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Behandlung des kardiogenen Schocks im Rahmen eines akuten Myokardinfarkts

Treatment of cardiogenic shock complicating acute myocardial infarction

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Zusammenfassung

Obgleich die Sterblichkeit des akuten Myokardinfarkts in den letzten Jahrzehnten deutlich reduziert werden konnte, ist die Mortalitätsrate bei Patienten, die im Rahmen eines akuten Koronarsyndroms einen kardiogenen Schock entwickeln, sehr hoch. Die supportive medikamentöse Therapie des kardiogenen Schocks ist häufig mit unerwünschten Nebenwirkungen (Arrhythmien, erhöhter myokardialer Sauerstoffverbrauch) oder unzureichender Kreislaufunterstützung verbunden. Für die mechanische kreislaufunterstützende Therapie konnte jedoch bislang keine Verbesserung des Kurzzeit- und Langzeitüberlebens gezeigt werden. Allerdings gibt es Hinweise auf Überlebensvorteile im therapierefraktären kardiogenen Schock. Zukünftige Studien sollten einerseits weitere medikamentöse Therapieoptionen überprüfen und klären, welches mechanische Unterstützungssystem zu welchem Zeitpunkt den besten Therapieerfolg bringt.

Abstract

While the mortality rate of acute myocardial infarction has decreased drastically in the last decades, the outcome of patients with cardiogenic shock complicating acute myocardial infarction is still devastating. The effectiveness of supportive medicinal therapy of cardiogenic shock is often limited by undesired side effects (e.g. arrhythmia and increased myocardial oxygen consumption) or inadequate hemodynamic support. Mechanical circulatory support in cardiogenic shock failed to show beneficial effects on short-term and long-term survival; however, there are hints for a survival benefit in therapy refractory cardiogenic shock. Therefore, future trials need to evaluate further medicinal treatment options and also the best type of mechanical support as well as the optimal time of initiation to improve the success of therapeutic management.

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Abbreviations

CI:

Kardialer Index

ECLS:

Extrakorporale Kreislaufunterstützung

HZV:

Herzzeitvolumen

IABP:

Intraaortale Gegenpulsation

LVAD:

Linksventrikuläres Unterstützungssystem

MAP:

Mittlerer arterieller Blutdruck

STEMI:

ST-Hebungs-Infarkt

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Blazek, K. Fengler, T. Stiermaier, P. Lurz, G. Schuler und G. Fürnau geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Blazek, S., Fengler, K., Stiermaier, T. et al. Behandlung des kardiogenen Schocks im Rahmen eines akuten Myokardinfarkts. Herz 39, 702–710 (2014). https://doi.org/10.1007/s00059-014-4124-z

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