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Aktuelle Diagnostik und Therapie der Lungenarterienembolie

Current diagnosis and therapy of pulmonary embolism

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Zusammenfassung

Die Lungenarterienembolie (LAE) stellt eine häufige kardiopulmonale Erkrankung dar. Durch Verlegung der Lungenstrombahn kann es zum Auftreten einer akuten oder chronischen Rechtsherzinsuffizienz kommen. Fulminante Embolien sind durch eine akute hämodynamische Verschlechterung mit Schock und letalem Verlauf charakterisiert. Im Gegensatz dazu bleiben kleine LAE meist klinisch stumm oder fallen durch unspezifische Symptome auf. Da sich sowohl für die Akutphase als auch im chronischen Verlauf therapeutische Konsequenzen ergeben, ist eine schnelle und sichere Diagnosestellung wichtig. Wegen ihrer Häufigkeit und ihres akuten Verlaufs spielt die LAE nicht nur postoperativ eine Rolle, sondern stellt auch in der präklinischen Versorgung von Notfallpatienten eine wichtige Differenzialdiagnose dar. Im vorliegenden Beitrag werden das diagnostische und therapeutische Vorgehen bei LAE anhand der aktuellen Leitlinien der „American Heart Association“ und der „European Society of Cardiology“ dargestellt.

Abstract

Pulmonary embolism represents a common cardiopulmonary disease. Obstruction of the pulmonary arterial bed results in acute or chronic right heart failure. Fulminant embolism is characterized by acute hemodynamic impairment with shock or lethal progress. In contrast, minor pulmonary emboli usually do not result in acute clinical disorders but may present with unspecific symptoms. Fast and safe diagnosis is important as therapeutic consequences arise for the acute phase of the disease as well as for the chronic course. Based on their prevalence and acute manifestation pulmonary embolism plays an important clinical role post-surgery but represents also an essential differential diagnosis for the preclinical management of emergency patients. This article summarizes current diagnostic and therapeutic procedures of pulmonary embolism according to the guidelines of the American Heart Association and the European Society of Cardiology.

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Abbreviations

ACS:

Akutes Koronarsyndrom

aPTT :

„Activated partial thromboplastin time“

BGA:

Blutgasanalyse

BNP:

„Brain natriuretic peptid“

CK:

Kreatinkinase

COPD :

„Chronic obstructive pulmonary disease“

c/p:

Kardial/pulmonal

CPR:

Kardiopulmonale Reanimation

CT:

Computertomographie

CTEPH :

Chronische thrombembolische pulmonale Hypertonie

EKG:

Elektrokardiogramm

GFR:

Glomeruläre Filtrationsrate

HAS-BLED :

„Hypertension/abnormal kidney or liver function/stroke/bleeding/labile INR/elderly/drugs and/or alcohol“

HIT:

Heparininduzierte Thrombozytopenie

INR:

„International normalized ratio“

KG:

Körpergewicht

LAE:

Lungenarterienembolie

LMWH:

„Low molecular weight heparin“

NT-proBNP:

„Amino-terminal pro-brain natriuretic peptid“

NYHA:

„New York Heart Association“

PEEP :

„Positive end-expiratory pressure“

PESI:

„Pulmonary embolism severity index“

rtPA :

„Recombinant tissue plasminogen activator“

SpO2 :

Pulsoxymetrisch gemessene Sauerstoffsättigung

TBVT:

Tiefe Beinvenenthrombose

TIA:

Transitorische ischämische Attacke

UFH:

Unfraktioniertes Heparin

VCS:

Venöse Kompressionssonographie

ZNS:

Zentralnervensystem

ZVD:

Zentraler Venendruck

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Authors and Affiliations

  1. Herz- und Gefäßzentrum Oberallgäu – Kempten, Im Stillen 3, 87509, Immenstadt, Deutschland

    O. Zimmermann & S. Heetel

  2. Sektion Notfallmedizin, Klinik für Anästhesiologie, Universitätsklinikum Ulm, Ulm, Deutschland

    A. Bauer

Authors
  1. O. Zimmermann
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  2. S. Heetel
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  3. A. Bauer
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Correspondence to O. Zimmermann.

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Zimmermann, O., Heetel, S. & Bauer, A. Aktuelle Diagnostik und Therapie der Lungenarterienembolie. Notfall Rettungsmed 15, 539–551 (2012). https://doi.org/10.1007/s10049-012-1605-6

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  • DOI: https://doi.org/10.1007/s10049-012-1605-6

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