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Anästhesiol Intensivmed Notfallmed Schmerzther 2015; 50(5): 330-338
DOI: 10.1055/s-0041-101596
Fachwissen
Anästhesiologie: Topthema
© Georg Thieme Verlag Stuttgart · New York

Perioperative Herzinsuffizienz – Präoperative Einschätzung

Perioperative heart failure – Preoperative Approach
Peter Mirtschink
,
Sebastian N Stehr
Further Information

Publication History

Publication Date:
29 May 2015 (online)

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Zusammenfassung

Herzinsuffizienz ist eine häufige Diagnose mit einer klaren Assoziation mit einem erhöhten perioperativen Risiko. Im Folgenden werden die Pathophysiologie, die aktuelle Therapie und Empfehlungen zum präoperativen Vorgehen dargestellt.

Abstract

Heart failure is a common disease which is associated with an increased perioperative risk. In the following, we summarize pathophysiology, momentary treatment options and a preoperative approach to patients with heart failure.

Kernaussagen

  • Das Leitsymptom der Herzinsuffizienz ist eine belastungsinduzierte Dyspnoe. Nach der Klassifikation der New York Heart Association (NYHA) werden 4 Schweregrade unterschieden.

  • Viele der meist unspezifischen Symptome der Herzinsuffizienz sind die Folge einer Elektrolytstörung und einer Hypervolämie. Unter einer adäquaten Therapie sind diese Symptome meist rasch regredient.

  • Unterschieden werden 2 Formen der Herzinsuffizienz: die Herzinsuffizienz mit erhaltener systolischer Funktion (diastolische Herzinsuffizienz; Heart Failure with Preserved Ejection Fraction = HF-PEF) und die Herzinsuffizienz mit reduzierter systolischer Funktion (Heart Failure with Reduced Ejection Fraction = HF-REF).

  • Im Rahmen der präoperativen Vorbereitung eines elektiven Eingriffs sind 3 Konstellationen speziell bezüglich einer Herzinsuffizienz vorstellbar: Erstdiagnose einer Herzinsuffizienz, Patienten mit bekannter, stabiler Herzinsuffizienz sowie Patienten mit einer Verschlechterung einer bekannten Herzinsuffizienz.

Schlüsselworte:

Linksherzversagen - Rechtsherzversagen - pulmonalarterielle Hypertonie - kardiogener Schock - diastolische Dysfunktion - low-cardiacoutput Syndrom - Anästhesie.

Keywords:

Left heart failure - right heart failure - pulmonary arterial hypertension - cardiogenic shock - diastolic dysfunction - low-cardiac output syndrome - anesthesia.

Ergänzendes Material

 

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