Zusammenfassung
Etwa jeder fünfte Todesfall in den westlichen Industriestaaten ist unter die Rubrik „plötzlicher Herztod“ einzuordnen. Betrachtet man die Bevölkerung insgesamt, so besteht eine Inzidenz von ca. 0,1–0,2%/Jahr. Unverändert ist die koronare Herzerkrankung die wichtigste und quantitativ bei weitem führende Erkrankung, die mit dem Auftreten des plötzlichen Herztodes verknüpft ist. Beim Großteil der Betroffenen ist der akute Herz-Kreislauf-Stillstand die Erstmanifestation der Erkrankung. Die Prophylaxe des plötzlichen Herztodes ist immer auch — oder sogar zuerst — eine Prävention der koronaren Herzerkrankung. Seit 1980 ist insbesondere in den Vereinigten Staaten eine Trendwende bei der Prävalenz der koronaren Herzerkrankung zu verzeichnen. Dies macht verständlich, dass z. B. in Seattle (Bundesstaat Washington) im gleichen Zeitraum ein kontinuierlicher Rückgang an dokumentiertem Kammerflimmern außerhalb des Krankenhauses zu verzeichnen ist.
Das folgende Kapitel soll v.a. Krankheitsbilder neben der Koronararteriosklerose beschreiben, die in einem höheren Ausmaß mit dem Auftreten plötzlicher Todesfälle verbunden sind. Grosses Interesse haben in den letzten Jahren insbesondere auch „primär elektrische“ Erkrankungen hervorgerufen, bei denen Funktionsstörungen von lonenkanälen („channelopathy“) ursächlich für den plötzlichen Herztod anzunehmen sind. Die Erkennung Betroffener vor dem Erstereignis hat hier eine besondere Priorität.
Akute Wiederbelebungsmaßnahmen bei plötzlichem Herz-Kreislaufstillstand werden in Kap. 67 abgehandelt, auf das Kap. 22 sei hingewiesen. Die zuverlässigste Therapie, einem erneuten Herz-Kreislaufstillstand vorzubeugen, ist die Implantation eines automatischen Kardioverters/Defibrillators (ICD). Die Indikation besteht fast immer, es sei denn, der akute Herzstillstand wurde eindeutig durch ein akutes ischämisches Ereignis ausgelöst. Die gesicherten Indikationen zur ICD-Implantation sind in Abschn. 51.3.2 dargelegt.
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Kalusche, D. (2004). Plötzlicher Herztod. In: Roskamm, H., Neumann, FJ., Kalusche, D., Bestehorn, HP. (eds) Herzkrankheiten. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-18649-3_19
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