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Akute Herzinsuffizienz

Acute heart failure

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Zusammenfassung

Die Zahl der an Herzinsuffizienz Leidenden nahm in den letzten Jahren stetig zu. Sie wird als das führende kardiale Krankheitsbild des 21. Jahrhunderts angesehen. Ressourcen werden v. a. durch Krankenhauskosten in Anspruch genommen. Die koronare Herzkrankheit (KHK) allein oder in Kombination mit der arteriellen Hypertonie ist sicher die häufigste Ursache der Herzinsuffizienz. Bei nahezu 50% der Patienten mit akuter Herzinsuffizienz ist die linksventrikuläre Pumpfunktion erhalten. Die therapeutischen Ziele in der Behandlung der akuten Herzinsuffizienz sind rasche Stabilisierung der Hämodynamik, Verbesserung der Symptome und des respiratorischen Status sowie der kurz- und langfristigen Prognose. Diuretika, Vasodilatatoren und positiv inotrope Substanzen stehen neben allgemeinen und supportiven Maßnahmen im Zentrum der Versorgung. Klare und strukturierte Abläufe bei der Diagnostik und Therapie in der Notaufnahme, der Intensiv-, der Wach- und der Normalstation sind zwingend erforderlich.

Abstract

Acute decompensated heart failure (ADHF) is a major public health problem throughout the world and its importance is continuing to grow. More than 50% of ADHF patients have coronary artery disease, which is generally associated with a history of hypertension. Recent data suggest that half of the patients presenting with acute heart failure have preserved left ventricular systolic function. The diagnosis of ADHF may be difficult at times, and the clinical assessment and patient profiling is essential for appropriate therapy. Immediate therapeutic goals are not only to improve symptoms, restore oxygenation and stabilize hemodynamic conditions, but also to improve short- and long-term survival. In addition to general supportive measures such as oxygen supplementation, noninvasive ventilation, analgesia, diuretics, vasodilators together with inotropic agents and/or vasopressors remain the cornerstone of therapy in patients with ADHF.

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Literatur

  1. Neumann T, Biermann J, Erbel R et al (2009) Herzinsuffizienz: Häufigster Grund für Krankhenhausaufenthalte. Medizinische und ökonomische Aspekte. Dtsch Arztebl Int 106:269–275

    PubMed  Google Scholar 

  2. Schappert SM, Rechtsteiner EA (2008) Ambulatory medical care utilization estimates for 2006. Natl Health Stat Report 8:1–29

    PubMed  Google Scholar 

  3. Schappert SM, Rechtsteiner EA (2011) Ambulatory medical care utilization estimates for 2007. Vital Health Stat 13:1–38

    Google Scholar 

  4. Weintraub NL, Collins SP, Pang PS et al (2010) Acute heart failure syndromes: emergency department presentation, treatment, and disposition: current approaches and future aims: a scientific statement from the American Heart Association. Circulation 122:1975–1996

    Article  PubMed  Google Scholar 

  5. Berry C, Murdoch DR, McMurray JJ (2001) Economics of chronic heart failure. Eur J Heart Fail 3:283–291

    Article  PubMed  CAS  Google Scholar 

  6. Janssens U (2009) Die akute Herzinsuffizienz: Diagnostik und Monitoring. Dtsch Med Wochenschr 134:1287–1292

    Article  PubMed  CAS  Google Scholar 

  7. Cowie MR, Mosterd A, Wood DA et al (1997) The epidemiology of heart failure. Eur Heart J 18:208–225

    Article  PubMed  CAS  Google Scholar 

  8. Mosterd A (1999) Heart failure in the population at large; news from the real world. Eur Heart J 20:398–399

    Article  PubMed  CAS  Google Scholar 

  9. Mosterd A, Hoes AW, Bruyne MC de et al (1999) Prevalence of heart failure and left ventricular dysfunction in the general population; the Rotterdam Study. Eur Heart J 20:447–455

