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Hochdruckherz und hypertensive Mikroangiopathie

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Zusammenfassung

Klinisch relevante kardiale Manifestationen der arteriellen Hypertonie werden unter dem Begriff des Hochdruckherzen zusammengefasst. Diese Manifestationen umfassen die stenosierende koronare Makro- und Mikroangiopathie, Störungen der vaskulären Homöostase und der endothelialen Funktion, die Fibrose des perivaskulären und interstitiellen Gewebes, die linksventrikuläre Hypertrophie und ischämische Kardiomyopathie, der erhöhte Sympathikustonus und eine Überdehnung des linken Vorhofes sowie degenerative Veränderungen der Aortenklappe. Das klinische Bild des Patienten mit Hochdruckherzen wird damit v. a. durch die Koronarinsuffizienz, die Herzinsuffizienz sowie supraventrikuläre und ventrikuläre Rhythmusstörungen bestimmt. Für die Erstdiagnostik und die Verlaufskontrolle kommen unterschiedliche diagnostische Verfahren zum Einsatz. Therapeutisches Ziel muss neben einer Senkung des arteriellen Blutdrucks die Regression der hypertensiv bedingten kardialen Veränderungen durch Einleitung spezifischer Therapiemaßnahmen sein.

Abstract

Cardiac alterations in patients with arterial hypertension comprise the manifestation of stenosis in epicardial arteries, disease of coronary resistive vessels, prothrombotic changes and endothelial dysfunction, pronounced perivascular and interstitiell fibrosis, left ventricular hypertrophy, dilatation of the left atrium, increased sympathetic drive and degeneration of aortic valve. These alterations leads to the major clinical manifestations of hypertensive heart disease, that are symptoms of reduced coronary conductance, left ventricular hypertrophy, diastolic and systolic dysfunction with or without left ventricular enlargement and arrythmia. Different non-inavsive and invase procedures are available for screening and follow up of patients with hypertensive heart disease. The primary therapeutic target is, apart from lowering blood pressure, to reverse cardiac manifestations of arterial hypertension using specific therapeutic algorithms.

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  1. Klinik für Kardiologie, Pneumologie und Angiologie, Medizinische Klinik und Poliklinik B, Heinrich-Heine-Universität Düsseldorf

    M. Kelm & B. E. Strauer

  2. Medizinische Klinik und Poliklinik B, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf

    M. Kelm

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Kelm, M., Strauer, B.E. Hochdruckherz und hypertensive Mikroangiopathie. Internist 44, 793–805 (2003). https://doi.org/10.1007/s00108-003-0946-0

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