Zusammenfassung
Die akute Herzinsuffizienz ist definiert durch das plötzliche Auftreten von Symptomen einer Herzinsuffizienz, die einer notfallmäßigen Therapie bedürfen. Die Krankenhausmortalität beträgt bis zu 10 %, beim kardiogenen Schock sogar 50–70 %. Entscheidend für eine adäquate Therapie sind das rasche Erkennen der zugrunde liegenden Ursache der akuten Herzinsuffizienz und eine möglichst kausale Therapie. Beim akuten Koronarsyndrom steht daher die Akutkoronarangiographie mit Intervention im Vordergrund. Die medikamentösen und apparativen Therapieprinzipien zielen auf eine Reduzierung klinischer Stauungszeichen, eine Vor- und Nachlastsenkung, eine myokardiale Kontraktilitätsteigerung und die Durchbrechung der neurohumoralen Aktivierung. Bis heute gibt es im Gegensatz zur chronischen Herzinsuffizienz keine medikamentöse Therapie, welche die Sterblichkeit senken kann. Von neuen Therapieansätzen ist zumindest eine Symptomverbesserung, das Verhindern von Endorganschäden und im günstigsten Fall eine Reduktion der kardiovaskulären Ereignis-, Rehospitalisations- und Mortalitätsrate zu fordern.
Abstract
Acute heart failure is defined as the acute onset of symptoms due to hear failure necessitating emergency therapy. The in-hospital mortality rate ranges up to 10 % and in cardiogenic shock is 50–70 %. In acute heart failure, rapid diagnosis and causal therapy are necessary to avoid cardiogenic shock. In cases of acute coronary syndromes, primary percutaneous intervention should be performed immediately. Medical and apparative treatment strategies focus on decreasing pulmonary congestion, afterload, and neurohormonal activation in order to improve hemodynamics and reduce symptoms of dyspnea. In contrast to chronic heart failure, no medical therapy has been able to reduce mortality rates in acute heart failure. However, new medical therapies should at least improve clinical symptoms of congestion and favorably reduce cardiovascular events, re-hospitalization, and mortality rates.
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Interessenkonflikt. A. Link und M. Böhm geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Link, A., Böhm, M. Neues zur akuten Herzinsuffizienz. Internist 55, 655–662 (2014). https://doi.org/10.1007/s00108-013-3426-1
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DOI: https://doi.org/10.1007/s00108-013-3426-1