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Diagnostik und Therapie bei akut dekompensierter Herzinsuffizienz und kardiogenem Schock

Therapeutic strategies in acute decompensated heart failure and cardiogenic shock

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Zusammenfassung

Infolge der immer älter werdenden Bevölkerung wird es zu einer Zunahme der stationären Aufnahmen wegen akuter kardialer Dekompensation kommen. Häufigste Ursachen sind Flüssigkeitsüberlagerung, unzureichende Medikation, Non-Compliance bei der Einnahme der Medikamente oder Verschlechterung der kardialen Pumpfunktion. Die Dekompensation infolge Flüssigkeitsüberladung kann durch intravenöse Diuretika gebessert werden. Auch Vasodilatatoren und inotrope Medikamente haben Eingang in die Therapiepläne gefunden. Im Rahmen des ADHERE-Registers (Acute Decompensated Heart Failure National Registry) wurden in über 275 Krankenhäusern Patienten mit akut dekompensierter Herzinsuffizienz charakterisiert. Bei diesen Patienten handelt es sich um eine Gruppe mit unterschiedlichen Herzinsuffizienzursachen und Schweregraden, was verschiedene Therapiestrategien im Rahmen der Notfallbehandlung notwendig macht. Gerade bei der Akutbehandlung wird ein interdisziplinäres Vorgehen gefordert, da die Patienten häufig älter sind und unter Komorbiditäten leiden. Da nur wenige Studien effektive Therapiestrategien nachweisen konnten und verschiedene Register gezeigt haben, dass spezifische Medikamente schwere Nebenwirkungen haben können, sind basierend auf der Pathophysiologie neue spezifischere Therapiestrategien für unterschiedliche Formen der akut dekompensierten Herzinsuffizienz notwendig.

Abstract

As the population of elderly people is increasing, the number of patients requiring hospitalization for acute exacerbations is rising. Traditionally, these episodes of hemodynamic instability were viewed as a transient event characterized by systolic dysfunction, low cardiac output, and fluid overload. Diuretics, along with vasodilator and inotropic therapy, eventually became elements of standard care. In a multicenter observational registry (ADHERE – Acute Decompensated Heart Failure National Registry) of more than 275 hospitals, patients with acute decompensated heart failure were analyzed for their characteristics and treatments options. These data have shown that this population consists of multiple types of heart failure, various forms of acute decompensation, combinations of comorbidities, and varying degrees of disease severity. The challenges in the treatment require multidisciplinary approaches since patients typically are elderly and have complex combinations of comorbidities. So far only a limited number of drugs is currently available to treat the different groups. Over the past years it was shown that even “standard drugs” might be deleterious by induction of myocardial injury, worsening of renal function or increasing mortality upon treatment. Therefore, based on pathophysiology, different types of acute decompensated heart failure require specialized treatment strategies.

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  1. Universitätsklinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06097, Halle/Saale, Deutschland

    M. Buerke, H. Lemm, M. Russ, A. Schlitt & K. Werdan

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Buerke, M., Lemm, H., Russ, M. et al. Diagnostik und Therapie bei akut dekompensierter Herzinsuffizienz und kardiogenem Schock. Internist 51, 963–974 (2010). https://doi.org/10.1007/s00108-009-2537-1

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