Der Internist
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Acute coronary syndrome is one of the most common reasons for a presentation in an emergency room. The biggest component of the overall mortality in adults is acute coronary syndrome or in this context its complications. ⋯ Although the underlying disease has not changed, especially with the introduction of troponins and the changes of their reference values the concept and importance of acute myocardial infarction has changed. This article emphasises on the current nomenclature and its importance for the adequate diagnosis and treatment are explained.
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Bradycardic (heart rate<50/min) and tachycardic heart rhythm disturbances (100/min) require rapid therapeutic strategies. Supraventricular tachycardias (SVT) are sinus tachycardia, atrial tachycardia, AV-nodal reentrant tachycardia and tachycardia due to accessory pathways. Mostly SVT are characterized by small QRS complexes (QRS width<0.12 ms). ⋯ For acute therapy, we will present the new concept of the "5A" that includes adenosine, adrenaline, ajmaline, amiodarone and atropine. Additional "B, C and D strategies" include betablocking agents, cardioversion as well as defibrillation. The "5A" concept allows a safe and effective antiarrhythmic treatment of all bradycardic and tachycardic arrhythmias as well as asystolia.