    Article  PubMed  CAS  Google Scholar 

  10. McMurray JJ, Stewart S (2000) Epidemiology, aetiology, and prognosis of heart failure. Heart 83:596–602

    Article  PubMed  CAS  Google Scholar 

  11. Janssens U, Werdan K (2006) Erforderliches Monitoring auf der Intensivstation. Herz 31:749–760

    Article  PubMed  Google Scholar 

  12. Statistisches Bundesamt (2011) Statistisches Bundesamt, Wiesbaden, http://www.destatis.de. Zugegriffen: 25.03.2012

  13. Blüthgen A (2002) Differenzialdiagnostik des kardialen Versagens. In: Eckart J, Forst H, Burchardi H (Hrsg) Intensivmedizin Kompendium und Repetitorium zur interdisziplinären Fort- und Weiterbildung. Ecomed, Landsberg, S 1–12

  14. Buerke M, Lemm H, Russ M et al (2010) Diagnostik und Therapie bei akut dekompensierter Herzinsuffizienz und kardiogenem Schock. Internist (Berl) 51:963–974

    Google Scholar 

  15. Joseph SM, Cedars AM, Ewald GA et al (2009) Acute decompensated heart failure: contemporary medical management. Tex Heart Inst J 36:510–520

    PubMed  Google Scholar 

  16. Acute Decompensated Heart Failure National Registry (ADHERE®) (2007) Core Module Q1 2006. Final Cumulative National Benchmark Report

  17. Gheorghiade M, Abraham WT, Albert NM et al (2006) Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA 296:2217–2226

    Article  PubMed  CAS  Google Scholar 

  18. Perna ER, Barbagelata A, Grinfeld L et al (2006) Overview of acute decompensated heart failure in Argentina: lessons learned from 5 registries during the last decade. Am Heart J 151:84–91

    Article  PubMed  Google Scholar 

  19. Cleland JG, Swedberg K, Cohen-Solal A et al (2000) The Euro Heart Failure Survey of the EUROHEART survey programme. A survey on the quality of care among patients with heart failure in Europe. The Study Group on Diagnosis of the Working Group on Heart Failure of the European Society of Cardiology. The Medicines Evaluation Group Centre for Health Economics University of York. Eur J Heart Fail 2:123–132

    Article  PubMed  CAS  Google Scholar 

  20. Nieminen MS, Brutsaert D, Dickstein K et al (2006) Euroheart failure survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J 27:2725–2736

    Article  PubMed  Google Scholar 

  21. Zannad F, Mebazaa A, Juilliere Y et al (2006) Clinical profile, contemporary management and one-year mortality in patients with severe acute heart failure syndromes: the EFICA study. Eur J Heart Fail 8:697–705

    Article  PubMed  Google Scholar 

  22. Tavazzi L, Maggioni AP, Lucci D et al (2006) Nationwide survey on acute heart failure in cardiology ward services in Italy. Eur Heart J 27:1207–1215

    Article  PubMed  Google Scholar 

  23. Metra M, Felker GM, Zaca V et al (2010) Acute heart failure: multiple clinical profiles and mechanisms require tailored therapy. Int J Cardiol 144:175–179

    Article  PubMed  Google Scholar 

  24. Greenberg B (2012) Acute decompensated heart failure – treatments and challenges. Circ J 76:532–543

    Article  PubMed  CAS  Google Scholar 

  25. Nieminen MS, Harjola VP (2005) Definition and epidemiology of acute heart failure syndromes. Am J Cardiol 96:5G–10G

    Article  PubMed  Google Scholar 

  26. Dickstein K, Cohen-Solal A, Filippatos G et al (2008) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Eur Heart J 29:2388–2442

    Article  PubMed  CAS  Google Scholar 

  27. Nieminen MS, Bohm M, Cowie MR et al (2005) Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology. Eur Heart J 26:384–416

