Zusammenfassung
Die akute Herzinsuffizienz beschreibt ein klinisches Syndrom, das sich aus einer systemischen Kongestion und erhöhten intrakardialen Füllungsdrücken ergibt. Prinzipiell kann es sich um eine Erstdiagnose handeln (De-novo-Herzinsuffizienz) oder um eine akute Verschlechterung einer vorbestehenden links- oder rechtsventrikulären Dysfunktion. Das Patientenkollektiv ist insgesamt sehr inhomogen, und folglich besteht auch eine deutliche Heterogenität bezüglich der zugrunde liegenden kardialen Pathologie, welche zur akuten Präsentation führt. Letztlich führt eine Dysfunktion des Ventrikels zur erhöhten Vor- und Nachlast mit resultierender retrograder Stauung und Minderdurchblutung. Aufgrund des Vorwärtsversagens (Hypoperfusion) und der systemischen Kongestion (Rückwärtsversagen) kann es zu einer Beeinträchtigung der Endorganfunktion kommen, was in seiner Maximalform dem kardiogenen Schock entspricht, bei dem eine ausreichende Organ- und Gewebeperfusion nicht mehr gewährleistet ist. Gegenwärtig konzentrieren sich die therapeutischen Ansätze vornehmlich auf die Behebung der zugrunde liegenden kardialen Dysfunktion, der Reduktion der Volumenüberladung (Dekongestion) und der hämodynamischen Stabilisierung mit kreislaufunterstützenden Medikamenten im Falle eines Hypoperfusionssyndroms. Trotz zahlreicher neuer therapeutischer Ansätze innerhalb der letzten Jahrzehnte ist die empirische Studienlage aktuell deutlich weniger breit als für die chronische Herzinsuffizienz, was sich auch in der nach wie vor hohen Einjahresletalität von etwa 20–30 % ausdrückt.
Abstract
Acute heart failure is a clinical syndrome resulting from elevated intracardiac filling pressures and a systemic venous congestion. In general, patients can present acutely without a history of structural cardiac disease (de novo heart failure) or with acute worsening of a pre-existing dysfunction of the right or left ventricle. The patient population is overall very inhomogeneous and as a result there is also a distinct heterogeneity with respect to the underlying cardiac pathology that leads to the acute presentation. Ultimately, ventricular dysfunction leads to increased preload and afterload resulting in decreased perfusion and retrograde congestion. The forward failure (hypoperfusion) and backwards failure (systemic congestion) can lead to impaired end organ function or even organ failure resulting in cardiogenic shock, in which sufficient organ and tissue perfusion is no longer possible. Consequently, therapeutic strategies currently focus on rectification of the underlying cardiac dysfunction, reduction of volume overload (decongestion) and hemodynamic stabilization with drugs supporting the circulation in the case of a hypoperfusion syndrome. Despite numerous new therapeutic strategies within the last two decades, the empirical data based on randomized trials is considerably less solid than in chronic heart failure, which is expressed in the almost unchanged 1‑year mortality of approximately 20–30%.
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J.G. Westphal und P.C. Schulze geben an, dass kein Interessenkonflikt besteht.
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Westphal, J.G., Schulze, P.C. Akute Herzinsuffizienz und kardiogener Schock. Herz 48, 95–100 (2023). https://doi.org/10.1007/s00059-022-05159-x
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DOI: https://doi.org/10.1007/s00059-022-05159-x