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Therapie der Erregungsbildungs- und -leitungsstörungen

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Herzkrankheiten

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Zusammenfassung

Die normale elektrische Tätigkeit der einzelnen Myokardzelle ist ebenso wie die funktionelle bioelektrische Hierarchie im Herzen zur Sicherung von normaler Erregungsbildung und -ausbreitung auf vielerlei Weise zu stören. Änderungen des extracellulären Ionenmilieus (Kalium, Calcium, Lactat, Wasserstoff, Bicarbonat etc.), Überdehnung, Sauerstoffoder Substratmangel, überhöhter Sympathico- oder Vagotonus, Digitalisüberdosierung u. v. a. können die geordnete Erregungsbildung und -ausbreitung auch dann empfindlich stören, wenn keine kardiale Erkrankung vorliegt. Die Beseitigung solcher Dysrhythmiefaktoren muß deshalb ebenso wie die Therapie allgemeiner und eventuell kausaler Krankheitsprozesse ein integrierender Bestandteil der medikamentösen Therapie von Störungen der Bildung und Leitung der Erregung im Herzen sein (Gettes 1971, Gettes U. Surawicz 1972). Antiarrythmica im engeren Sinne beeinflussen direkt die elektrophysiologischen Eigenschaften des Herzmuskels. Ihre Wirkung auf die normale und die pathologisch veränderte elektrische Aktivität im Herzen ist in vivo vor allem durch die verfeinerten intrakardialen Ableitverfahren und in vitro durch Mikroelektrodenmessungen des Aktionspotentials präzisiert worden. Bei normaler wie bei dysrhythmischer Aktivität im Herzen sind die Potentialänderungen Ausdruck der transmembranären Membranströme an den Myokardzellen, welche von passiven und dynamischen elektrischen Eigenschaften der Zellmembran, die die lonenpermeabilität steuern, bestimmt werden. Antiarrhythmica im engeren Sinne modifizieren diese transmembranären Ionenströme und beeinflussen so den Potentialablauf bei Bildung, Leitung und Rückbildung der Erregung im Herzen.

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Authors
  1. H. A. Tritthart
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  2. D. Kalusche
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  3. H. Roskamm
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  4. G. Csapo
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  5. Ch. Büchner
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Tritthart, H.A., Kalusche, D., Roskamm, H., Csapo, G., Büchner, C. (1982). Therapie der Erregungsbildungs- und -leitungsstörungen. In: Herzkrankheiten. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-96617-0_30

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