    Article  PubMed  Google Scholar 

  28. Drexler H, Bonin J von (2002) Kardiogener Schock nach Myokardinfarkt: Therapieansätze. In: Eckart J, Forst H, Burchardi H (Hrsg) Intensivmedizin – Kompendium und Repetitorium zur interdisziplinären Fort- und Weiterbildung. Ecomed, Landsberg, S 1–12

  29. Böhm M (2002) Pathophysiologie der Herzinsuffizienz heute. Herz 27:75–91

    Article  PubMed  Google Scholar 

  30. Cairns CB (1996) Heart failure and pulmonary edema. In: Tintinalli JE, Ruiz E, Krome RL (Hrsg) Emergency medicine. McGraw-Hill, New York, S 354–357

  31. Wollert KC, Drexler H (1998) Akute Herzinsuffizienz. Internist (Berl) 39:459–466

  32. Adams HA, Baumann G, Gänsslein A et al (2001) Die Definition der Schockformen. Intensivmedizin 38:541–553

    Article  Google Scholar 

  33. Janssens U, Graf J (2004) Was ist „Schock“. Internist (Berl) 45:258–266

    Google Scholar 

  34. Hochman JS (2003) Cardiogenic shock complicating acute myocardial infarction: expanding the paradigm. Circulation 107:2998–3002

    Article  PubMed  Google Scholar 

  35. Mitaka C, Hirata Y, Yokoyama K et al (2003) Relationships of circulating nitrite/nitrate levels to severity and multiple organ dysfunction syndrome in systemic inflammatory response syndrome. Shock 19:305–309

    Article  PubMed  CAS  Google Scholar 

  36. Kierdorf H (2009) Einsatz von Nierenersatzverfahren bei akut dekompensierter Herzinsuffizienz. Intensivmedizin 46:421–428

    Article  Google Scholar 

  37. Adams KF Jr, Fonarow GC, Emerman CL et al (2005) Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J 149:209–216

    Article  PubMed  Google Scholar 

  38. Ronco C, Haapio M, House AA et al (2008) Cardiorenal syndrome. J Am Coll Cardiol 52:1527–1539

    Article  PubMed  Google Scholar 

  39. Schiff GD, Fung S, Speroff T et al (2003) Decompensated heart failure: symptoms, patterns of onset, and contributing factors. Am J Med 114:625–630

    Article  PubMed  Google Scholar 

  40. Cleland JG, Swedberg K, Follath F et al (2003) The Euro Heart Failure survey programme – a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis. Eur Heart J 24:442–463

    Article  PubMed  CAS  Google Scholar 

  41. Killip T, III, Kimball JT (1967) Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol 20:457–464

    Article  PubMed  Google Scholar 

  42. Tsai TH, Chua S, Hussein H et al (2011) Outcomes of patients with Killip class III acute myocardial infarction after primary percutaneous coronary intervention. Crit Care Med 39:436–442

    Article  PubMed  Google Scholar 

  43. Forrester JS, Diamond G, Chatterjee K et al (1976) Medical therapy of acute myocardial infarction by application of hemodynamic subsets (second of two parts). N Engl J Med 295:1404–1413

    Article  PubMed  CAS  Google Scholar 

  44. Nohria A, Tsang SW, Fang JC et al (2003) Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. J Am Coll Cardiol 41:1797–1804

    Article  PubMed  Google Scholar 

  45. Chung P, Hermann L (2006) Acute decompensated heart failure: formulating an evidence-based approach to diagnosis and treatment (part I). Mt Sinai J Med 73:506–515

    PubMed  Google Scholar 

  46. Adams HA, Baumann G, Cascorbi I et al (2005) Empfehlungen zur Diagnostik und Therapie der Schockformen der IAG Schock der DIVI. Teil 3: Kardialer Schock. Intensivmedizin 42:196–210

