Zusammenfassung
Herrn Prof. Dr. med. Eduard Perings zum 75. Geburtstag gewidmet
Der plötzliche Herztod als zumeist letales, arrhythmogenes Ereignis basiert in der
Mehrheit auf tachykarden Arrhythmien und stellt ein epidemiologisches Breitenproblem
dar. Erfreulicherweise haben wir dank intensiver Forschungsbemühungen in den vergangenen
30 Jahren viel über die zugrundliegenden Erkrankungen und Mechanismen erfahren können.
So können wir heute Patienten aufgrund der frühen Detektion bestimmter kardialer Grunderkrankungen
und verschiedener arrhythmieauslösender Begleitumstände als „gefährdet”, genauer aber
noch als „nicht gefährdet” identifizieren. Hierfür steht uns mittlerweile ein breites
Arsenal unterschiedlicher allgemeinmedizinischer - oder kardiologischer - Spezialdiagnostik
zur Verfügung. Dabei liegt insbesondere in der allgemeinmedizinischen Versorgung multimorbider
Patienten aufgrund des heterogenen Zusammenspiels verschiedener, auch pharmakotherapeutisch
beeinflussbarer, Triggermechanismen ein hohes Gefahrenpotential iatrogen verursachter
Arrhythmien.
Insgesamt sind wir aber nach wie vor außer Stande, den exakten Zeitpunkt des Auftretens
solch fataler Ereignisse ausreichend präzise zu prognostizieren. Dabei ist es uns
dank der Bemühungen immerhin gelungen, rhythmologische Hochrisikokollektive zu identifizieren
um diese zum Beispiel mittels implantierbarer Cardioverter-Defibrillatoren im Sinne
einer Primärprävention zu schützen. Da die Entstehung relevanter Kammerarrhythmien
ganz überwiegend an das Vorhandensein einer koronaren Herzerkrankung gebunden ist,
bedarf es weiterer Anstrengungen im Sinne einer Früherkennung dieser Erkrankungsentität
sowie ihrer Prävention, um dem Problem des plötzlichen Herztodes effektiv zu begegnen.
Schließlich muss die so genannte Rettungskette der Erstversorgung von Patienten, die
einen Herz-Kreislaufstillstand erlitten haben, verbessert werden, da eine enge zeitliche
Korrelation zwischen dem Beginn der Reanimation einerseits und einem neurologischen
Defizit andererseits besteht. Hier könnte zum Beispiel der breitere Einsatz von automatischen
externen Defibrillatoren, die auch von medizinischen Laien bedient werden können,
zum Tragen kommen.
Summary
Sudden cardiac death is an arrhythmogenic event that in the majority of cases is based
on tachycardic arrhythmias, and is a widespread epidemiological problem. Fortunately,
as a result of intensive research efforts over the past 30 years, we have learned
a great deal about underlying pathologies and mechanisms. For example, on the basis
of the early detection of certain underlying diseases and arrhythmia-triggering concomitant
situations, we can now identify patients at risk or, more accurately, those not at
risk. For this purpose, we have a large arsenal of general-medical - or cardiological
diagnostic - procedures available. In this connection, there is a high risk potential
for iatrogenic arrhythmias, in particular associated with general-medical care of
multimorbid patients and due to the heterogeneous interactions of various trigger
mechanisms that can also be impacted by pharmacotherapeutic measures. Overall, we
are still unable to predict such fatal events with an adequate degree of accuracy.
However, the prior efforts have made it possible us to identify rhythmological high-risk
groups (of patients) who, for example, by means of implantable cardioverter-defibrillators,
can be protected by primary prevention. Since the development of relevant ventricular
arrhythmias is, in the great majority of cases, associated with coronary heart disease,
further efforts are needed to make possible the early detection and prevention of
this pathological entity so as effectively to combat the problem of sudden cardiac
death. Finally, the so-called „rescue chain” in the initial management of patients
who have suffered cardiac arrest must be improved, since there is a close temporal
correlation between the initiation of resuscitation on the one hand, and a neurological
deficit on the other. Here, for example, the widespread implementation of automated
external defibrillators that can be employed by laypersons could play a useful role.
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Anschrift für die Verfasser
Priv.-Doz. Dr. med. Christian Perings
Klinik für Kardiologie und Angiologie
Ruhr-Universität Bochum
Marienhospital Herne
Hölkeskampring 40
44625 Herne
