Es hat sich viel getan - Aktuelle Daten und Fakten zur medikamentösen Therapie der Herzinsuffizienz

Zusammenfassung

Die Inzidenz der Herzinsuffizienz steigt stetig. Hauptursachen hierfür sind die koronare Herzkrankheit und die arterielle Hypertonie. Im Bereich der nichtinvasiven Diagnostik kommt der (Doppler-)Echokardiografie auch in Hinblick auf Dokumentation sowohl der systolischen als auch der diastolischen Herzinsuffizienz überragende Bedeutung zu. Die moderne Behandlung der Herzinsuffizienz kann medikamentös und/oder nichtmedikamentös erfolgen. Vor allem bei terminaler Herzmuskelschwäche sind jedoch die Allgemeinmaßnahmen wie tägliche, eigene Gewichtskontrollen des Patienten sowie Kochsalz- und Flüssigkeits-Restriktion von besonderer Relevanz. Auch ein regelmäßiges Bewegungstraining scheint die oxidative Kapazität der Skelettmuskulatur und die gestörte Endothelfunktion deutlich verbessern zu können. Ziel der Pharmakotherapie ist - neben der Reduktion der Mortalität und der Morbidität - auch eine Verbesserung der Lebensqualität der Patienten. Hierfür ist die frühzeitige Kombinationstherapie aus ACE-Hemmern, Beta-Blockern, Diuretika und additiv auch AT₁-Rezeptorantagonisten (Candesartan) prognostisch sinnvoll.

Summary

The incidence of congestive heart failure is steadily increasing. The main causes of this condition are coronary heart disease and arterial hypertension. Doppler echocardiography is of great importance as a non-invasive diagnostic technique for systolic and diastolic heart failure - also for the purpose of documentation. Of particular relevance, above all in terminal myocardial weakness, are such general measures as daily weighing by the patient and a restriction in the intake of salt and fluids. Regular physical exercise also appears to appreciably improve the oxidative capacity of the skeletal muscles and the disordered endothelial function. Apart from reducing mortality and morbidity, the aim of pharmacotherapy is also to improve the patient's quality of life. For this purpose, early combination treatment comprising ACE-inhibitors, beta blockers, diuretics and AT₁-receptor antagonists (candesartan) has a good prognostic outcome.

cardiac failure - diagnosis - echocardiography - pharmacotherapy

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1 valsartan heart failure trial

2 evaluation of losartan in the elderly

3 digitalis investigation group

4 survival and ventricular enlargement

5 studies of left ventricular dysfunction

6 cooperative north scandinavian enalapril survival study

7 acute infarction ramipril efficacy

8 trandolapril cardiac evaluation

9 assessment of treatment with lisinopril and survival

10 cardiac insufficiency bisoprolol study

11 carvedilol and ACE-inhibitor remodelling mild heart failure evaluation trial

12 metoprolol CR/XL randomized intervention trial in heart failure

13 carvedilol prospective randomized cumulative survival trial

14 carvedilol or metoprolol european trial

15 randomised aldactone evaluation study

16 eplerenon post-MI heart failure efficacy and survival study

17 toresamide in chronic heart failure

18 candesartan in heart failure - assessment of reduction in mortality and morbidity

19 valsartan in acute myocardial infarction trial

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