    Google Scholar 

  47. Maisel AS, Krishnaswamy P, Nowak RM et al (2002) Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 347:161–167

    Article  PubMed  CAS  Google Scholar 

  48. Remme WJ, Swedberg K (2001) Guidelines for the diagnosis and treatment of chronic heart failure. Eur Heart J 22:1527–1560

    Article  PubMed  CAS  Google Scholar 

  49. Christenson RH (2008) What is the value of B-type natriuretic peptide testing for diagnosis, prognosis or monitoring of critically ill adult patients in intensive care? Clin Chem Lab Med 46:1524–1532

    Article  PubMed  CAS  Google Scholar 

  50. Kociol RD, Pang PS, Gheorghiade M et al (2010) Troponin elevation in heart failure prevalence, mechanisms, and clinical implications. J Am Coll Cardiol 56:1071–1078

    Article  PubMed  CAS  Google Scholar 

  51. Janssens U (2001) Monitoring des herzkranken Intensivpatienten. Intensivmedizin 38:232–250

    Article  Google Scholar 

  52. Janssens U (2000) Hämodynamisches Monitoring. Internist (Berl) 41:995–1010

    Google Scholar 

  53. Müller T, Pfeifer M, Muders F (2003) Das Monitoring der zentralvenösen und gemischtvenösen Sauerstoffsättigung in der Intensivmedizin. Physiologische und technische Grundlagen, Indikationen und Aussagen. Intensivmedizin 40:711–719

    Article  Google Scholar 

  54. Binanay C, Califf RM, Hasselblad V et al (2005) Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. JAMA 294:1625–1633

    Article  PubMed  Google Scholar 

  55. Goedje O, Hoeke K, Lichtwarck-Aschoff M et al (1999) Continuous cardiac output by femoral arterial thermodilution calibrated pulse contour analysis: comparison with pulmonary arterial thermodilution. Crit Care Med 27:2407–2412

    Article  PubMed  CAS  Google Scholar 

  56. Cotter G, Moshkovitz Y, Kaluski E et al (2003) The role of cardiac power and systemic vascular resistance in the pathophysiology and diagnosis of patients with acute congestive heart failure. Eur J Heart Fail 5:443–451

    Article  PubMed  Google Scholar 

  57. Janssens U, Graf J (2004) Systemische Optimierung des Sauerstoffangebotes. Kardiologische Optimierung. Anasthesiol Intensivmed Notfallmed Schmerzther 40:640–652

    Article  Google Scholar 

  58. Müller E, Kindgen-Milles D (2002) Der Patient mit Lungenversagen und Myokardinsuffizienz. In: Eckart J, Forst H, Burchardi H (Hrsg) Intensivmedizin – Kompendium und Repetitorium zur interdisziplinären Fort- und Weiterbildung. Ecomed, Landsberg, S 1–10

  59. Link A, Böhm M (2009) ESC Leitlinien 2008 – Leitlinien zur akuten Herzinsuffizienz. Intensivmedizin 46:377–382

    Article  Google Scholar 

  60. Engelmann L (2009) Bedeutung und Einsatz der Beatmung bei akut dekompensierter Herzinsuffizienz. Intensivmedizin 46:391–398

    Article  Google Scholar 

  61. Nava S, Carbone G, DiBattista N et al (2003) Noninvasive ventilation in cardiogenic pulmonary edema: a multicenter randomized trial. Am J Respir Crit Care Med 168:1432–1437

    Article  PubMed  Google Scholar 

  62. Mehta S, Jay GD, Woolard RH et al (1997) Randomized, prospective trial of bilevel versus continuous positive airway pressure in acute pulmonary edema. Crit Care Med 25:620–628

    Article  PubMed  CAS  Google Scholar 

  63. Park M, Lorenzi-Filho G, Feltrim MI et al (2001) Oxygen therapy, continuous positive airway pressure, or noninvasive bilevel positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema. Arq Bras Cardiol 76:221–230

