Zusammenfassung
Das klinisch außerordentlich vielfältige Syndrom der Herzinsuffizienz hat sich bisher einer verbindlichen, allen Erscheinungsformen gerecht werdenden Definition entzogen. Wir beschreiben den Zustand wie folgt: Das erkrankte, oder aber auch das gesunde Herz ist trotz ausreichenden venösen Blutangebotes nicht in der Lage, die Blutversorgung des Organismus bei Ruhe und/oder unter Belastung hinreichend zu befriedigen. Die Insuffizienz tritt dann ein, wenn bei erkranktem Myokard unter normalen oder erschwerten Arbeitsbedingungen das Kammervolumen zu -, die Auswurfleistung abnimmt und der Füllungsdruck vor der betroffenen oder beiden Herzkammern ansteigt. Mehrbelastungen (z. B. Hypertonie, Herzklappenfehler) können oft über lange Zeit kompensiert werden, bis diese Kompensationsmechanismen (z. B. Myokardhypertrophie) eigenständige Probleme aufwerfen (z. B. Verlängerung der Diffusionsstrecke an der hypertrophierenden Herzmuskelfaser) oder wenn zusätzliche Erschwerungen der Arbeitsbedingungen für das Myokard hinzukommen (Entwicklung einer koronaren Herzkrankheit bei Hypertonie, Herzklappenfehlern, Eintreten eines Infarktes oder eines Reinfarktes bei koronarer Herzerkrankung u. a.). Bei primär gesundem Herzmuskel kann es zur Insuffizienz kommen, wenn aus akutem Anlaß eine Mehrbelastung eintritt, so z. B. bei einer akuten, massiven Lungenembolie, oder bei einem sehr raschen arteriellen Widerstands- und Blutdruckanstieg, etwa in der Eklampsie, bei akuten Herzklappenzerstörungen bei bakterieller Endokarditis oder bei akuten arteriovenösen Fisteln. Sowohl Druck-, als auch Volumenbelastung können, wenn sie entsprechend stark ausgeprägt sind, zu Insuffizienz bei Belastung oder auch schon bereits bei Ruhe bei einem gesunden oder sogar übernormal leistungsfähigen Herzmuskel führen.
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Just, H. et al. (1985). Herzinsuffizienz. In: Miehlke, K. (eds) 91. Kongreß. Verhandlungen der Deutschen Gesellschaft für innere Medizin, vol 91. J.F. Bergmann-Verlag. https://doi.org/10.1007/978-3-642-85458-3_3
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