Abstract
Right heart failure may be due to increased afterload caused by
pulmonary hypertension, increased volume load as in valvular incompetence,
myocardial ischemia, and cardiomyopathy. The clinical consequences of those
various disease entities are rather homogenous, venous congestion being the key
symptom. The diagnosis is based on clinical findings and echocardiography.
Right ventricular Tei-index and TAPSE (tricuspid annular plane systolic
excursion) are easily obtained measures of right ventricular contractile
function. Brain natriuretic peptide is helpful to follow changes in right
ventricular dysfunction during therapy. Treatment of right heart failure aims
at the correction of the underlying condition, especially if underlying
pulmonary disease can be improved. Unifying principles are reduction of
excessive pre- and afterload, improved myocardial oxygen delivery and
correction of hypercapnia and acidosis, e.g. by ventilatory support. Diuretic
therapy must avoid volume depletion resulting in renal failure, whereas volume
substitution should be done cautiously. Specific pulmonary vasodilators are
indicated only in pulmonary arterial hypertension (PAH) and in inoperable
chronic thromboembolic pulmonary hypertension (CTEPH). The standard medical
treatment of left heart failure is not generally suitable for right heart
dysfunction, except if secondary to left heart disease. In many instances, an
interdisciplinary approach to right heart failure is needed, involving the
expertise both of the cardiologist and the pulmonologist.
Kernaussagen
-
Pathophysiologie, Ätiologie und Klinik der
Rechtsherzinsuffizienz unterscheiden sich wesentlich von der
Linksherzinsuffizienz.
-
Die Echokardiografie ist für die Diagnostik der
Rechtsherzinsuffizienz unersetzlich, wobei auf spezifische Parameter
(Dimensionen, TAPSE, Tei-Index, PA-Druck) geachtet werden muss. NT-proBNP ist
ein weiterer wichtiger Parameter.
-
Die evidenzbasierte Therapie der Linksherzinsuffizienz ist
bei der isolierten Rechtsherzinsuffizienz meist nicht angezeigt.
-
Die spezifische Therapie der pulmonal-arteriellen Hypertonie
ist für andere Formen des Cor pulmonale in der Regel nicht angezeigt.
-
Ist eine Lungenerkrankung die Ursache der
Rechtsherzinsuffizienz, so sind an erster Stelle Störungen der
Atemmechanik, Hypoxie, Hyperkapnie und Azidose zu behandeln.
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Priv.-Doz. Dr. med. Mathias M. Borst
Chefarzt Medizinische Klinik I
Caritas-Krankenhaus Bad
Mergentheim
Uhlandstr. 7
97980 Bad Mergentheim
Email: mathias.borst@ckbm.de
