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Hepatokardiale Wechselwirkungen

Interaktionen zweier Organsysteme

Hepatocardiac disorders

Interactions between two organ systems

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Zusammenfassung

Interaktionen zwischen dem kardialen und hepatalen System sind häufige Komplikationen bei Patienten mit Lebererkrankungen. Eine reduzierte kardiale Funktion ohne zugrunde liegende kardiale Erkrankung bei Patienten mit Leberzirrhose wird als zirrhotische Kardiomyopathie (CCMP) bezeichnet. Die typische hyperdyname Kreislaufregulation äußerst sich durch ein gesteigertes Herzzeitvolumen sowie einen herabgesetzten systemischen Gefäßwiderstand und kann so eine manifeste Herzinsuffizienz maskieren. Die portopulmonale Hypertension (POPH), eine Form der pulmonalarteriellen Hypertonie in Zusammenhang mit portaler Hypertension, ist eine seltene, doch schwerwiegende Komplikation bei Patienten mit chronischer Lebererkrankung. Als medikamentöse Therapieoption stehen Vasodilatoren, wie Prostazykline, Endothelinrezeptorantagonisten und Phosphodiesterase-5-Hemmer, zur Verfügung. Die hypoxische Hepatitis (HH) oder auch Schockleber geht mit einem fulminanten Transaminasenanstieg bedingt durch Leberzellnekrose infolge von kardialem, zirkulatorischem oder respiratorischem Versagen einher. Im folgenden Beitrag wird eine Übersicht über die genannten Krankheitsbilder gegeben.

Abstract

Interactions between the hepatic portal and cardiovascular systems are frequently found in patients with liver disease. Cirrhotic cardiomyopathy (CCMP) is defined as reduced cardiac function in patients with liver cirrhosis in the absence of other known causes of cardiac disease. The typical hyperdynamic circulatory state by means of increased cardiac output and reduced systemic vascular resistance may mask left ventricular failure. Portopulmonary hypertension (POPH) is defined as increased pulmonary arterial pressure and the presence of portal hypertension, and is associated with increased mortality. Targeted medical therapies include vasodilators such as prostanoids, endothelin receptor antagonists and phosphodiesterase-5 inhibitors. Hypoxic or ischaemic hepatitis (HH) is defined by a sharp increase of serum aminotransferase levels due to liver cell necrosis as result of cardiac, circulatory or respiratory failure. An overview of these diseases is provided in this article.

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  1. Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    T. Horvatits, A. Drolz, K. Rutter, K. Roedl, S. Kluge & V. Fuhrmann

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  1. T. Horvatits
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  2. A. Drolz
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Correspondence to T. Horvatits.

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Interessenkonflikt

T. Horvatits, A. Drolz, K. Rutter, K. Roedl, S. Kluge und V. Fuhrmann geben an, dass kein Interessenkonflikt besteht.

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Horvatits, T., Drolz, A., Rutter, K. et al. Hepatokardiale Wechselwirkungen. Med Klin Intensivmed Notfmed 111, 447–452 (2016). https://doi.org/10.1007/s00063-015-0043-x

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  • DOI: https://doi.org/10.1007/s00063-015-0043-x

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