Download PDF
Aktuelle Kardiologie 2016; 5(03): 185-190
DOI: 10.1055/s-0042-106894
Übersichtsarbeit
Georg Thieme Verlag KG Stuttgart · New York

Therapie der akuten Herzinsuffizienz und des kardiogenen Schockes

Therapy of Acute Heart Failure and Cardiogenic Shock
R. Zahn
Medizinische Klinik B, Herzzentrum Ludwigshafen
,
R. Brütsch
Medizinische Klinik B, Herzzentrum Ludwigshafen
,
R. Winkler
Medizinische Klinik B, Herzzentrum Ludwigshafen
› Author Affiliations
Further Information

Publication History

Publication Date:
17 June 2016 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die akute Herzinsuffizienz (aHF) ist ein lebensbedrohliches Krankheitsbild. Im Gegensatz zur chronischen Herzinsuffizienz ist jedoch die Therapie der aHF deutlich weniger gut untersucht. Wichtig ist zunächst eine rasche Diagnostik, begleitet von einer symptomatischen Therapie. Beim kardiogenen Schock, der extremsten Form der aHF, gilt das Gleiche. Neben der Therapie mit Katecholaminen gibt es hier auch die Möglichkeit des Einsatzes von Kreislaufunterstützungssystemen, die eine hohe Expertise erfordern und deren Stellenwert wissenschaftlich noch nicht ausreichend gesichert ist. Hier ist die frühe Verlegung an ein Zentrum, das diese Möglichkeiten vorhält, immer zu erwägen.

Abstract

Acute heart failure (aHF) is a life-threatening disease. In contrast to chronic heart failure, therapy for aHF is less well established. Besides a rapid diagnostic work-up a symptomatic therapy has to be given. The same is true for cardiogenic shock, the most extreme form of aHF. Therapy with vasopressors can be supported by the use of mechanical circulatory support systems (MCS). However, their use requires a high personal and hospital expertise and their role is scientifically less well established. In all patients with cardiogenic shock, a transfer to a referral centre that has all MCS possibilities should be considered.

Schlüsselwörter

akute Herzinsuffizienz - kardiogener Schock - mechanische Kreislaufunterstützungssysteme

Key words

acute heart failure - cardiogenic shock - mechanical circulatory support
 

  • Literatur

  • 1 McMurray JJ, Adamopoulos S, Anker SD et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33: 1787-1847
    CrossrefPubMedGoogle Scholar
  • 2 Yancy CW, Jessup M, Bozkurt B et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2013; 128: e240
    CrossrefPubMedGoogle Scholar
  • 3 Werdan K, Ruß M, Buerke M et al. Deutsch-österreichische S3-Leitlinie „Infarkt-bedingter kardiogener Schock – Diagnose, Monitoring und Therapie“. Kardiologe 2011; 5: 166-224
    CrossrefPubMedGoogle Scholar
  • 4 Schock. Im Internet: http://www.wikipedia.de Stand: 27.04.2016
    PubMedGoogle Scholar
  • 5 Abernethy AP, McDonald CF, Frith PA et al. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet 2010; 376: 784-793
    CrossrefPubMedGoogle Scholar
  • 6 Felker GM, Lee KL, Bull DA et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med 2011; 364: 797-805
    CrossrefPubMedGoogle Scholar
  • 7 OʼConnor CM, Starling RC, Hernandez AF et al. Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med 2011; 365: 32-43
    CrossrefPubMedGoogle Scholar
  • 8 Mebazaa A, Nieminen MS, Packer M et al. Levosimendan vs. dobutamine for patients with acute decompensated heart failure: the SURVIVE Randomized Trial. JAMA 2007; 297: 1883-1891
    CrossrefPubMedGoogle Scholar
  • 9 Teerlink JR, Metra M, Felker GM et al. Relaxin for the treatment of patients with acute heart failure (Pre-RELAX-AHF): a multicentre, randomised, placebo-controlled, parallel-group, dose-finding phase IIb study. Lancet 2009; 373: 1429-1439
    CrossrefPubMedGoogle Scholar
  • 10 Teerlink JR, Cotter G, Davison BA et al. Serelaxin, recombinant human relaxin-2, for treatment of acute heart failure (RELAX-AHF): a randomised, placebo-controlled trial. Lancet 2013; 381: 29-39
    CrossrefPubMedGoogle Scholar
  • 11 Gray A, Goodacre S, Newby DE et al. Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med 2008; 359: 142-151
    CrossrefPubMedGoogle Scholar
  • 12 Hochman JS, Sleeper LA, Webb JG et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med 1999; 341: 625-634
    CrossrefPubMedGoogle Scholar
  • 13 Sjauw KD, Engstrom AE, Vis MM et al. A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines?. Eur Heart J 2009; 30: 459-468
    CrossrefPubMedGoogle Scholar
  • 14 Thiele H, Zeymer U, Neumann FJ et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012; 367: 1287-1296
    CrossrefPubMedGoogle Scholar
  • 15 Thiele H, Zeymer U, Neumann FJ et al. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet 2013; 382: 1638-1645
    CrossrefPubMedGoogle Scholar
  • 16 Thiele H, Allam B, Chatellier G et al. Shock in acute myocardial infarction: the Cape Horn for trials?. Eur Heart J 2010; 31: 1828-1835
    CrossrefPubMedGoogle Scholar
  • 17 Beurtheret S, Mordant P, Paoletti X et al. Emergency circulatory support in refractory cardiogenic shock patients in remote institutions: a pilot study (the cardiac-RESCUE program). Eur Heart J 2013; 34: 112-120
    CrossrefPubMedGoogle Scholar