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Interaktion zwischen Herz und Hirn bei plötzlichem Herztod

Interaction between heart and brain in sudden cardiac death

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Zusammenfassung

Eine Interaktion von Herz und Gehirn ist schon unter physiologischen Bedingungen und unter Einbindung sympathischer und parasympathischer Nervenbahnen und beteiligter Hirnstrukturen nachweisbar. Wir zeigen Einflüsse des erkrankten Gehirns auf das Herz am Beispiel epileptischer Syndrome oder des Schlaganfalls – mit bislang heterogenen Daten zur Lateralisation der den Herzrhythmus beeinflussender Hirnfunktionen. Im klinischen Alltag bedeutsamer ist der Einfluss des Herzens auf das Gehirn im Moment des Herzstillstands. Die pathophysiologischen Prozesse der dabei entstehenden globalen Hypoxie, die ethischen Fragen über den Zeitpunkt des erloschenen Bewusstseins und die Instrumente zur Prognoseabschätzung werden hier skizziert. All diese Informationen erlauben es im Sinne einer Gesamtschau, das Ausmaß der zerebralen Schädigung zu ermessen und eine prognostische Einschätzung zu geben.

Abstract

The heart and brain are constantly interacting under normal physiological conditions. This interaction is under the control of the autonomic nervous system with parasympathetic and sympathetic nerve fibers including the participating brain structures. Pathological conditions, such as epilepsy and ischemic cerebral stroke influence heart function, especially the frequency and may result in severe arrhythmia. An asymmetric influence of the left and right brain hemispheres on the heart rate is still under debate. Conversely, the influence of the heart in cases of acute cardiac arrest on brain function is equally relevant and a common clinical problem after resuscitation. We review the damaging cascade of global cerebral hypoxia and the value of different diagnostic procedures as well as the ethical problem of the point in time of termination of consciousness and the instruments for estimating the prognosis.

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Authors and Affiliations

  1. Neurologische Klinik, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Deutschland

    M. Fatar, M. Platten & A. Alonso

  2. I. Medizinische Klinik/Kardiologie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Deutschland

    I. Akin & M. Borggrefe

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  1. M. Fatar
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  2. I. Akin
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  4. M. Platten
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Correspondence to M. Fatar.

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Interessenkonflikt

M. Fatar, I. Akin, M. Borggrefe, M. Platten und A. Alonso geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Fatar, M., Akin, I., Borggrefe, M. et al. Interaktion zwischen Herz und Hirn bei plötzlichem Herztod. Herz 42, 171–175 (2017). https://doi.org/10.1007/s00059-017-4547-4

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  • DOI: https://doi.org/10.1007/s00059-017-4547-4

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