Akute Herzinsuffizienz – eine Sache für sich

Zusammenfassung

Akute Herzinsuffizienz (AHI) ist häufig, lebensbedrohlich, und führt oft zur Hospitalisierung. Leitsymptome sind Luftnot, Ödeme und Fatigue. Ein breites Spektrum von Risikofaktoren, Herzkrankheiten und Komorbiditäten prädisponieren dazu. Typische Auslöser (z. B. Arrhythmien) modulieren das individuelle klinische Bild. Wird es fehlgedeutet, kann das die Diagnose verzögern, die durch kardiale Bildgebung (Echokardiographie) gesichert werden muss. Die Akutbehandlung strebt Symptombesserung und Stabilisierung der Vitalparameter an. Anders als bei chronischer HI gibt es wenig Evidenz für die Wirksamkeit verfügbarer Therapien, Innovationen fehlen hier seit Langem. Der klinische Verlauf geht mit hoher Kurz- und Langzeitmortalität und erneuten Dekompensationen einher. Multidisziplinäre Betreuung ohne Versorgungslücken und bessere Krankheitskompetenz und Selbstüberwachung der Patienten können aber die Prognose bessern. Palliativen Bedürfnissen von AHI-Patienten wird heute noch zu wenig Rechnung getragen.

Abstract

Acute heart failure (AHF) is frequent, often life threatening and followed by emergency hospitalization. Leading symptoms are dyspnea, edema and fatigue. A broad spectrum of risk factors, cardiac diseases and comorbidities predisposes to AHF. Typical triggers (e. g. arrhythmias) modulate the individual clinical picture. Their misinterpretation may delay the diagnosis, which always needs to be ascertained by cardiac imaging (echocardiography). Rescue therapy aims at amelioration of symptoms and stabilization of vital parameters. In contrast to chronic heart failure evidence of the efficacy of available treatments is limited and in the past innovations have been sparse in this area. The clinical course is characterized by high short- and long-term mortality and repeat cardiac decompensations, but seamless multidisciplinary care and better knowledge and self-supervision on the patients’ side might improve prognosis. Today, too little attention is paid to the palliative needs of patients with AHF.

Schlüsselwörter

akute Herzinsuffizienz - Morbidität - Mortalität - Diagnose - Therapie

Keywords

acute heart failure - morbidity - mortality - diagnosis - herapy

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