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Perioperative Betreuung von Patienten mit diastolischer Herzinsuffizienz

Schnittstelle zur Anästhesie

Perioperative care of patients with diastolic heart failure

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Zusammenfassung

Das Vorliegen einer diastolischen Herzinsuffizienz geht mit einer erhöhten perioperativen Morbidität und Mortalität einher. Die Prävalenz dieser Erkrankung ist zunehmend, und mehrere Risikofaktoren konnten bereits identifiziert werden. Hierzu zählen neben höherem Patientenalter und weiblichem Geschlecht insbesondere arterielle Hypertonie, Diabetes mellitus und koronare Herzerkrankung (KHK). Außer der klinischen Untersuchung und Laborbestimmungen steht v. a. die Echokardiographie im Zentrum der Diagnosestellung und perioperativen Evaluierung. Im transmitralen Flussprofil kann über das Verhältnis des frühen passiven Bluteinstroms (E) zu dem durch die Vorhofkontraktion ausgelösten späten, aktiven Einstrom (A) der Schweregrad der diastolischen Dysfunktion festgelegt werden. Daten bezüglich des idealen Narkoseverfahrens fehlen großteils, der Einsatz einer thorakalen Epiduralanästhesie scheint aber vorteilhaft zu sein. Intraoperativ ist bei Patienten mit diastolischer Herzinsuffizienz besonders auf den Volumenstatus zu achten, da sich sowohl Hypo- als auch Hypervolämie negativ auswirken. Zusätzlich gefährden Arrhythmien und Blutdruckschwankungen diese Patientengruppe in besonderem Maß.

Abstract

Diastolic heart failure leads to an increase in perioperative morbidity and mortality. The prevalence of this disease is rising and multiple risk factors have already been identified. Besides higher age and female gender, arterial hypertension, diabetes mellitus and coronary artery disease in particular have to be considered. Clinical examination and laboratory analyses are important for preoperative evaluation; however, echocardiography plays the most important role in the diagnostics of diastolic heart failure. The transmitral flow profile can be used to differentiate the grades of diastolic dysfunction using the ratio between early passive ventricular filling (E) and late active filling due to atrial contraction (A). Data concerning the ideal anesthesia technique are for the most part lacking; however, the application of thoracic epidural anesthesia seems to be beneficial. A great deal of attention has to be paid to the intraoperative volume status of patients with diastolic dysfunction as hypovolemia and hypervolemia can both have detrimental effects. Arrhythmias and major changes in blood pressure put this special group of patients at additional risks.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Heschl, C. Colantonio, B. Pieske und W. Toller geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Universitätsklinik für Anästhesiologie und Intensivmedizin, Klin. Abteilung für Herz-, Thorax-, Gefäßchirurgische Anästhesiologie und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 29, 8036, Graz, Österreich

    S. Heschl & W. Toller

  2. Universitätsklinik für Innere Medizin, Klin. Abteilung für Kardiologie, Medizinische Universität Graz, Graz, Österreich

    C. Colantonio & B. Pieske

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  1. S. Heschl
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  2. C. Colantonio
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  3. B. Pieske
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  4. W. Toller
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Correspondence to S. Heschl.

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Heschl, S., Colantonio, C., Pieske, B. et al. Perioperative Betreuung von Patienten mit diastolischer Herzinsuffizienz. Anaesthesist 63, 951–957 (2014). https://doi.org/10.1007/s00101-014-2404-x

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