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Akutes Rechtsherzversagen

Diagnostik und Therapie

Acute right ventricular failure

Diagnosis and treatment

  • Leitthema
  • Published:
Intensivmedizin und Notfallmedizin

Zusammenfassung

Die ansteigende Prävalenz prädisponierender Erkrankungen führt dazu, dass das akute Rechtsherzversagens mit zunehmender Häufigkeit zur kardiozirkulatorischen Dekompensation führt. Durch diagnostische Verfahren wie der Analyse von Biomarkern sowie neuerer echokardiographischer und hämodynamischer Parameter kann die Funktion des rechten Ventrikels, die im Bereich der Bildgebung aufgrund der komplexen Anatomie schwierig ist, besser beschrieben werden. Therapeutisch steht weiterhin die Behebung der Ursache im Vordergrund. Die klassischen Therapieoptionen werden zunehmend durch Medikamente ergänzt, die eine selektive Steuerung des pulmonalvaskulären Widerstandes erlauben und die Kopplung des rechten Ventrikels an die pulmonale Strombahn (ventrikulovaskuläre Kopplung) verbessern. Problematisch bleiben weiterhin die geringe Studienzahl zum akuten Rechtsherzversagen und die damit einhergehende geringe Evidenz vieler Empfehlungen.

Abstract

Due to the increasing prevalence of predisposing conditions, right ventricular failure is increasingly encountered as the cause of cardiocirculatory decompensation. Analysis of biomarkers and newer echocardiographic and hemodynamic parameters allow for a better characterization of right ventricular function, which is deemed difficult with imaging due to the complex anatomy of the right ventricle. Therapeutically, the treatment of the underlying cause is mandatory. Classical therapeutic options are supplemented by medications that allow selective steering of pulmonary vascular resistance and improve ventriculo-vascular coupling. There are still concerns about the small number of studies in acute right ventricular failure and the low grade evidence for the treatment recommendations.

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  1. Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland

    M. Ruß, K. Werdan & M. Buerke

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  1. M. Ruß
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  2. K. Werdan
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  3. M. Buerke
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Correspondence to M. Ruß.

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Ruß, M., Werdan, K. & Buerke, M. Akutes Rechtsherzversagen. Intensivmed 46, 415–420 (2009). https://doi.org/10.1007/s00390-009-0081-9

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  • DOI: https://doi.org/10.1007/s00390-009-0081-9

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