    Article  PubMed  CAS  Google Scholar 

  64. Schönhofer B, Kuhlen R, Neumann P et al (2008) Clinical practice guideline: non-invasive mechanical ventilation as treatment of acute respiratory failure. Dtsch Arztebl Int 105:424–433

    PubMed  Google Scholar 

  65. Loo A van de (2002) Therapie hämodynamische wirksamer Herzrhythmusstörungen. In: Eckart J, Forst H, Burchardi H (Hrsg) Intensivmedizin – Kompendium und Repetitorium zur interdisziplinären Fort- und Weiterbildung. Ecomed, Landsberg, S 1–15

  66. Hamm CW, Bassand JP, Agewall S et al (2011) ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the Management of Acute Coronary Syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 32(23):2999–3054

    Article  PubMed  Google Scholar 

  67. Buccelletti F, Hermann L (2006) Acute decompensated heart failure: formulating an evidence-based approach to diagnosis and treatment (part II). Mt Sinai J Med 73:516–527

    PubMed  Google Scholar 

  68. Vasan RS, Larson MG, Benjamin EJ et al (1999) Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population-based cohort. J Am Coll Cardiol 33:1948–1955

    Article  PubMed  CAS  Google Scholar 

  69. Bayliss J, Norell M, Canepa-Anson R et al (1987) Untreated heart failure: clinical and neuroendocrine effects of introducing diuretics. Br Heart J 57:17–22

    Article  PubMed  CAS  Google Scholar 

  70. Francis GS, Siegel RM, Goldsmith SR et al (1985) Acute vasoconstrictor response to intravenous furosemide in patients with chronic congestive heart failure. Activation of the neurohumoral axis. Ann Intern Med 103:1–6

    PubMed  CAS  Google Scholar 

  71. De Bruyne LK (2003) Mechanisms and management of diuretic resistance in congestive heart failure. Postgrad Med J 79:268–271

    Article  Google Scholar 

  72. Marx G, Cope T, McCrossan L et al (2004) Assessing fluid responsiveness by stroke volume variation in mechanically ventilated patients with severe sepsis. Eur J Anaesthesiol 21:132–138

    PubMed  CAS  Google Scholar 

  73. Gunn SR, Pinsky MR (2001) Implications of arterial pressure variation in patients in the intensive care unit. Curr Opin Crit Care 7:212–217

    Article  PubMed  CAS  Google Scholar 

  74. Acute Decompensated Heart Failure National Registry (ADHERE®) (2004) The Adhere registry: second quarter 2003. National Benchmark Report

  75. Emerman CL (2003) Treatment of the acute decompensation of heart failure: efficacy and pharmacoeconomics of early initiation of therapy in the emergency department. Rev Cardiovasc Med [Suppl 7] 4:13–20

    Google Scholar 

  76. Fonarow GC (2001) The treatment targets in acute decompensated heart failure. Rev Cardiovasc Med [Suppl 2] 2:7–12

    Google Scholar 

  77. Felker GM, Lee KL, Bull DA et al (2011) Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med 364:797–805

    Article  PubMed  CAS  Google Scholar 

  78. Möllhoff T (2002) Einsatz vasoaktiver Substanzen bei Myokardinsuffizienz. In: Eckart J, Forst H, Burchardi H (Hrsg) Intensivmedizin – Kompendium und Repetitorium zur interdisziplinären Fort- und Weiterbildung. Ecomed, Landsberg, S 1–22

  79. Cotter G, Metzkor E, Kaluski E et al (1998) Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet 351:389–393

    Article  PubMed  CAS  Google Scholar 

  80. Hirschl MM (2006) Aktuelles: Aortendissektion. Austrian J Hypertens 10:35–37

    Google Scholar 

  81. O’Connor CM, Starling RC, Hernandez AF et al (2011) Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med 365:32–43

    Article  Google Scholar 

  82. McMurray JJ, Teerlink JR, Cotter G et al (2007) Effects of tezosentan on symptoms and clinical outcomes in patients with acute heart failure: the VERITAS randomized controlled trials. JAMA 298:2009–2019

