Herz-Hirn-Interaktion in der Intensivmedizin

Zusammenfassung

Auf der einen Seite sind kardiale Erkrankungen häufige Ursache neurologischer Notfälle. Andererseits werden akut neurologische Erkrankungen von systemischen, vor allem kardialen und pulmonalen Komplikationen begleitet. Thema dieser Übersicht sind die kardialen Folgen von Hirnschädigungen. Unabhängig von der Art der Hirnerkrankung spielt die zentrale Sympathikus-Aktivierung die entscheidende pathophysiologische Rolle. Dadurch werden autonome Herzfunktionen beeinflusst. EKG-Veränderungen, Herzenzymanstieg, Rhythmusstörungen, bis hin zum plötzlichen Herztod sind die Folge. Wenn die Herzschädigung Folge der zerebralen autonomen Störung ist, ist die Behandlung der Grundkrankheit entscheidend für die Besserung der systemischen Symptome. Die Erkrankungen (Stress-Kardiomyopathie, neurogenes Lungenödem) haben dann eine gute Prognose. Für die zukünftige Planung von Studien zur Therapie der neurogen-kardialen Störungen wird die Zusammenfassung der verstreut definierten Erkrankungen wichtig sein, weil diese eine gemeinsame pathopysiologische Grundlage haben.

Abstract

Cardial diseases are common causes of neurological emergencies. On the other hand, acute neurological disorders go along with systemic abnormalities, in particular they show cardial and pulmonary complications. This review is focused on the cardial consequences of cerebral lesions. Independent on the etiology of the brain disorder, the central activation of the adrenergic system plays a key role in the pathophysiology. The adrenergic stimulation modulates cardial function. ECG-changes, elevated cardial enzymes, arrhythmias, and sudden cardial death can be the consequences. In these cases, the adequate treatment of the neurological disorder is essential for the improvement of systemic symptoms. The cardial disorders (apical ballooning cardiomyopathy, neurogenic pulmonary edema) then have a favourable prognosis. For future studies on treatment of neurogenic-cardial disorders, the classification of the differently defined disorders based on their common pathophysiology will be essential.

Schlüsselwörter

Stress-Kardiomyopathie - Tako-Tsubo-Kardiomyopathie - neurogenes Lungenödem - Subarachnoidalblutung - Hirndruck

Keywords

left apical ballooning syndrome - tako-tsubo cardiomyopathy - neurogenic pulmonary edema - subarachnoid hemorrhage - intracranial pressure

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