Die akute Herzinsuffizienz – Rasches Handeln ist gefragt

Die akute Herzinsuffizienz (AHF) stellt eine akut lebensbedrohliche klinische Situation dar, die rasches Handeln erfordert, um die Entwicklung des Vollbildes eines kardiogenen Schocks mit Multiorganversagen zu verhindern. Neben kausalen Therapieansätzen, wie der koronaren Revaskularisation im akuten Myokardinfarkt, stehen etablierte intensivmedizinische Maßnahmen zur Aufrechterhaltung von suffizientem Kreislauf und Oxygenierung, in Verbindung mit kreislaufwirksamen Medikamenten sowie moderne Therapieansätze der extrakorporalen Kreislaufunterstützung zur Verfügung. Die hier aufgeführten Therapieanweisungen spiegeln die aktuellen Leitlinien zur Therapie der AHF wider und basieren zum großen Teil noch auf Expertenmeinungen, da hier im Gegensatz zur chronischen Herzinsuffizienz noch eine harte evidenzbasierte Datenlage geschaffen werden muss.

Acute Heart Failure (AHF) represents an acute life-threatening clinical situation, requiring rapid action to avoid the development of cardiogenic shock with downstream multi organ failure. Beside causal therapeutic strategies like coronary revascularisation in acute myocardial infarction, the application of intensive care therapy to maintain adequate circulation and oxygenation, as well as inotropic medications and various forms of mechanical circulatory support (MCS) are available. The following manuscript reflects current guidelines for the treatment of AHF, mainly based on expert opinions in a field, where evidences still need to be established.

Key words

Acute heart failure - cardiogenic shock - revascularization - mechanical circulatory support

• Literatur

• 1 Reynolds HR, Hochman JS. Cardiogenic shock: current concepts and improving outcomes. Circulation 2008; 117: 686-697
• 2 Thiele H, Allam B, Chatellier G, Schuler G, Lafont A. Shock in acute myocardial infarction: the Cape Horn for trials?. Eur Heart J 2010; 31: 1828-1835
• 3 Hochman JS, Sleeper LA, Webb JG et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med 1999; 341: 625-634
• 4 Thiele H, Zeymer U, Neumann FJ et al. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet 2013; 382: 1638-1645
• 5 Rogers JG, O'Connor CM. The changing landscape of advanced heart failure therapeutics. J Am Coll Cardiol 2014; 64: 1416-1417
• 6 Dickstein K, Cohen-Solal A, Filippatos G et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail 2008; 10: 933-989
• 7 Chockalingam A, Mehra A, Dorairajan S, Dellsperger KC. Acute left ventricular dysfunction in the critically ill. Chest 2010; 138: 198-207
• 8 McMurray JJV, Adamopoulos S, Anker SD et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2012; 14: 803-869
• 9 Felker GM, Benza RL Chandler et al. Heart failure etiology and response to milrinone in decompensated heart failure: results from the OPTIME-CHF study. J Am Coll Cardiol 2003; 41: 997-1003
• 10 Mebazaa A, Nieminen MS, Packer M et al. Levosimendan vs dobutamine for patients with acute decompensated heart failure: the SURVIVE Randomized Trial. JAMA 2007; 297: 1883-1891
• 11 O'Connor CM, Starling RC, Hernandez AF et al. Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med 2011; 365: 32-43
• 12 Teerlink JR, Cotter G, Davison BA et al. Serelaxin, recombinant human relaxin-2, for treatment of acute heart failure (RELAX-AHF): a randomised, placebo-controlled trial. Lancet 2013; 381: 29-39
• 13 O'Neill WW, Schreiber T, Wohns DHW et al. The current use of Impella 2.5 in acute myocardial infarction complicated by cardiogenic shock: results from the USpella Registry. J Interv Cardiol 2014; 27: 1-11
• 14 Lauten A, Engström AE, Jung C et al. Percutaneous left-ventricular support with the Impella-2.5-assist device in acute cardiogenic shock: results of the Impella-EUROSHOCK-registry. Circ Heart Fail 2013; 6: 23-30
• 15 Werdan K, Gielen S, Ebelt H, Hochman JS. Mechanical circulatory support in cardiogenic shock. Eur Heart J 2014; 35: 156-167
• 16 Kar B, Basra SS, Shah NR, Loyalka P. Percutaneous circulatory support in cardiogenic shock: interventional bridge to recovery. Circulation 2012; 125: 1809-1817
• 17 Stretch R, Sauer CM, Yuh DD, Bonde P. National trends in the utilization of short-term mechanical circulatory support: incidence, outcomes, and cost analysis. J Am Coll Cardiol 2014; 64: 1407-1415