    Article  PubMed  CAS  Google Scholar 

  83. Konstam MA, Gheorghiade M, Burnett JC Jr et al (2007) Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST outcome trial. JAMA 297:1319–1331

    Article  PubMed  CAS  Google Scholar 

  84. Massie BM, O’Connor CM, Metra M et al (2010) Rolofylline, an adenosine A1-receptor antagonist, in acute heart failure. N Engl J Med 363:1419–1428

    Article  PubMed  Google Scholar 

  85. Teerlink JR, Metra M, Felker GM et al (2009) Relaxin for the treatment of patients with acute heart failure (Pre-RELAX-AHF): a multicentre, randomised, placebo-controlled, parallel-group, dose-finding phase IIb study. Lancet 373:1429–1439

    Article  PubMed  CAS  Google Scholar 

  86. Shah SJ, Blair JE, Filippatos GS et al (2009) Effects of istaroxime on diastolic stiffness in acute heart failure syndromes: results from the hemodynamic, echocardiographic, and neurohormonal effects of istaroxime, a novel intravenous inotropic and lusitropic agent: a randomized controlled trial in patients hospitalized with heart failure (HORIZON-HF) trial. Am Heart J 157:1035–1041

    Article  PubMed  CAS  Google Scholar 

  87. Cleland JG, Teerlink JR, Senior R et al (2011) The effects of the cardiac myosin activator, omecamtiv mecarbil, on cardiac function in systolic heart failure: a double-blind, placebo-controlled, crossover, dose-ranging phase 2 trial. Lancet 378:676–683

    Article  PubMed  CAS  Google Scholar 

  88. Lapp H, Mitrovic V, Franz N et al (2009) Cinaciguat (BAY 58–2667) improves cardiopulmonary hemodynamics in patients with acute decompensated heart failure. Circulation 119:2781–2788

    Article  PubMed  CAS  Google Scholar 

  89. Delle-Karth G, Heinz G (2004) Levosimendan in Kardiologie und Intensivmedizin. Wien Klin Wochenschr 116:6–14

    Article  PubMed  CAS  Google Scholar 

  90. Communal C, Singh K, Sawyer DB et al (1999) Opposing effects of beta(1)- and beta(2)-adrenergic receptors on cardiac myocyte apoptosis: role of a pertussis toxin-sensitive G protein. Circulation 100:2210–2212

    Article  PubMed  CAS  Google Scholar 

  91. Prondzinsky R, Werdan K (2004) Kardiogener Schock: Kriterien, gesicherte und ungesicherte Therapieverfahren. In: Eckart J, Forst H, Burchardi H (Hrsg) Intensivmedizin – Kompendium und Repetitorium zur interdisziplinären Fort- und Weiterbildung. Ecomed, Landsberg, S 1–22

  92. Buerke M, Lemm H, Dietz S, Werdan K (2010) Infarktbedingter kardiogener Schock – Ursache, Diagnose und Behandlung. Intensivmedizin 47:597–611

    Article  Google Scholar 

  93. Mebazaa A, Parissis J, Porcher R et al (2011) Short-term survival by treatment among patients hospitalized with acute heart failure: the global ALARM-HF registry using propensity scoring methods. Intensive Care Med 37:290–301

    Article  PubMed  Google Scholar 

  94. Ferrari M (2009) Die akute Herzinsuffizienz: Mechanische Kreislaufunterstützung. Dtsch Med Wochenschr 134:1474–1477

    Article  PubMed  CAS  Google Scholar 

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Der korrespondierende Autor hat Vorträge für die Firma Abbott und Orion gehalten, mit Bezug auf Levosimendan, und war als Referent für die Firmen Orion, Maquet und Abbott tätig.

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Janssens, U. Akute Herzinsuffizienz. Med Klin Intensivmed Notfmed 107, 397–425 (2012). https://doi.org/10.1007/s00063-012-0118-x

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