Kardiopulmonale Komorbiditäten

Besonders bei älteren Patienten sind kardiopulmonale Komorbiditäten häufig – und die Prognose ist schlecht. Pulmonale Erkrankungen wie z. B. COPD oder die pulmonale Hypertonie beeinflussen das Herz auf vielfältige Weise. Doch die physiologische Achse zwischen linkem Herz, Lunge und rechtem Herz führt auch dazu, dass Herzerkrankungen Lungenprobleme hervorrufen. Die kardiopulmonale Differenzialdiagnostik hat deshalb einen hohen klinischen Stellenwert.

Kernaussagen

• Kardiopulmonale Komorbiditäten sind häufig, treten insbesondere in der alternden Bevölkerung auf und haben eine schlechte Prognose.

• Insbesondere eine systemische Inflammation – u. a. durch Tabakrauch – bedingt die Komorbidität von COPD und Atherosklerose.

• Die Ursachen für eine pulmonale Hypertonie sind vielschichtig und die Therapien gegen die zugrunde liegenden Ursachen gerichtet. Die häufigste Ursache ist eine Linksherzinsuffizienz.

• Eine umfassende und zielgerichtete Differenzialdiagnostik in einem Expertenzentrum ist eine wichtige Voraussetzung für eine adäquate Therapie kardiopulmonaler Komorbiditäten.

• Patienten mit Herzinsuffizienz und/oder abgelaufenem Myokardinfarkt sollten auch bei einer COPD Betablocker erhalten.

• Bei COPD-Patienten sollte die Therapie mit β₂-Mimetika bei kardiovaskulären Komorbiditäten soweit wie möglich vermieden werden.

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