Summary
Echocardiography provides quick and reliable information on critically ill patients with haemodynamic instability. Transthoracic echocardiography should be performed preferentially. In special indications or if image quality from the transthoracic approach is insufficient, the more invasive transoesophageal echocardiography has to be performed. This article focuses on the echocardiographic assessment of left ventricular (LV) global systolic and diastolic function and of LV preload and afterload. LV enddiastolic and end-systolic areas allow for evaluation of LV global systolic function and preload. In addition, LV end-systolic area and systolic blood pressure allow for estimation of afterload. Parameters of LV diastolic function are obtained from Doppler signals of mitral inflow and from tissue Doppler derived signals of mitral annulus excursion. Diagnostic and therapeutic decision must be based on evaluation of all four chambers of the heart as well as of the four valves. In addition, the patient’s history and previous and current medication have to be taken into account. A written report on the most important measurements, findings and interpretations, and storage of the echocardiographic images is needed to communicate the findings and to facilitate interpretation of subsequent studies.
Zusammenfassung
Die Echokardiographie erlaubt eine rasche und zuverlässige Beurteilung des hämodynamisch instabilen Patienten auf der Intensivstation. Dieser Übersichtsartikel zeigt auf, wie die globale systolische und diastolische Funktion des linken Ventrikels sowie seine Vor- und Nachlast echokardiographisch beurteilt werden können. Die enddiastolische und die end-systolische Fläche, aufgenommen im linksventrikulären Querschnitt, erlauben eine rasche und recht zuverlässige Abschätzung der systolischen Globalfunktion des linken Ventrikels und seiner Vorlast. Zusammen mit dem systolischen Blutdruck erlauben sie auch Rückschlüsse auf die Nachlast. Das mitrale Einstrommuster und die Geschwindigkeit der Bewegungen des Mitralklappenringes erlauben Aussagen über die diastolischen Funktion. Bevor diagnostische und therapeutische Schlussfolgerungen gezogen werden, müssen im Minimum die Größe aller vier Herzkammern und die Funktion beider Ventrikel, sowie die Funktion der vier Herzklappen beurteilt und die anamnestischen und klinischen Angaben (z. B. Medikamenten- und Volumentherapie) mitberücksichtigt werden. Eine gute bildliche Dokumentation und eine schriftliche Befundung sind Voraussetzung für eine optimale Nutzung der Untersuchungsbefunde und für Verlaufskontrollen.
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Serie: Echokardiographie im perioperativen und intensivmedizinischen Bereich Herausgegeben von M. D. Seeberger und H.-R. Zerkowski (Basel)
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Filipovic, M., Skarvan, K. & Seeberger, M.D. Wie geht es dem linken Ventrikel? Die linksventrikuläre Funktion und ihre Bedeutung bei hämodynamisch instabilen Patienten. Intensivmed 42, 413–423 (2005). https://doi.org/10.1007/s00390-005-0620-y
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DOI: https://doi.org/10.1007/s00390-005-0620-y