Notfall + Rettungsmedizin

, Volume 17, Issue 4, pp 293–299 | Cite as

Medikamentöse Therapie der akuten Herzinsuffizienz

Leitthema
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Zusammenfassung

Hintergrund

Die Therapie der akuten Herzinsuffizienz besteht in der schnellstmöglichen Beseitigung der Lungen- und/oder systemischen Stauung. Eine gezielte Diagnostik und ein schneller Therapiebeginn sind wichtig. Auslösende Ursachen sollten gesucht und behandelt werden.

Methode

Recherche und Auswertung der Literatur.

Ergebnisse

Da die Herzinsuffizienz ein heterogenes Syndrom ist, muss die Behandlungsstrategie nach dem klinischen Profil des Patienten erfolgen. Die aktuellen Richtlinien empfehlen primär eine Behandlung mit Sauerstoff zur Oxygenierung, ggf. ergänzt durch nichtinvasive Beatmung, Furosemid intravenös zur Senkung der Vorlast und Nitrate zur Verminderung der Vor- und Nachlast.

Schlussfolgerungen

Diese Maßnahmen erzielen bei der großen Mehrzahl der Patienten eine eindeutige Verbesserung der Symptome und der klinischen Zeichen der Herzinsuffizienz. Leider fehlen große klinische Studien die zeigen, wie die aktuell verfügbaren Medikamente am besten eingesetzt werde können, um auch harte klinische Endpunkte wie Mortalität und Morbidität (Rehospitalisation) zu verringern.

Schlüsselwörter

Akute Herzinsuffizienz Lungenödem Kardiogener Schock Diuretika Nitrate 

Pharmacological treatment of acute heart failure

Abstract

Background

The aim of treating acute heart failure is to reduce pulmonary and/or systemic congestion. Rapid diagnosis and initiation of treatment are important. Triggering causes should be sought as they offer additional specific treatment options.

Method

Research and analysis of the literature.

Results

Because acute heart failure is a heterogeneous syndrome, fine-tuning the treatment strategy according to the clinical profile is warranted. The current guidelines recommend primary treatment with oxygen for oxygenation, possibly supplemented by noninvasive ventilation, intravenous furosemide to reduce preload, and nitrates to reduce preload and afterload.

Conclusions

These measures achieve a substantial improvement of symptoms and clinical signs of heart failure in the majority of patients. Unfortunately, large clinical studies that show the best possible use of currently available drugs in order to also reduce hard clinical endpoints such as mortality and morbidity (rehospitalization) are lacking.

Keywords

Acute heart failure Pulmonary edema Shock, cardiogenic Diuretic drugs Nitrates 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Department of Cardiology and Cardiovascular Research Institute BaselUniversitätsspital BaselBaselSchweiz

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