Herz

, Volume 39, Issue 6, pp 702–710 | Cite as

Behandlung des kardiogenen Schocks im Rahmen eines akuten Myokardinfarkts

  • S. Blazek
  • K. Fengler
  • T. Stiermaier
  • P. Lurz
  • G. Schuler
  • G. Fürnau
Schwerpunkt
  • 363 Downloads

Zusammenfassung

Obgleich die Sterblichkeit des akuten Myokardinfarkts in den letzten Jahrzehnten deutlich reduziert werden konnte, ist die Mortalitätsrate bei Patienten, die im Rahmen eines akuten Koronarsyndroms einen kardiogenen Schock entwickeln, sehr hoch. Die supportive medikamentöse Therapie des kardiogenen Schocks ist häufig mit unerwünschten Nebenwirkungen (Arrhythmien, erhöhter myokardialer Sauerstoffverbrauch) oder unzureichender Kreislaufunterstützung verbunden. Für die mechanische kreislaufunterstützende Therapie konnte jedoch bislang keine Verbesserung des Kurzzeit- und Langzeitüberlebens gezeigt werden. Allerdings gibt es Hinweise auf Überlebensvorteile im therapierefraktären kardiogenen Schock. Zukünftige Studien sollten einerseits weitere medikamentöse Therapieoptionen überprüfen und klären, welches mechanische Unterstützungssystem zu welchem Zeitpunkt den besten Therapieerfolg bringt.

Schlüsselwörter

Kardiogener Schock Akutes Koronarsyndrom Medikamentöse Therapie Mechanische Unterstützungssysteme 

Abkürzungen

CI

Kardialer Index

ECLS

Extrakorporale Kreislaufunterstützung

HZV

Herzzeitvolumen

IABP

Intraaortale Gegenpulsation

LVAD

Linksventrikuläres Unterstützungssystem

MAP

Mittlerer arterieller Blutdruck

STEMI

ST-Hebungs-Infarkt

Treatment of cardiogenic shock complicating acute myocardial infarction

Abstract

While the mortality rate of acute myocardial infarction has decreased drastically in the last decades, the outcome of patients with cardiogenic shock complicating acute myocardial infarction is still devastating. The effectiveness of supportive medicinal therapy of cardiogenic shock is often limited by undesired side effects (e.g. arrhythmia and increased myocardial oxygen consumption) or inadequate hemodynamic support. Mechanical circulatory support in cardiogenic shock failed to show beneficial effects on short-term and long-term survival; however, there are hints for a survival benefit in therapy refractory cardiogenic shock. Therefore, future trials need to evaluate further medicinal treatment options and also the best type of mechanical support as well as the optimal time of initiation to improve the success of therapeutic management.

Keywords

Cardiogenic shock Acute coronary syndrome Drug therapy Mechanical support 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Blazek, K. Fengler, T. Stiermaier, P. Lurz, G. Schuler und G. Fürnau geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Copyright information

© Urban & Vogel 2014

Authors and Affiliations

  • S. Blazek
    • 1
  • K. Fengler
    • 1
  • T. Stiermaier
    • 1
  • P. Lurz
    • 1
  • G. Schuler
    • 1
  • G. Fürnau
    • 1
  1. 1.Klinik für Innere Medizin/KardiologieUniversität Leipzig – HerzzentrumLeipzigDeutschland

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