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Kardiologie up2date 2014; 10(02): 147-158
DOI: 10.1055/s-0034-1365723
Kardiovaskuläre Notfälle
© Georg Thieme Verlag KG Stuttgart · New York

Kardiogener Schock

Armin Grawe
,
Georg Fröhlich
,
Markus Ferrari
Further Information

Publication History

Publication Date:
28 July 2014 (online)

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Abstract

The cardiogenic shock remains one oft he greatest challenges in cardiology because of its high mortality. Pathophysiology of the cardiogenic shock is not completely understood. Supportive therapy contains circulatory support, guided by a hemodynamic monitoring, as well as therapy of secondary dysfunction of other organs.

Kernaussagen

  • Der kardiogene Schock bleibt aufgrund einer weiterhin inakzeptabel hohen Sterblichkeit eine der großen Herausforderungen in der Kardiologie.

  • Ätiologisch müssen beim kardiogenen Schock akute mechanische kardiale Störungen von primär myokardialen Dysfunktionen unterschieden werden. Die häufigste Ursache des kardiogenen Schocks ist der akute Myokardinfarkt. In 78 % der Fälle liegt dem infarktbedingten kardiogenen Schock primär eine myokardiale LV-Dysfunktion zugrunde.

  • Die Pathophysiologie des kardiogenen Schocks ist noch nicht vollständig verstanden. Auf mehreren Ebenen entstehen Circuli vitiosi, die den Schock bis zum MODS vorantreiben.

  • Die wichtigsten diagnostischen Werkzeuge im kardiogenen Schock sind das 12-Kanal-EKG, die transthorakale und ggf. transösophageale Echokardiografie und ggf. die Koronarangiografie. Das Monitoring des Patienten umfasst neben einem intensivmedizinischen Standardmonitoring aus EKG, Pulsoxymetrie, Atemfrequenz und Körpertemperatur ein invasives hämodynamisches Monitoring. Für eine vollständige Charakterisierung der hämodynamischen Situation eines Patienten ist hierbei die Kenntnis des mittleren arteriellen Blutdrucks, des HZV und des SVR erforderlich.

  • Die supportive Therapie umfasst zum einen die differenzierte Kreislaufunterstützungstherapie, welche anhand eines erweiterten hämodynamischen Monitorings gesteuert wird. Zum anderen müssen sekundäre Dysfunktionen anderer Organe als Folge des kardiogenen Schocks therapiert werden.

 

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