Thromboembolische Erkrankungen können zu kardiologischen Notfällen mit einer hohen
Mortalität führen. Deren Erkennung, akute Behandlung und Sekundärprävention stellen
daher einen wesentlichen Behandlungsschwerpunkt in der kardiologischen Praxis dar.
Dieser Beitrag zeigt das kardiologische Work-up sowie die medikamentöse und interventionelle
Therapie bei thromboembolischen Erkrankungen im venösen und im arteriellen Stromgebiet.
Abstract
Thromboembolic disease is associated with a high mortality. It can be divided into
two groups: embolism from a venous and embolism from an arterial side. This article
gives an overview on thromboembolic disease (with a focus on pulmonary embolism and
ischemic stroke) from a cardiologist’s perspective.
The therapeutic options for acute pulmonary embolism range from anticoagulation to
fibrinolysis to interventional recanalization and surgery. The deciding factor for
choice of therapy is the risk of early death. Besides clinical parameters, laboratory
markers like cardiac troponin and right ventricular function on echocardiography or
CTPA (computed tomography pulmonary angiography) are used to determine the early mortality
risk. In hemodynamically instable patients, immediate thrombolysis is required, whereas
patients with intermediate and low risk can be treated with anticoagulation. Interventional
recanalization is currently being studied in patients at risk for development of CTEPH
(chronic thromboembolic pulmonary hypertension) or an intermediate risk of early mortality.
In ischemic stroke, early interdisciplinary workup involving a cardiologist is paramount.
Post stroke screening should include monitoring for arrythmias (especially atrial
fibrillation) and transthoracic echocardiography as well as sonography of extra- and
intracranial arteries. If no embolic source can be detected (embolic stroke of undetermined
source), transesophageal echo can be helpful to detect intracardiac shunts like patent
foramen ovale (PFO) or intracardiac tumors. Post stroke care includes secondary prevention
measures like risk factor modification and lipid lowering therapy as well as anticoagulation.
In high risk for paradoxical embolization, interventional PFO closure can be performed.
Interventional closure of the left atrial appendage (LAA) can be discussed in patients
with both high thromboembolic and bleeding risk.
Schlüsselwörter
Lungenembolie - ischämischer Insult - thromboembolische Erkrankungen
Keywords
pulmonary embolism - ischemic stroke - thromboembolic disease
