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Bradykarde Herzrhythmusstörungen

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Zusammenfassung

Die Behandlungsbedürftigkeit einer Bradykardie entscheidet sich nicht an einem fixen Frequenzkriterium, sondern an der Symptomatik, die sie hervorruft. Die (zu) langsame Herzschlagfolge kann durch verminderte Bildung oder durch Blockierung in der Fortleitung elektrischer Reize an das Myokard verursacht werden. Eindrücklichste Manifestation ist die Synkope, andere sind Schwindel, bradykarde Herzinsuffizienz mit Leistungsminderung, Belastungsdyspnoe oder Ödemansammlung. Wichtigstes Element der Basisuntersuchung ist die Anamnese, die rhythmologische gegen andere Auslöser der aktuellen Symptomatik abzuwägen und potenziell reversible Ursachen einer Bradykardie aufzuspüren hilft. Außerhalb der Symptomatik zeigt das EKG nur selten die gesuchte Rhythmusstörung und muss dann mittels Holter-Monitoring, Belastungstest, implantierbarem Loop-Rekorder oder invasiver elektrophysiologischer Untersuchung ergänzt werden. Dabei gilt es, die Symptom-Rhythmus-Korrelation zu dokumentieren (zumindest wahrscheinlich zu machen) oder Risikomarker für Blockierungen der Erregungsleitung zu finden. Vagolytische oder sympathikomimetische Pharmakotherapie kommt allenfalls kurzzeitig bei reversiblen Bradykardien in Betracht. Dauerhaft hilft nur die künstliche Stimulation mittels Herzschrittmacher, die nach definierten Leitlinienkriterien indiziert werden sollte.

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  1. Klinik für Innere Medizin III, Universitätsklinikum, Kirrberger Str., 66424, Homburg/Saar, Deutschland

    Gerd Fröhlig

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  1. Medizinische Klinik I, Universitätsklinikum Schleswig-Hoslstein, Campus Lübeck, Lübeck, Schleswig-Holstein, Germany

    Hendrik Lehnert

  2. TU Dresden Universitätsklinikum Carl Gustav Carus, Dresden, Germany

    Sebastian M. Schellong

  3. FB Gastroenterologie und Hepatologie, Universitätsklinikum Leipzig Medizinische Klinik und Poliklinik II, Leipzig, Sachsen, Germany

    Joachim Mössner

  4. Krankenhaus Barmherzige Brüder, Regensburg, Germany

    Cornel C. Sieber

  5. Nürnberg, Bayern, Germany

    Walter Swoboda

  6. Universitätsklinikum Giessen und Marburg Klinik für Innere Medizin, Marburg, Hessen, Germany

    Andreas Neubauer

  7. Interdisziplinärer Schwerpunkt für Hämos, Universitätsklinikum Gießen und Marburg, Gießen, Germany

    Bettina Kemkes-Matthes

  8. Klinik für Gastroenterologie,Hepatologie, Medizinische Hochschule Hannover, Hannover, Germany

    Michael P. Manns

  9. Sektion für Molekulare und Klinische Inf, Universitätsklinikum Schleswig-Holstein,, Lübeck, Germany

    Jan Rupp

  10. Abt. Kardiologie und Pneumologie, Universitätsklinikum Göttingen Herzzentrum Göttingen, Göttingen, Germany

    Gerd Hasenfuß

  11. Abt. Nephrologie und Klinische Immunologie, Univ.Klinikum Aachen Medizinische Klinik II, Aachen, Germany

    J. Floege

  12. Universitätsklinikum Köln Klinik I für Innere Medizin, Köln, Germany

    Michael Hallek

  13. Klinik für Pneumologie, Medizinische Hochschule Hannover (MHH) Zentrum Innere Medizin, Hannover, Germany

    Tobias Welte

  14. Klinik u. Poliklinik für Innere Medizin, Universitätsmedizin Greifswald, Greifswald, Germany

    Markus Lerch

  15. Dr.-Horst-Schmidt-Kliniken GmbH, Wiesbaden, Germany

    Elisabeth Märker-Hermann

  16. Klinische Toxikologie, Giftinformation, Universitätsklinikum Mainz II. Medizinische Klinik und Poliklinik, Mainz, Germany

    Ludwig Sacha Weilemann

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Fröhlig, G. (2014). Bradykarde Herzrhythmusstörungen . In: Lehnert, H., et al. SpringerReference Innere Medizin. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54676-1_486-1

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Online ISBN: 978-3-642-54676-1

  • eBook Packages: Springer Referenz Medizin

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