Echokardiografie bei akuter Rechtsherzinsuffizienz

Zusammenfassung

Die akute Rechtsherzinsuffizienz wird als Ursache einer kardiopulmonalen Insuffizienz häufig übersehen und kann vital bedrohlich sein. Die verschiedenen Krankheitsbilder, die der Rechtsherzinsuffizienz ätiologisch auf Ebene der Nachlast, Vorlast und Kontraktilität zugrunde liegen, können mittels zielgerichteter Diagnostik abgeklärt werden. Neben klinischen Symptomen ist vor allem die Echokardiografie für die Diagnosestellung relevant.

Abstract

The anesthetist is increasingly faced with more complex operations in combination with an aging patient population characterized by pre-existing conditions. Acute right heart failure is often not recognized as the cause of cardiopulmonary insufficiency. Echocardiography has emerged as an important diagnostic tool. Not only perioperatively and in the intensive care unit, transesophageal (TEE) and transthoracic echocardiography (TTE) allow the diagnosis of right heart failure at bedside, promptly and with low invasiveness. Possible causes of right heart insufficiency on the level of afterload, preload and contractility can be clarified. Life-saving immediate measures can be initiated and, in addition, the success of the therapy can be visualized virtually “live”. If indicated, a peri-/intraoperative echocardiographic examination also has a direct influence on therapy control. With a focused cardiac examination crucial information can be gained and the outcome of the patient can be positively influenced by adapted therapy control. By using standard ultrasound views, right heart failure can be detected as the cause of hemodynamic instability.

Kernaussagen

• Das akute Rechtsherzversagen ist ein lebensbedrohliches Krankheitsbild.

• In der raschen Point-of-Care-Diagnostik steht die fokussierte Echokardiografie im Vordergrund.

• Eine TEE sollte dann durchgeführt werden, wenn im TTE keine ausreichende Qualität der zu erhebenden Befunde erzielbar ist oder die TEE in der Aussagekraft überlegen ist.

• Die Echokardiografie eignet sich hervorragend, um die Ätiologie des Rechtsherzversagens auf Ebene der Kontraktilität, Vor- und Nachlast zu beurteilen.

• Die Kombination mehrerer echokardiografischer Beurteilungsansätze hilft, um zwischen einer normalen und eingeschränkten RV-Funktion zu differenzieren.

• Peri-/intraoperativ hat die echokardiografische Untersuchung unmittelbaren Einfluss auf die Therapiesteuerung mit positiver Beeinflussung des Patientenoutcomes.

Schlüsselwörter

Rechtsherzversagen - Echokardiografie - Akutdiagnostik - Anästhesiologie - perioperativ

Key words

right heart failure - echocardiography - acute diagnostics - anesthesiology - perioperative

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