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Intensivmedizin up2date 2007; 3(4): 313-331
DOI: 10.1055/s-2006-925326
Pädiatrische Intensivmedizin

© Georg Thieme Verlag KG Stuttgart · New York

Intensivmedizinische Behandlung der Herzinsuffizienz im Kindesalter

Brigitte  Stiller, Felix  Berger
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Publication History

Publication Date:
29 October 2007 (online)

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Kernaussagen

  • Bei neu aufgetretener Herzinsuffizienz muss vor einer längerfristigen medikamentösen Behandlung eine kausale Ursache behoben werden.

  • Bei angeborenen Herzfehlern müssen individuelle pathophysiologische Besonderheiten beachtet werden:
    - bei Links-rechts-Shunt Vorsicht mit Sauerstoffgabe!
    - bei zyanotischer Krise und dynamischer infundibulärer Pulmonalstenose keine Katecholamine!

  • Milrinon als Nachlastsenker und Inotropikum ist wirksam bei akuter Herzinsuffizienz und im Kindesalter erprobt.

  • Bei schwerem akutem myokardialen Versagen Katecholamine mit Nachlastsenkern kombinieren, um das HZV zu steigern.

  • Begleitumstände (Temperatur, Herzfrequenz, Rhythmus, Säure-Basen-Haushalt, Beatmung) optimieren.

  • Nach der akuten Phase einschleichende Einstellung auf Herzinsuffizienztherapie (ACE-Hemmer, Diuretika, β-Blocker).

  • Bei progredienter Herzinsuffizienz und Schock trotz aller Medikation mechanische Kreislaufunterstützung erwägen. Ist ein längerfristiger Bedarf abzusehen, ist das Berlin Heart EXCOR das System der Wahl.

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Brigitte Stiller

Abteilung für angeborene Herzfehler, Kinderkardiologie
Deutsches Herzzentrum

Augustenburger Platz 1

13353 Berlin

Phone: 030/4593-2800

Fax: 030/4593-2900

Email: stiller@dhzb.de