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Innere Medizin up2date 2014; 2(04): 285-296
DOI: 10.1055/s-0034-1387481
Herz, Kreislauf und Gefäße
© Georg Thieme Verlag KG Stuttgart · New York

Akute Herzinsuffizienz

Henning Ebelt
,
Karl Werdan
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Publication History

Publication Date:
09 December 2014 (online)

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Akute HerzinsuffizienzIntensivmedizin up2date 2012; 08(02): 117-127
DOI: 10.1055/s-0032-1306787

Kernaussagen

Von akuter Herzinsuffizienz wird definitionsgemäß gesprochen, wenn sich innerhalb kurzer Zeit typische Symptome des Herzversagens wie Luftnot und Leistungseinbruch entwickeln, die eine dringliche Behandlung erforderlich machen. Pathophysiologisch können dem Syndrom „akute Herzinsuffizienz“ verschiedene Ursachen wie ein akutes Koronarsyndrom, Herzrhythmusstörungen oder Klappenfehler zugrunde liegen. Neben der kausalen Therapie steht bei der medikamentösen Therapie die Nachlastsenkung und die Gabe von Diuretika im Vordergrund. Zur Sicherstellung einer ausreichenden Oxygenierung gibt man Sauerstoff, ggf. folgt eine nicht invasive oder invasive Beatmung. Im Falle einer anhaltenden Hypotonie werden primär Inotropika eingesetzt (Dobutamin, Levosimendan), die Gabe des Vasopressors Noradrenalin ist der Behandlung des kardiogenen Schocks vorbehalten. Als nichtmedikamentöse Therapieoptionen kann man die Ultrafiltration und mechanische Herz-Kreislauf-Unterstützungssysteme erwägen.

 

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