Skip to main content
SpringerLink
Log in

Pathophysiologie des rechten Ventrikels bei Lungenerkrankungen

Pathophysiology of the right ventricle in lung diseases

  • Schwerpunkt
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Der muskelschwache rechte Ventrikel ist durch eine niedrige Masse-Volumen-Relation gekennzeichnet. Die Ventrikelfunktion wird dabei durch mehrere Determinanten bestimmt, v. a. durch Nachlast, Vorlast (Füllungsdruck bzw. Vorhofdruck), Myokardperfusion, Kontraktilität und Herzfrequenz. Da insbesondere die Nachlast wesentlich durch intrathorakale Druckverhältnisse und den pulmonalvaskulären Druck bzw. Widerstand vorgegeben ist, wird der Einfluss dieser Größen auf die rechtsventrikuläre Funktion deutlich. Morphologische Veränderungen des Ventrikels beeinflussen dabei die funktionelle Dynamik des Cor pulmonale. So ist der nicht hypertrophierte rechte Ventrikel sehr empfindlich gegen Druckerhöhungen, umgekehrt führen bereits geringe Abnahmen des pulmonalarteriellen Drucks zu einer massiven Abnahme der rechtsventrikulären Wandspannung, des Sauerstoffverbrauchs und wahrscheinlich auch der Arrhythmieneigung. Die klinischen Auswirkungen und Komplikationen der pulmonalarteriellen Hypertonie sind somit wesentlich von der Rechtsherzdynamik abhängig.

Abstract

The thin-walled right heart is characterized by a low mass-volume-relation. Right ventricular function is influenced basically by loading conditions (afterload and preload), myocardial perfusion, contractility and heart rate. Afterload is determined by intrathoracal and pulmonary vascular pressure/resistance. Morphologic adaptions of the right ventricle affect right ventricular function in cor pulmonale. So the normal, not hypertrophied right ventricle is extremely sensitive to increasing pulmonary artery pressure. Otherwise, minor reductions in afterload lead to a substantial decrease of right ventricular wall stress, myocardial oxygen demand and likely the risk of arrhythmia. Therefore clinical consequences and complications of pulmonary hypertension are substantially dependent on right ventricular dynamics.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Alfakih K, Plein S, Bloomer T et al. (2003) Comparison of right ventricular volume measurements between axial and short axis orientation using steady-state free precession magnetic resonance imaging. J Magn Reson Imaging 18: 25–32

    Article  PubMed  Google Scholar 

  2. Berger H, Johnstone D, Sands J et al. (1979) Response of right ventricular ejection fraction to upright bicycle exercise in coronary heart disease. Circulation 60: 1292–1300

    PubMed  CAS  Google Scholar 

  3. Brooks H, Kirk E, Vokonas P et al. (1971) Performance of the right ventricle under stress: relation to right coronary flow. J Clin Invest 50: 2176–2183

    Article  PubMed  CAS  Google Scholar 

  4. DÀlonzo G, Barst R, Ayres S (1991) Survival in patients with primary pulmonary hypertension. Results from a national prospective registry. Ann Intern Med 115: 343–349

    Google Scholar 

  5. Ferlinz J (1982) Right ventricular function in adult cardiovascular disease. Prog Cardiovasc Dis 25: 225–267

    Article  PubMed  CAS  Google Scholar 

  6. Gamis A, Hodge D, Herges R et al. (2007) Obstructive sleep apnea, obesity, and the risk of atrial fibrillation. J Am Coll Cardiol 49: 565–571

    Article  Google Scholar 

  7. Globits S, Burghaber O, Koller J et al. (1994) Effect of lung transplantation on right and left ventricular volumes and functionmeasured by magnetic resonance tomography. Am J Respir Crit Care Med 149: 1000–1004

    PubMed  CAS  Google Scholar 

  8. Grimm W, Hoffmann J, Menz V et al. (1996) Electrophysiologic evaluation of sinus node function and atrioventricular conduction in patients with prolonged ventricular asystole during obstructive sleep apnea. Am J Cardiol 77: 1310–1314

    Article  PubMed  CAS  Google Scholar 

  9. Guyton R, Andrews M, Hickey P et al. (1976) The contribution of atrial contraction to right heart function before and after right ventriculotomy. J Thorac Cardiovasc Surg 71: 1–10

    PubMed  CAS  Google Scholar 

  10. Henquell L, Honig C (1976) O2 extraction of right and left ventricles. Proc Soc Exp Biol Med 152: 52–56

    PubMed  CAS  Google Scholar 

  11. Johnsen L, McCarthy D, Sciacca R, Cannon PJ (1979) Right ventricular ejection fraction during exercise in patients with coronary artery disease. Circulation 60: 1284–1291

    Google Scholar 

  12. Lee S, McClelland A, Zaragoza A (1970) The right ventricular function during exercise in patients with and without right ventricular failure. Acta Cardiol 25: 313–318

    PubMed  CAS  Google Scholar 

  13. Mahler D, Brendt B, Loke J et al. (1984) Right ventricular performance and central circulatory hemodynamics during upright exercise in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 130: 722–729

    PubMed  CAS  Google Scholar 

  14. Olschewski H, Hoeper M, Borst M et al. (2007) Diagnostik und Therapie der chronischen pulmonalen Hypertonie. Pneumologie 60: 749–771

    Article  Google Scholar 

  15. Rahlf G (1978) Chronic cor pulmonale. Weight and intraventricular volume of the right ventricle in chronic pulmonary diseases. Virchows Arch A Pathol Anatom Hist 378: 273–386

    Article  CAS  Google Scholar 

  16. Riecker G, Grohmann H, Avenhaus H, Sigl A (1968) Die diastolische Druckanstiegsgeschwindigkeit des rechten Ventrikels beim Menschen. Klin Wochenschr 23: 1254–1257

    Article  Google Scholar 

  17. Starr I, Jeffers W, Meade R (1943) The absence of conspicious increments in venous pressure after severe damage to the right ventricle of the dog, with a discussion of the relation between clinical congestive heart failure and heart disease. Am Heart J 3: 291–301

    Article  Google Scholar 

  18. Steiner S (2008) Pathophysiologie der Koronarinsuffizienz und Angina pectoris. Grundlegende Mechanismen der myokardialen Minderdurchblutung. Klinikarzt 37: 459–463

    Article  Google Scholar 

  19. Steiner S, Strauer B (2004) Functional dynamics of the right ventricle and pulmonary circulation in obstructive sleep apnea. Therapeutic consequences. Internist 45: 1101–1107

    Article  PubMed  CAS  Google Scholar 

  20. Vizza C, Lynch J, Ochoa L et al. (1998) Right and left ventricular dysfunction in patients with severe pulmonary disease. Chest 113: 576–583

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    S. Steiner & B.E. Strauer

Authors
  1. S. Steiner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B.E. Strauer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Steiner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Steiner, S., Strauer, B. Pathophysiologie des rechten Ventrikels bei Lungenerkrankungen. Internist 50, 1054–1063 (2009). https://doi.org/10.1007/s00108-009-2334-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-009-2334-x

Schlüsselworte

Keywords

Search

Navigation