Herz

, Volume 35, Issue 2, pp 94–101

Therapie der fortgeschrittenen Herz - insuffizienz: medikamentös, Resynchronisation (CRT), Operation

Article

Zusammenfassung

Die Therapie der fortgeschrittenen Herzinsuffizienz folgt dem Primat der kausalen Therapie der Grundkrankheit als wichtigstem Prinzip der Behandlung. Dies setzt eine umfassende Kenntnis der Ätiologie und Pathophysiologie voraus. Das gilt für die koronare Herzerkrankung ebenso wie für die arterielle Hypertonie, die Herzklappenerkrankungen, die Kardiomyopathien mit und ohne Inflammation und die mikrobielle Infektion. Die medikamentöse Behandlung stützt sich sowohl bei der chronischen Herzinsuffizienz mit eingeschränkter als auch weitgehend uneingeschränkter linksventrikulärer Funktion auf herzentlastende Maßnahmen und Medikamente (Angiotensin-converting-Enzym-Hemmer, Angio tensinantagonisten, β-Blocker, Diuretika, Antiarrhythmika sowie Antikoagulazien), wenn erforderlich. Sie wird in späteren oder schweren Stadien gefolgt von einer Device-Therapie zur Resynchronisation und/ oder Defibrillation. Sind alle diese Maßnahmen ausgeschöpft, verbleiben Herztransplantation und linksventrikuläre Unterstützungssysteme als letzte Optionen der Behandlung der terminalen Herzinsuffizienz.

Schlüsselwörter:

Chronische Herzinsuffizienz Pharmakotherapie CRT ICD Chirurgische Therapie 

Treatment of Progressive Heart Failure: Pharmacotherapy, Resynchronization (CRT), Surgery

Abstract

The treatment of progressive and terminal heart failure follows the principle of causative therapy. Therefore, etiology and pathophysiology of the underlying disease and its hemodynamic conditions are indispensable. This applies to coronary artery disease, hypertension, valvular heart disease, the cardiomyopathies with and without inflammation, and microbial persistence similarly. The classic treatment algorithms both in heart failure with and without reduced ejection fraction are based on measures onloading the heart (angiotensin-converting enzyme inhibitors, angiotensin antagonists, β-blockers, diuretics) and on antiarrhythmics and anticoagulation, when needed. Device therapy for cardiac resynchronization in left bundle branch block and permanent stimulation therapy may contribute to the hemodynamic benefit. ICD (implantable cardioverter defibrillator) therapy prevents sudden cardiac death, which is often associated with progressive heart failure. Heart transplantation and left ventricular assist devices are final options in the treatment repertoire of terminal heart failure.

Key Words:

Heart failure Pharmacotherapy CRT ICD Surgical treatment 

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Copyright information

© Urban & Vogel, Muenchen 2010

Authors and Affiliations

  1. 1.Klinik für Innere Medizin – Kardiologie, Philipps-UniversitätMarburg und UKGM GmbH, Standort MarburgMarburgGermany
  2. 2.Direktor der Klinik für Innere Medizin – Kardiologie UKGM GmbHStandort Marburg und Philipps-Universität MarburgMarburgGermany

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