Herzbeteiligung bei systemischen inflammatorischen Erkrankungen

Abstract

Systemic inflammatory diseases frequently involve the cardiovascular system, and cardiac and vascular manifestations are extremely variable. An early diagnosis of cardiac involvement is essential for the patients since in many inflammatory systemic conditions cardiac disease determines prognosis and mortality. In addition to history, electrocardiographic and echocardiographic examinations cardiac magnetic resonance imaging is particularly useful to detect morphological and functional changes as well as myocardial perfusion abnormalities and to unmask inflammatory reactions of the myocardium or quantify myocardial scars. If cardiac involvement is present the usual anti-inflammatory or immunosuppressive treatment will be completed by usual cardiac care such as cardioactive drugs, intracardiac defibrillator or pacemaker implantation.

Kernaussagen

• Das klinische Spektrum der systemischen inflammatorischen Erkrankungen ist extrem vielfältig, eine Beteiligung des Herzens und der großen Gefäße ebenfalls äußerst variabel.

• Das frühzeitige Erkennen einer Herzbeteiligung ist für viele Patienten von eminenter klinischer Bedeutung, da bei einer Reihe von Krankheitsbildern das Fortschreiten der kardialen Erkrankung die Prognose und die Letalität der Patienten bestimmt.

• Die klassischen diagnostischen Werkzeuge sind die Anamnese und klinische Untersuchung, die Röntgenuntersuchung, das EKG und die Echokardiografie sowie bei speziellen Fragestellungen spezielle histologische und nuklearmedizinische Methoden.

• Daneben kann aber der frühzeitige Einsatz der CMR-Bildgebung mit den Möglichkeiten der Beurteilung der Herzfunktion und der Myokarddurchblutung sowie der Detektion von entzündlichen und/oder narbigen Myokardveränderungen die klinische Situation und den Schweregrad klären und bei der therapeutischen Führung der Patienten eine wesentliche Hilfestellung leisten.

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