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Management beim akuten Aortensyndrom

Management of acute aortic syndrome

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Der Kardiologe Aims and scope

Zusammenfassung

Hintergrund

Der Begriff des akuten Aortensyndroms (AAS) beschreibt ein Spektrum heterogener akuter Pathologie der Aorta mit ähnlichem klinischem Erscheinungsbild. Dazu gehören die Aortendissektion, das intramurale Aortenhämatom (IMH) und das penetrierende arteriosklerotische Aortenulkus (PAU).

Ursachen

Der häufigste Risikofaktor bei Patienten mit Aortendissektion oder IMH ist die arterielle Hypertonie. Andere Risikofaktoren sind Rauchen, ein stumpfes Trauma und der Gebrauch von illegalen Drogen. Etwa 20 % der jüngeren Patienten mit Aortendissektion oder mit thorakalen Aortenaneurysmen haben einen meist zugrunde liegenden autosomal-dominanten Gendefekt.

Symptome und Diagnostik

Das Hauptsymptom des AAS ist der akute Thoraxschmerz. Da es keine paraklinischen Ausschlusskriterien für eine AAS gibt, sollte angesichts der hohen Letalität des AAS jeder klinische Verdacht zu zügiger diagnostischer Bildgebung führen.

Therapie und Nachsorge

Die Initialtherapie besteht in der Senkung des meist dysregulierten Blutdrucks auf systolische Werte. Das weitere Vorgehen besteht dann entweder in der chirurgischen oder endovaskulären Behandlung, die heute die Therapie der Wahl darstellt. Die Nachsorge der Patienten mit Aortenerkrankungen ist aufgrund der Komplexität und potenziellen Progression unabdingbar.

Abstract

Background

The term acute aortic syndrome (AAS) describes a spectrum of heterogeneous acute pathologies of the aorta with similar clinical symptoms. These include aortic dissection, intramural aortic hematoma (IMH) and penetrating arteriosclerotic aortic ulcer (PAU).

Causes

The most common risk factor in patients with aortic dissection or IMH is arterial hypertension. Other risk factors are smoking, blunt force trauma and consumption of illegal drugs. Approximately 20 % of younger patients with aortic dissection or thoracic aortic aneurysms have mostly an underlying autosomal dominant genetic defect.

Symptoms and diagnostics

The main symptom of AAS is acute thoracic pain. Because there are no clinical exclusion criteria for AAS and due to the high mortality, all clinically suspect symptoms should be rapidly investigated by diagnostic imaging.

Therapy and monitoring

The initial therapy consists of reduction of the mostly dysregulated blood pressure to systolic values. The next step in the approach is either surgical or endovascular treatment which nowadays represents the therapy of choice. Follow-up treatment of patients with aortic diseases is indispensable due to the complexity and potential progression.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Aboukoura, T. Najjar, I. Akin, T.C. Rehders, B. Mrevlje, M. Weinrich und C.A. Nienaber geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigten oder des gesetzlich bestellten Betreuers vor.

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Authors and Affiliations

  1. Universitäres Herzzentrum, Medizinische Klinik I. Im Zentrum für Innere Medizin, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland

    M. Aboukoura, T. Najjar, I. Akin, T.C. Rehders, B. Mrevlje, M. Weinrich &  C.A. Nienaber

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  1. M. Aboukoura
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  2. T. Najjar
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  3. I. Akin
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  4. T.C. Rehders
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  5. B. Mrevlje
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  6. M. Weinrich
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  7. C.A. Nienaber
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Corresponding author

Correspondence to C.A. Nienaber.

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Aboukoura, M., Najjar, T., Akin, I. et al. Management beim akuten Aortensyndrom. Kardiologe 8, 399–406 (2014). https://doi.org/10.1007/s12181-014-0601-0

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