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Pathophysiologie des Schocks

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Mechanische Unterstützung im akuten Kreislaufversagen

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Zusammenfassung

Der Schock ist definiert als Zustand des akuten Kreislaufversagens mit Organdysfunktion, welche eine entscheidende Rolle für den Verlauf spielt. Grundlegende Mechanismen sind Hypovolämie, kardiale Dysfunktion, Obstruktion und Maldistribution. Das Auftreten gemischter Pathophysiologien erschwert die Differenzialdiagnostik und die Therapie: So kann der septische Schock zu einer begleitenden Kardiomyopathie führen, und im Verlauf des kardiogenen Schocks kommt es häufig zu einer systemischen inflammatorischen Reaktion ähnlich wie bei der Sepsis. Während die kausale Therapie häufiger Schockformen wie die des septischen oder des kardiogenen Schocks bei akutem Myokardinfarkt weitgehend standardisiert ist, stellen seltenere Formen wie das Vasoplegie-Syndrom oder das Rechtsherzversagen mit Schock komplexe klinische Situationen dar. Das invasive hämodynamische Monitoring wird routinemäßig nicht mehr empfohlen, ist aber bei unklarer Konstellation und instabilem Patienten weiterhin sinnvoll.

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  1. Kerckhoff-Klinik/Kardiologie, Campus der Justus-Liebig-Universität Gießen, Bad Nauheim, Deutschland

    Andreas Rieth

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  1. Klinik für Herzchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany

    Udo Boeken

  2. Klinik für Herzchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany

    Alexander Assmann

  3. Klinik für Herzchirurgie und Gefäßchirurgie, Segeberger Kliniken GmbH, Bad Segeberg, Germany

    Stefan Klotz

  4. Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, München, Germany

    Frank Born

  5. Kardiologie, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany

    Andreas Rieth

  6. Klinik für Herz-, Thorax- und herznahe Gefäßchirurgie, Universitätsklinikum Regensburg, Regensburg, Germany

    Christof Schmid

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Rieth, A. (2020). Pathophysiologie des Schocks. In: Boeken, U., Assmann, A., Klotz, S., Born, F., Rieth, A., Schmid, C. (eds) Mechanische Unterstützung im akuten Kreislaufversagen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-59901-3_2

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