Bedeutung der Herzinsuffizienz für Prävention, Therapie und Prognose des ischämischen Schlaganfalls

Zusammenfassung

Schätzungsweise 1,2 Mio. Bundesbürger leiden unter einer Herzinsuffizienz, darunter auch 13–29% aller Patienten, die einen ischämischen Schlaganfall erleiden. Eine bestehende Herzinsuffizienz ist aber nicht nur ein Risikofaktor für einen ischämischen Schlaganfall, sondern ist zudem mit einer höheren Krankheitsschwere und Sterblichkeit nach einem Schlaganfall assoziiert. Wenig ist hingegen über die Bedeutung einer Herzinsuffizienz für die Akuttherapie des ischämischen Schlaganfalls bekannt. In diesem Kontext beachtenswert ist zudem die Hypothese, dass ein Schlaganfall möglicherweise auch zu einer Verschlechterung bzw. zum Auftreten einer Herzinsuffizienz beitragen kann. Zur Schlaganfallprävention sollten herzinsuffiziente Patienten nur dann oral antikoaguliert werden, wenn ein Vorhofflimmern vorliegt. Der vorliegende Artikel fasst den aktuellen Kenntnisstand basierend auf einer selektiven Literaturrecherche sowie derzeit vorliegenden Leitlinienempfehlungen zusammen und gibt Empfehlungen für die klinische Praxis.

Abstract

About 1.2 million Germans suffer from heart failure (HF), including about 13–29% of all patients with acute ischemic stroke. HF is a risk factor for ischemic stroke and it is accompanied by high morbidity and mortality after stroke. So far, only limited data are available regarding the relevance of HF in acute ischemic stroke. The hypothesis that an acute ischemic stroke may contribute to deterioration and occurrence of heart failure seems to be relevant. Stroke prevention by oral anticoagulation is only recommended for HF patients with concomitant atrial fibrillation. This article is based on a selective literature review, summarizes the present knowledge as well as the resulting guideline recommendations and provides recommendations for clinical practice.

Schlüsselwörter

Herzinsuffizienz - ischämischer Schlaganfall - Schlaganfallprävention - orale Antikoagulation

Keywords

heart failure - ischemic stroke - stroke prevention - oral anticoagulation

• Literatur

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