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Diagnostik der pulmonalen Hypertonie

Diagnostics of pulmonary hypertension

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Genaue Anamnese, körperliche Untersuchung und Basisuntersuchungen wie EKG, Röntgenthorax und Lungenfunktion sowie die gezielte Fahndung nach Risikofaktoren führen zur Verdachtsdiagnose pulmonale Hypertonie. Der primäre Nachweis erfolgt mittels Dopplerechokardiographie. Wichtig ist die Bestimmung des klinischen Schweregrades entsprechend der WHO-Klassifikation und durch Belastungsuntersuchungen (6-min-Gehtest, Spiroergometrie). Behandelbare Grunderkrankungen wie Lungen-, Herz- und Leberkrankheiten, Kollagenosen und insbesondere chronische Lungenarterienembolien müssen identifiziert werden. Dies umfasst auch die moderne Bildgebung mittels CT und MRT. Bei bedeutsamer pulmonaler Hypertonie ist stets ein Rechtsherzkatheter, ggf. mit pharmakologischem Reversibilitätstest, erforderlich. Ist die Diagnose primär gestellt, wird die Kontaktaufnahme mit einem spezialisierten Zentrum dringend empfohlen.

Abstract

A meticulous history, physical examination, and basic exams including ECG, chest X-ray and pulmonary function tests as well as the targeted search for risk factors lead to the diagnosis of pulmonary hypertension. An elevated pulmonary arterial pressure is primarily detected by Doppler echocardiography. It is important to assess the clinical severity according to the WHO (modified NYHA) functional class and by exercise testing (6-min walking test, cardiopulmonary exercise test). An interdisciplinary approach is needed to identify treatable underlying conditions such as pulmonary, cardiac, liver, collagen vascular, and chronic thromboembolic disease. This includes modern imaging techniques such as CT and MRI. In cases of significant pulmonary arterial hypertension, right heart catheterisation including pharmacological reversibility testing is indispensable. Once the diagnosis has been established it is advisable to contact a centre specialising in pulmonary hypertension.

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Authors and Affiliations

  1. Universitätsklinikum Heidelberg

    F. J. Meyer &  M. M. Borst

  2. Deutsches Krebsforschungszentrum Heidelberg

    S. Ley

  3. Medizinische Klinik I, Caritas-Krankenhaus Bad Mergentheim, Uhlandstraße 7, 97980 , Bad Mergentheim

    M. M. Borst

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  1. F. J. Meyer
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  2. S. Ley
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  3. M. M. Borst
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Correspondence to M. M. Borst.

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Meyer, F.J., Ley, S. & Borst, M.M. Diagnostik der pulmonalen Hypertonie. Pneumologe 1, 83–94 (2004). https://doi.org/10.1007/s10405-004-0013-0

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  • DOI: https://doi.org/10.1007/s10405-004-0013-0

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