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Hypertensive Folgeschäden am Herzen

Cardiac sequelae of hypertension

  • Schwerpunkt: Hypertonie
  • Published:
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Zusammenfassung

Die arterielle Hypertonie führt zu Umstrukturierung und Schädigung des Herzens. Diese „Hypertensive Herzkrankheit“ umfasst die linksventrikuläre Hypertrophie. Ihr werden zudem diastolische und systolische Dysfunktion, die vaskulären Manifestationen der Mikroangiopathie und im weiteren Sinn auch koronare Herzkrankheit, sowie Herzrhythmusstörungen und plötzlicher Herztod zugeschrieben. Die pathophysiologischen Mechanismen beruhen auf einer komplexen neurohumoralen Regulation und der daraus entstehenden Änderung der Struktur und Leistung des Herzens. Der initialen Kompensation des vermehrten kardialen Leistungsbedarfs folgt die dauerhafte Schädigung des Herzens und sukzessive Dekompensation. Erst hier werden typische Beschwerden von Herzinsuffizienz oder -ischämie evident. Eine Diagnosestellung ist besonders zu Beginn wichtig, da sich die Prognose hinsichtlich Morbidität und Mortalität mit Fortbestehen des Hypertonus und Entwicklung einer dauerhaften Schädigung des Herzens verschlechtert.

Abstract

Arterial hypertension leads to cardiac restructuring and damage. This“hypertensive heart disease” includes left ventricular hypertrophy. In addition, it is also considered responsible for diastolic and systolic dysfunction, vascular manifestations of microangiopathy and in a broader sense also coronary heart disease as well as cardiac dysrhythmias and sudden cardiac death. The pathophysiological mechanisms depend on a complex neurohumoral regulation and the ensuing change in cardiac structure and output. The initial compensation for increased cardiac demand is followed by permanent heart damage and successive decompensation. At this point the typical complaints involved in cardiac insufficiency or ischemia become evident. Determining the diagnosis is particularly important early on since the prognosis with regard to morbidity and mortality deteriorates if the hypertensive condition persists and the heart develops lasting damage.

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Abbreviations

ACC/AHA:

American College of Cardiology/American Heart Association

ACE:

Angiotensin Converting Enzyme

AngII:

Angiotensin II

ANP:

Atrial Natriuretic Peptide

AR:

Adrenorezeptoren

BNP:

Brain Natriuretic Peptide

CNP:

C-type Natriuretic Peptide

EKG:

Elektrokardiogramm

ET:

Endothelin

ICD:

Implantierbarer Kardioverter/Defibrillator

IGF:

Insulin-like Growth Factor

IVUS:

Intravaskulärer Ultraschall

KHK:

Koronare Herzkrankheit

LVEDP:

Left Ventricular End-diastolic Pressure

LVH:

Linksventrikuläre Hypertrophie

MAPK:

Mitogen Activated Protein Kinase

MCP-1:

Monocyte Chemoattractant Protein 1

NO:

Stickstoffmonoxid

NPRA:

Natriuretic Peptide Receptor A

NYHA:

New York Heart Association

PCWP:

Pulmonary Capillary Wedge Pressure

RA(A)S:

Renin-Angiotensin-(Aldosteron-)System

ROS:

Reactive Oxygen Species

RWT:

Relative Wall Thickness

TGF-β:

Transforming Growth Factor β

TNF-α:

Tumornekrosefaktor α

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  1. Med. Klinik und Poliklinik II/Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Bonn,, Sigmund-Freud-Straße 25, 53105, Bonn, Deutschland

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Steinmetz, M., Nickenig, G. Hypertensive Folgeschäden am Herzen. Internist 50, 397–409 (2009). https://doi.org/10.1007/s00108-008-2289-3

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