Der Klinikarzt 2014; 43(3): 144-148
DOI: 10.1055/s-0034-1373728
Schwerpunkt
© Georg Thieme Verlag Stuttgart · New York

Hypertensive Kardiopathie und diastolische Herzinsuffizienz – Pathophysiologie, Diagnose, Prognose und Therapie

Hypertensive cardiopathy and diastolic heart failure – Pathophysiology, diagnosis, prognosis and therapy
Jasmin A Saar
1   Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg
,
Christoph Maack
1   Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg
› Author Affiliations
Further Information

Publication History

Publication Date:
25 March 2014 (online)

Die hypertensive Kardiopathie ist die Folge einer arteriellen Hypertonie, die bei hypertensiver Entgleisung oder körperlicher Belastung zu Luftnot und Angina pectoris führen kann. Der Angina pectoris kann bei Abwesenheit einer koronaren Makroangiopathie eine koronare mikrovaskuläre Dysfunktion zugrunde liegen. Luftnot kann bei hypertensiver Entgleisung durch eine akute hämodynamische Kompromittierung des linken Ventrikels (LV) durch Nachlasterhöhung erklärt werden und sollte gegen belastungsabhängige Luftnot bei diastolischer oder systolischer Herzinsuffizienz abgegrenzt werden. Die Prognose der hypertensiven Kardiopathie ist verglichen mit diastolischer und systolischer Herzinsuffizienz günstig, allerdings stellt die LV Hypertrophie einen zentralen Pathomechanismus und Risikofaktor dar, eine Herzinsuffizienz zu entwickeln. Der Entwicklung einer LV Hypertrophie kann durch eine konsequente Behandlung einer arteriellen Hypertonie vorgebeugt werden. Im Gegensatz zur systolischen Herzinsuffizienz hat bei der Therapie der diastolischen Herzinsuffizienz noch keine Medikation oder Intervention einen prognostischen Vorteil erbracht. Körperliches Training ist jedoch zur Verbesserung der Lebensqualität bei Patienten mit Hypertonie als auch Herzinsuffizienz indiziert.

Hypertensive cardiopathy is the result of arterial hypertension and can lead to angina and dyspnea at exertion or during hypertensive emergencies. In these scenarios, symptoms of angina can be induced by coronary microvascular dysfunction in the absence of coronary stenoses, while dyspnea is the result of left ventricular (LV) hemodynamic deterioration in the face of increased afterload. In patients with systolic or diastolic heart failure, dyspnea occurs also during exertion and is caused by increased arterial and left ventricular stiffness and/or frank systolic dysfunction. Although the prognosis of hypertensive cardiopathy is better than of systolic and diastolic heart failure, LV hypertrophy is a common pathogenetic risk factor for the development of heart failure. The development of LV hypertrophy can be prevented by antihypertensive treatment. In contrast to systolic heart failure, the no treatment has proven prognostic benefit in patients with diastolic heart failure yet. Physical exercise, however, is a promising approach to improve functional capacity and quality of life in patients with hypertension and heart failure.

 
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