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Herzinsuffizienz Update 2010 und aktuelle ESC-Leitlinien

Heart failure update 2010 and current ESC guidelines

Herz volume 35, pages 535–541 (2010)Cite this article

Zusammenfassung

Bei einer chronischen Herzinsuffizienz kann eine Einschränkung der systolischen Pumpfunktion und/oder der diastolischen Ventrikelfüllung bestehen. Die Basistherapie der systolischen Herzinsuffizienz umfasst einen ACE-Hemmer, β-Blocker, bei Flüssigkeitsretention zusätzlich Diuretika und bei schwerster Symptomatik einen niedrig dosierten Aldosteronantagonisten. Ein AT1-Antagonist ist bei Patienten, die ACE-Hemmer nicht vertragen, als Alternative indiziert. Verbleiben Patienten trotz optimaler Pharmakotherapie im NYHA-Stadium III–IV, können bei Nachweis einer kardialen Dyssynchronie durch die Implantation eines biventrikulären Schrittmachers die Beschwerden und die Prognose verbessert werden. Eine leitliniengerechte Behandlung reduziert bei systolischer Herzinsuffizienz deutlich die Mortalität und Morbidität. Zur Behandlung der diastolischen Herzinsuffizienz liegen hingegen bisher kaum Studienergebnisse vor. Die Therapie dieser Patienten bleibt meist noch symptomatisch.

Abstract

Chronic heart failure may be caused by systolic pump failure and/or impairment of diastolic filling of the ventricles. Standard pharmacotherapy of systolic heart failure includes an ACE inhibitor, betablocker, diuretics and in patients with severe symptoms a low-dose aldosterone antagonist. An AT1 receptor blocker is indicated in those not tolerating ACE inhibitors. If patients remain in functional class NYHA III-IV despite optimal medication and have cardiac dyssynchrony, biventricular pacing may improve symptoms and prognosis. While evidence-based treatment significantly reduces morbidity and mortality in systolic heart failure, hardly any results of clinical trials are available for diastolic heart failure. Therefore, therapy in patients with diastolic heart failure remains symptomatic in most cases.

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Affiliations

  1. Klinik III für Innere Medizin, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    U.C. Hoppe & E. Erdmann

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  1. U.C. Hoppe
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  2. E. Erdmann
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Correspondence to U.C. Hoppe.

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Hoppe, U., Erdmann, E. Herzinsuffizienz Update 2010 und aktuelle ESC-Leitlinien. Herz 35, 535–541 (2010). https://doi.org/10.1007/s00059-010-3396-1

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  • DOI: https://doi.org/10.1007/s00059-010-3396-1

Schlüsselwörter

  • Herzinsuffizienz
  • Leitlinien
  • Pharmakotherapie
  • Evidenzbasierte Medizin
  • Kardiale Resynchronisation

Keywords

  • Heart failure
  • Guidelines
  • Pharmacotherapy
  • Evidence-based
  • Cardiac resynchronization