Der Internist

, Volume 48, Issue 3, pp 236–245

Das Herz bei arterieller Hypertonie

Schwerpunkt

Zusammenfassung

Der Begriff „Hochdruckherz“ umfasst die Entitäten linksventrikuläre Hypertrophie, Mikroangiopathie, und Endothelfunktionsstörungen mit diastolischen und systolischen Funktionsstörungen, Arrhythmien und erhöhtem kardiovaskulären Risiko als Konsequenzen. Pathophysiologisch beruht dies auf einer Hypertrophie der Myozyten, einer interstitiellen Fibrose und Mediahypertrophie der Gefäße. Als frühestes Zeichen eines Hochdruckherzens kann eine Mikroangiopathie diagnostiziert werden. Auch eine diastolische Funktionsstörung stellt eine früh im Krankheitsverlauf zu erfassende Veränderung dar. Bei weiter bestehender Hypertonie kommt es zur Linksherzhypertrophie (oft asymmetrisch) und später zur systolischen Funktionsstörung. Klinisch zeigen sich pektanginöse Beschwerden, Dyspnoe und Herzrhythmusstörungen, unter denen besonders atriale Arrhythmien früh im Krankheitsverlauf auftreten. Eine ausgebildete linksventrikuläre Hypertrophie ist mit einem erhöhten Risiko verknüpft, auch ventrikuläre maligne Arrhyhtmien zu erleiden. Oberstes Therapieprinzip ist die antihypertensive Therapie zur Hypertrophieregression, die bei strenger Therapie erreicht werden und dann auch das Mortalitätsrisiko senken kann.

Schlüsselwörter

Hypertonie Diastolische Dysfunktion Hypertrophie Arrhythmien 

The heart in hypertension

Abstract

The term hypertensive heart disease covers the entities of left ventricular hypertrophy, microangiopathy and endothelial dysfunction resulting in diastolic and systolic dysfunction, arrhythmias and increased cardiovascular risk. From the pathophysiological point of view, this is caused by the hypertrophy of cardiac myocytes, interstitial fibrosis and media hypertrophy of the arterioles. Microangiopathy can be diagnosed as the earliest sign of hypertensive heart disease, with diastolic dysfunction also being found as an early change. In further persisting arterial hypertension left ventricular hypertrophy develops (often asymmetric) and later a systolic dysfunction. Clinically, the patients suffer from angina pectoris, dyspnea and rhythm disorders. Left ventricular hypertrophy is associated with an increased risk of malignant ventricular arrhythmias. Thus, the main therapeutic principle should be antihypertensive therapy with the goal of regression of hypertrophy leading to decreased mortality risk.

Key words

Hypertension Diastolic dysfunction Hypertrophy Arrhythmias 

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Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  1. 1.Klinik für Kardiologie, Pneumologie und AngiologieUniversitätsklinikum DüsseldorfDüsseldorfDeutschland

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