pacing-induced myocardial ischemia. Anesthesiology 64:147–156
Tennant R, Wiggers CJ (1935) The effect of coronary occlusion on myocardial infarction. Am J Physiol 112: 351
Tsuda H, Tabata H, Watanabe S, Inoue S, Hara H (1992) QRS complex changes in the V5 ECG lead during cardiac surgery. J Cardiothorac Vasc Anesth 6:658–662
Tuman KJ, Carroll GC, Ivankovich AD (1989) Pitfalls in interpretation of pulmonary artery catheter data. J Cardiothor Anesth 3; 5:625–641
Urban MK, Gordon MA, Harris SN, O’Connor T, Barash PG (1993) Intraoperative hemodynamic changes are not good indicators of myocardial ischemia. Anesth Analg 76: 942–949
Van Daele M, Sutherland GR, Mitchell MM, Fraser AG, Prakash O, Rulf EN, Roelandt J (1990) Do changes in pulmonary capillary wedge pressure adequately reflect myocardial ischemia during anesthesia? Circulation 81; 3:865–871
Vandenberg (1990) Transesophageal echocardiography and intraoperative monitoring of left ventricular function. Anesthesiology 73:799–801
Wang LTS, Milne B, Knight J (1992) Electrocardiographic ST segment changes associated with the inspiratory phase of positive-pressure ventillation after myocardial revascularization. J Cardiothorac Vasc Anesth 6; 1:62–64
Watanabe S, Buffington C (1994) Speed and sensitivity of mechanical versus electrographic indicators to mild or moderate myocardial ischemia in the pig. Anesthesiology 80:582–594
Waters DD, Da Luz P, Wyatt HL et al (1977) Early changes in regional and global left ventricular function induced by graded inductions in regional coronary perfusion. Am J Cardiol 39:537–543
Watters TA, Botvinick EH, Dae MW et al (1991) Comparison of the findings on preoperative dipyridamole perfusion scintigraphy and intraoperative transoesophageal echocardiography: implications regarding the identification on myocardium at ischemic risk. J Am Coll Cardiol 18:93–100
Wesslén Ö, Linden J, Ekroth R, Joachimsson PO, Nordgren L, Nyström SO (1990) Myocardial recovery after cardiac surgery: a study of hemodynamic performance and electrophysiology during the first 18 postoperative hours. J Cardtiothorac Anesth 6: 672–680
Wohlgelernter D, Cleman M, Highman HA et al (1986) Regional myocardial dysfunction during coronary angioplasty: Evaluation by two-dimensional echocardiography and 12 lead electrocardiography. J Am Coll Cardiol 7:1245–1254
Wyns W, Serruys PW, Slager C, Grimm J, Krayenbuehl HP, Hugenholtz PG, Hess OM (1986) Effects of coronary occlusion during percutaneous transluminal angioplasty in humans on left ventricular chamber stiffness and regional diastolic pressure-radius relations. J Am Coll Cardiol 7:455–463
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Metzler, H. (1995). Der Koronarpatient. In: List, W.F., Metzler, H., Pasch, T. (eds) Monitoring in Anästhesie und Intensivmedizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-08840-1_25
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